Suzie Lovett-Clements BLOOD PRESSURE This session is about Blood Pressure. In this presentation we will look at what it is, why and how we take blood pressure. With some group Interaction. Then we will watch a video of how to take a blood pressure recording with an sphygmomanometer (sphyg for short)/manual blood pressure monitor or mercury BP monitor and using an electronic monitor Then we will have the chance to practice using both machines and we will be around to guide you and we do have the facility of a double headed stethoscope to hear what your hearing. I have also got handouts on the procedures for using both mercury and electronic blood pressure monitors and a Health Promotion information sheet regarding Blood Pressure. HANDOUT BP MONITORS SO EVERYONE CAN SEE ONE - I WANT YOU TO BE ABLE TO GET TO KNOW THE MACHINE SO HANDLE IT AND GET FAMILIAR WITH IT. Independent Practice Nurse Facilitator Suzie Lovett-Clements

AIM OF THE SESSION To accurately record a patient’s blood pressure, recording and reporting results.

Objectives Demonstrate a basic understanding of anatomy and physiology in relation to blood pressure. Understand what factors may affect the blood pressure. Identify normal values for blood pressure. Identify the correct equipment for recording blood pressure. To know when to report any concerns

Learning Outcomes At the end of this session you will be able to: To have a better understanding of what blood pressure is Take accurate blood pressure recordings

Blood pressure High Blood Pressure is a key healthcare issue It affects approximately a third of the UK population. Generally it has no symptoms with the result that many people are undiagnosed and left untreated. The early identification and treatment of Hypertension will help prevent Coronary heart disease, Angina, Heart attacks and strokes The heart is a pump that beats by contracting and relaxing. When the heart contracts, the pressure goes up. When the heart relaxes, the pressure goes down. 2. There are two numbers that make up the blood pressure recording: The first number is the pressure as the heart contracts and is called ‘systolic blood pressure’. The second number is the pressure as the heart relaxes and is called ‘diastolic blood pressure’. 3. Everyone’s blood pressure varies from beat to beat, throughout the day as you exercise and rest and with stress and emotion. So it is important to get a trend of the patients blood pressure and not just a one off reading you may have to take a reading 2 or 3 times when a patient comes in for a blood pressure check, once at the beginning and once at the end of the appointment with you, as the patient may have what we call white coat syndrome. ANYBODY KNOW WHAT THIS MEANS --- so after talking to the patient for a while they may feel more relaxed and the blood pressure may come down. Your place of work should have a blood pressure procedure to give you guidelines on when to refer on to the Nurse/Doctor – IF IN DOUBT REFER

Definition The force exerted by blood against the walls of the vessels in which it is contained The pressure is determined by the force and the amount of blood pumped and the size and flexibility of the arteries

With your partner take a few minutes to consider the things which you think would affect a patients blood pressure

Factors affecting blood pressure Disease Age Heredity Blood Volume Weight Diet Hormones Salt Caffeine Environmental factors Psychological factors Stress/Anxiety Gravity Drugs Alcohol Time of day Ethnic Origin

Blood Pressure A diagnosis of high blood is not normally made unless the Blood Pressure is raised when tested of three separate occasions A Patients management depends critically on accurate estimation and recording of their Blood Pressure

Normal Values Normal Adult range Can fluctuate within a wide range and still be normal Systolic/diastolic 100/60 - 140/80

You have undertaken 4 new pt checks this morning and all the patients have raised Bp levels. What could be the causes? Tim - 58yr old builder. Overweight, smoker, enjoys alcohol and often exceeds 30 units a week Priya - 32 yr old housewife, has three children under the age of 7yrs. Arrives in surgery at 9.10am Samantha - 28yr old fitness instructor. BMI 22, non smoker Clive - 45 yr old company director. Non smoker, BMI 29. Mother treated for raised BP

Tim Age Overweight – poor diet therefore increased risk of CHD , hypertension, diabetes Smoker Excessive alcohol Physical activity-physically strenuous job

