09 Fall Blood Pressure

8/8/2019 09 Fall Blood Pressure

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Blood Pressure

The force of the blood against arterial walls

Systolic Pressure

The highest point of pressure on arterial walls

when the ventricles contract Diastolic Pressure

The lowest pressure present on arterial walls as

ventricles relax

Read as systolic number over diastolic number


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Factors Affecting Blood

Pressure Reading

Age- walls of arteries are less elastic-increases peripheralresistance, ^ B/P

Exercise- ^ systolic pressure

Race-hypertension more common in African American

Weight-B/P can be higher in overweight

Emotional state-anger, fear, pain, excitement ^ B/P Smoking-vasoconstriction, ^ B/P

Medications-oral contraceptives may ^ B/P,

antihypertensives lower B/P


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Ranges of Blood Pressure

[525]

Optimal= 180/110

Hypotension=90-115 forsystolic

may be normal for some but may be due to bloodloss or medication effects


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Orthostatic./ Postural Hypotension

change in position leads to low BP.

caused by medications, prolonged bed rest,

loss of blood

Korotkoff Sounds

Sounds you hear when taking a blood

pressure as blood can flow through thecompressed artery. Listen and make note

when they start, change tone, and quickly

stop


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Measuring Blood Pressure

Blood Pressure is measured in millimeters of

mercury (mm Hg)

Blood Pressure is recorded as a fraction:

The numerator is the systolic pressure

The denominator is the diastolic pressure

Pulse Pressure

The difference between the systolic and

diastolic pressure ie. systolic diastolic =

pulse pressure


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Methods of Assessing the

Blood Pressure Use a stethoscope and sphygmomanometer

Use a Doppler ultrasound

Estimate by palpation

Assess with electronic or automated devices


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How to Ensure an Accurate

Blood Pressure Reading

Ensure equipment is in good working order

Always use a cuff that is the correct size for

the patient- if too narrow-reading may be

high, if too wide, reading may be low

Ensure accurate limb placement

Use recommended deflation rate

Correctly interpret the sounds heard

ie. LOOK, LISTEN, FEEL


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u w o arm eng


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Continued..

Stethoscope- used to auscultate ie. listen

Sphygmomanometer and cuff (different

sizes) + manometer ie. mercury or

aneroid

Ensure reading starts at 0

If using mercury manometer make sure

you read at eye level

Always read at top of meniscus

Do not take the B/P on an arm: with an IV, on the side of a mastectomy,

weak arm from stroke, casted/injured arm


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Assessing Brachial B/P

Select the appropriate arm for application ofthe cuff

Have the patient assume a comfortable lying

or sitting position with the forearm supportedat the level of the heart and the palm of thehand upward

Expose the brachial artery by removinggarments, or move a sleeve, if it is not tootight, above the area where the cuff will beplaced

Palpate the location of the brachial artery


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Place the bell or diaphragm of the stethoscopefirmly but with as little pressure as possible overthe brachial artery

Pump the pressure 30 mm Hg above the pointat which the systolic pressure was palpated andestimated. Open the valve on the manometer

and allow air to escape slowly; allowing thegauge to drop 23 mm per heartbeat

Note the point on the gauge at which thefirst faint, but clear, sound appears that

slowly increases in intensity. Note thisnumber as the systolic pressure

Read this pressure to the closest even number


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Other Methods to DetermineBlood Pressure

Popliteal Artery Blood Pressure-usually10-40 higher

Patient to assume the prone position

Use an appropriate size cuff

Place cuff on thigh above popliteal artery

Same procedure as for assessing brachial bloodpressure


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Estimating by Palpation

Only need a sphygmomanometer

Pump up cuff same as for brachial bloodpressure assessment but using your fingersyou feel for the return of pulse

You only get a systolic reading

Doppler/Ultrasound amplifies sounds


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Electronic or Automated Devices

Determines Blood Pressure by monitoringvibrations

Still need to remember to check equipment Place cuff in correct position

Ensure to use correct size cuff

Check with brachial manual blood pressureto confirm accuracy of automated device


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Nursing Skills Lab 1

Week 13

Topical Medications

Please review the 3 checks and 6rights of medication preparation

and administration prior to this Lab

Documents

09 Fall Blood Pressure