1. VITAL SIGNS
BLOOD PRESSURE
(BP)

2. WHAT IS BP?
The pressure exerted on the arterial walls by the pumping action of the heart

3. FACTORS THAT CREATE YOUR BP
Heart rate
Force of heart’s contractions
Circulating blood volume
Elasticity of the blood vessels

4. MEASUREMENT OF BP
Systolic - the higher # - the pressure in the blood vessel when the heart is contracting
Diastolic – the lower # - the pressure in the blood vessel when the heart is at rest
Pulse pressure – the difference between the systolic & diastolic BP

5. NEW ADULT HYPERTENSION GUIDELINES
Normal BP = < 120/80
Pre-hypertension = /80-89
Stage I-Hypertension =
/90-99
Stage II-Hypertension = >160 systolic and > 100 diastolic

6. REMEMBER
YOU Need to know usual BP range of pt to be able to determine if problem exists
Major changes in BP from usual range usually indicate problem

7. BP VARIATIONS
BP can vary from minute to minute as the heart adjusts to demands & responses of the body & mind

8. FACTORS AFFECTING BP Age – BP  in young &  in elderly
Anxiety, fear & stress -  BP
Race – BP more common in certain races
Meds – can  or  BP (decongestants  BP)

9. Factors Affecting BP

10. FACTORS AFFECTING BP

11. Changes in Vital Signs Occurring with Aging
Systolic and diastolic blood pressure may rise with hardening of the arteries
Prolonged hypertension can cause permanent damage to the brain, kidneys, heart, retina of the eyes, & is a major cause of strokes (CVA)

12. ORTHOSTATIC (POSTURAL) HYPOTENSION
Drop in BP when change in position from lying or sitting to standing
CHECK BP IN SITTING & STANDING POSITIONS
Instruct pt to get up slowly
Common in elderly due to  elasticity of blood vessels with age. Blood pools in lower extremities. Elastic stockings may lessen the problem. Also common in people on certain meds!

13. OTHER CAUSES OF HYPOTENSION
MEDICATION
Loss of blood volume
Extreme hypotension = SHOCK
S&S of shock =  BP,  P, dizziness, blurred vision, apprehension, cold, clammy skin
Loss of blood volume – from hemorrhage, vomiting, diarrhea, burns, or MI (heart attack)

14. EQUIPMENT TO MEASURE BP
Stethoscope – used to hear (auscultate) the sounds made in the artery by the beats of the heart
Diaphragm- used to hear high-pitched  sounds
Bell- used to hear low-pitched  sounds
Sphygmomanometer – occludes the artery & then slowly allows blood flow through it

15. SPHYGMOMANOMETER
Cuff size – must fit pt limb (pedi, adult, large, X-large)
If use incorrect size = incorrect reading
False high reading if cuff too small

16. CORRECT SIZE CUFF: WIDTH IS 20% LARGER THAN DIAMETER OF ARM & INFLATABLE BLADDER SHOULD GO AROUND AT LEAST ¾ OF THE ARM

17. PARTS OF THE SPHYGMOMANOMETER
Gauge (measures BP)
Tubing from gauge to cuff
Cuff –with bladder inside (wrapped around arm or leg)
Control bulb (inflates & deflates cuff)

18. TYPES OF MANOMETERS Mercury gauge – most accurate Aneroid gauge
Automated BP machines (dinamap)- no stethoscope required

19. How to Accurately measure Blood Pressure
Nurses usually use the brachial artery for assessing BP
However, many factors can interfere with accurate BP measurement e.g. –An IV in an arm, a patient who has had a mastectomy, edema, AV fistula, a cast, or a wound dressing
If the arm cannot be used, you can use the forearm, thigh or calf

20. KAROTKOFF SOUNDS
The sounds heard with the stethoscope while measuring BP
Phase I – systolic BP reading-1st sound heard
Phase II-soft, swishing sound
Phase III-rhythmic tapping sound
Phase IV –Softer and fading-diastolic BP in children & some adults
Phase V –Silence- diastolic BP reading

21. Guidelines for Measuring BP
Have pt rest for 5 min. before measure
Use brachial artery, support arm on a level of heart
Check condition of equipment, position manometer so you can read eye level, gauge indicator should be at 0 when cuff deflated

22. Guidelines for Measuring BP
Use correct size cuff
Place stethoscope directly on skin
Palpate brachial artery before taking BP, inflate cuff & note the level at which the pulse disappears. Deflate cuff.
Place diaphragm of stethoscope firmly over brachial artery

23. Guidelines for Measuring BP
Inflate cuff 30 mm Hg. above where the pulse disappeared.
Slowly deflate cuff (2 mm. per second) and listen for 1st sound (systolic pressure). Continue listening until sound disappears or if sound continues until 0, note reading when sound becomes muffled (diastolic pressure).

25. REMEMBER Never reinflate cuff when deflating cuff
Always record reading as soon as possible
ALWAYS MEASURE BP & PULSE TOGETHER