1. Blood Pressure

2. Blood pressure is the force of blood against the arterial walls.
Responsible for the flow of blood.
Blood pressure is the result of:
- The pumping action of the heart.
- Resistance of the blood vessels.
- Volume of blood.

3. Blood pressure also depends on:
Distance from the heart.
Would B/P in the legs be lower or higher than in the arm?

4. Pumping Action of the Heart
Systolic Phase-Systole
Ventricles Contract
Blood flows to the body

5. Pumping Action of the Heart
Diastolic Phase – Diastole
Heart relaxes

6. Blood Pressure is Elevated by:
Sex and age of the patient.
Exercise, eating, emotions
Stimulants
Obesity
Arteriorsclerosis
Diabetes
Pain
Heredity factors
Some drugs

7. Blood Pressure is lowered by:
Fasting
Rest
Depressants
Weight loss
Loss of blood or shock
Diuretics

8. Blood Pressure is: Recorded as an improper fraction. 120/80
Numerator equals systolic pressure, the first sound you will hear.
Denominator equals diastolic pressure, the last sound you will hear.

9. Blood Pressure Sounds are:
Auscultated through a stethoscope
Sounds are correlated with the readings on a sphygmomanometer.
Blood pressure is recorded in milligrams of mercury. (mm HG)

10. Blood Pressure Variations
Determine baseline
- From medical record
- From systolic palpated pressure
Hypertension – High blood pressure
Hypotension – Low blood pressure
Orthostatic hypotension – decrease in B/P with position change from supine to erect.

11. Equipment

12. Stethoscope

13. Stethoscope

14. Aneroid Sphygmomanometer

15. Aneroid Sphygmomanometer
Use the proper size cuff
Undersized cuff artificially raises blood pressure
Oversized cuff artificially lowers blood pressure

16. The "ideal" cuff should have a bladder length that is 80% and a width that is at least 40% of arm circumference (a length-to-width ratio of 2:1).

17. Mercury Sphygmomanometer

18. Positioning for BP
Ideally have the patient seated and their arm at heart level. Make sure that they do not have any tight clothing which may constrict their arm.

19. Locate the brachial pulse
Palpate in the antecubital fossa for the point of maximal pulsation of the brachial artery.

20. Positioning of Blood Pressure Cuff
Cuff applied directly over skin (not through clothes)
Clothes artificially raises blood pressure
Center inflatable bladder over brachial artery
Position lower cuff border 1 inch above antecubital space

21. Estimation of systolic pressure
The examiner should assess the estimated systolic pressure. To do this, palpate the patient’s radial pulse. Now inflate the cuff until you feel the exact point when the pulse disappears. The point on the manometer at this moment represents the estimated systolic pressure.

22. Assessment of systolic & diastolic pressure
Place your stethoscope over the brachial artery area. Now inflatean extra 30mmHg worth of pressure above the estimate systolic pressure (e.g. if the estimate systolic pressure was 120mmHg – inflate the cuff to 150mmHg).

23. Korotkoff Sounds

24. Now slowly release the pressure in the cuff by using the valve.
The pressure should be reduced at a rate of 2-3mmHg per second. The point where consecutive tapping noises (i.e. Korotkoff phase 1) occur you should read off the pressure on the manometer – i.e. the systolic pressure.

25. When the consecutive heart beat sounds finally disappear (i. e
When the consecutive heart beat sounds finally disappear (i.e. Korotkoff phase 5), read off the measurement on the manometer. This represents the diastolic pressure.

26. Trouble-shooting False high reading - Cuff too small - Cuff too loose
- Slow cuff release
- Column or dial not at eye level
- Anxiety or recent exercise

27. False low reading
- Incorrect position of arm…be sure
to position at the level of the heart Failure to notice auscultatory gap:
Sounds fade out for 10 to 15 mm Hg then return
– Inaudibility of low volume sounds
– Column or dial not at eye level

28. systolic & diastolic pressure,
Blood pressure values
• Systolic normal range 90 – 140 mm Hg
Diastolic normal range 60 – 90 mm Hg
Pulse pressure: difference between
systolic & diastolic pressure,
approximately 40 mm Hg

29. Blood pressure readings…
Use same arm for
readings
• Do not take B/P on
arm with:
– An IV
– Paralysis
– Injury
– A – V shunt
– Edema