Samantha Physically fit – has she been exercising this morning? ? Use of substances ? Existing medical condition ?family history ?contraceptive pill

Priya Housewife - 3 young children busy life Arrived 9.10 ? Just dropped children of at school, rushed to surgery ? Raised Bp in pregnancy ? Existing medical conditions ? Risk factors smoker contraceptive pill poor diet Ethnic background

Clive Age Job ? Physical fitness levels Overweight ? dietary habits ? Caffeine intake Family history of hypertension ? Existing medical condition ? Alcohol intake

Hypotension Defined in adults as a systolic pressure below 100mm Hg Rarely treated in this country Postural Hypertension: is a fall in blood pressure that occurs when changing position from lying to sitting or from sitting to standing Postural=change in position Hypotension=fall in blood pressure to a low level A fall in blood pressure leads to a reduced blood supply to organs and muscles; this can cause a variety of symptoms: E.G Feeling dizzy Changes in vision such as blurring Feeling vague or muddled You may be asked to take a patients blood pressure lying down Some diabetic patients may suffer the symptoms of postural hypotension

Hypertension Defined as an elevation of systolic blood pressure Persistent hypertension very common 30% of people over 50 are hypertensive Never diagnosed on one reading Indication of cardiovascular disease Trauma Side effect of medication When blood pressure rises the blood travelling along the arteries roughens the lining of the arteries. To understand why this happens, picture what occurs when you turn a tap on. At normal pressure the water travels in a straight line, but when you turn the tap on full blast the water spurts out in all directions. Before it comes out it has been pushing in all directions against the sides of the pipes. This is what happens to the blood in the arteries if you have high blood pressure and puts an extra strain on the heart.

Prevention Reduce the risk of developing High Blood Pressure by making lifestyle changes….. Eat a healthy , well balanced diet Reduce salt and fat intake Exercise regularly Stop smoking Reduce alcohol and caffeine consumption to recommended levels Reduce weight

Weight Reduction

British Hypertension Society DVD on Blood Pressure Measurement demonstrated to group Tel 07716 467973 to order DVD £ 5.99 inc pp Email bhs@le.ac.uk www. bhsoc.og Suggest purchasing ! Valuable to all members of the Practice

Blood Pressure Measurement Warm, calm environment ! Provide an explanation of the procedure to the patient address any concerns/anxieties Allow the patient to rest for 5-10 mins if laying or seated Empty bladder Document any factors that could effect the BP level eg smoking , caffeine, exercise Sit upright feet flat on ground The arm must be supported at the level of the heart ensure no tight clothing constricts the arm The column of the mercury must be vertical and at the observers eye level Position the hose over the brachial artery The cuff should cover ¾ of the upper arm ?DEMONSTRATE BP RECORDING ON SOMEONE

Blood Pressure Measurement Ask the patient not to talk whilst BP is being taken Estimate the systolic beforehand: Palpate the brachial artery Inflate cuff until pulsation disappears Deflate cuff Estimate systolic pressure Then inflate to 30mmHg above the estimated systolic level needed to occlude the pulse Place the stethoscope over the brachial artery and deflate at a rate of 2-3mm/sec until you hear regular tapping sounds Measure systolic (1st sound) and diastolic pressures (sound disappears) to nearest 2mmHg.

Korotkoff’s Sounds Phase 2 A blowing or swishing sound Phase 3 A softer thud than sound 1 Phase 4 A softer blowing sound that disappears Phase 1 A sharp thud Phase 5 Silence WATCH VIDEO & PRACTICE

Surgery procedure and when to refer Does the surgery have Guidelines? Priority to have clear & agreed Practice Guidelines to support the HCA’s role for the Employer and for the Patients/Public protection Record keeping paramount! Clearly state when patients should be referred Legal responsibility NICE – clearly stated referral criteria Please read www.nice.org.uk

REFERENCES British Hypertension Society www.bhsoc.org Blood Pressure Association www.bpassoc.org.uk National Institute of Clinical Effectiveness (NICE) (2006). Hypertension: Management of hypertension in adults in primary care http://www.nice.org.uk