HOW TO MEASURE BP P.3311. Position pt arm with palm up at heart level, exposing upper arm –

measure directly on skin NOT over clothing!!

2. Feel for brachial artery on inner aspect of arm at bend of elbow

3. Apply cuff snugly directly over brachial artery (1 inch above antecubital area)

4. Put stethoscope into ears, position diaphragm over brachial artery

5. Inflate cuff to between 160 mm Hg and 180 mm HG

6. Deflate cuff slowly, listen for first regular sound heard (systolic pressure), note reading

7. Listen for very last sound heard (diastolic pressure), note reading; If rounding is needed, round UP to the nearest 2 mm HG

8. Record BP reading like a fraction ex. 126/82

BLOOD PRESSUREMod E: Ch. 20

BLOOD PRESSURE (BP) P. 329

• Measure of force of blood against artery walls

• Depends on:• Blood volume (amount)• Strength of heart – force of heartbeat• Artery walls: less elastic = higher pressure• Distance from heart – BP lower in legs than in arms

• Systolic: = working pressure; during contraction of ventricles, generally larger number, first sound heard

• Diastolic: = resting pressure; when ventricles relax, generally smaller number, last sound heard

Ex. BP 120/80: Systolic 120, Diastolic 80

• Average BP values p. 330!• 6-18 years: 83 + (2x age) / 52 + age ex. 17 yr old: 117/69• Over 18 years: up to 120/80

WHAT CAN INCREASE BP

• Gender (male higher than female)

• Exercise

• Eating

• Stimulants: ex. Caffeine, nicotine, medications

• Emotions: ex. Anger, stress, fear, sexual activity

• Diseases: arteriosclerosis (hardening of arteries), high cholesterol, diabetes

• Pain

• Obesity

• Age

WHAT CAN DECREASE BP (P. 330)

• Fasting (not eating)

• Rest / sleep

• Depressants (sedatives): alcohol, medications, drugs, ex. Valium

• Weight loss

• Emotions: grief

• Fluid loss: dehydration, hemorrhage

• Shock

SPHYGMOMANOMETER P. 330• Used to measure blood pressure;

• clean before and after every pt use!

• May be electronic parts:

• Cuff• Fits around patient’s arm • Rubber bladder inside; should be 80% of arm circumference (choose correct

size)

• Tubes (2)• One is connected to bladder inside cuff• Other is connected to pressure control bulb

• Pressure gauge• Aneroid gauge (round)• Column of mercury

STETHOSCOPE P.330

• Magnifies sounds; parts:

• Bell/diaphragm

• Tubing

• Earpieces

• Clean before and after every patient use!

BP READINGS P. 332• Pulse pressure: difference between systolic and diastolic pressure; indicates

health of arteries; average is 30-50 mm HG (ex. 120/80: pulse pressure 40)

• “Normal BP” between 100/60 and 120/80; ex. 115/76

• ANY reading besides “Normal” needs to be reported to the nurse right away!

• Hypotension: under 100/60 ex. 95/42, 98/58

• Prehypertension: 120-139 systolic and/or 80-89 diastolic ex. 128/86, 138/78

• Hypertension:• Stage I: 140-159 systolic and/or 90-99 diastolic ex. 156/96, 138/92• Stage II: >= 160 systolic and/or >= 100 diastolic ex. 168/102, 178/98

ORTHOSTATIC HYPOTENSION

• Also called “postural hypotension”

• Happens when BP drops due to position change (from lying to sitting and/or standing)

• Pt may be dizzy, light headed, severe cases loose consciousness

• Measure BP 3 times• Lying• Sitting• Standing

• Systolic pressure drops 20 mm HG or more and/or Diastolic drops 10 mm HG or more ex.: lying 140/80, sitting 132/72, standing 108/60

CAUSES OF INACCURATE READINGS P.334

• Wrong size BP cuff• Improperly wrapped cuff• Incorrect arm positioning• Different arm for different readings• Deflating cuff too slowly• Mistaking auscultatory gap (sound goes away for 10-15 mm HG and then

comes back)as diastolic pressure

HOW TO READ GAUGE P.334• Increments of 2 mm HG, long lines 10 mm Hg

• Mercury gauge:• At eye level, not tilted• At top of mercury column

• Aneroid gauge• At eye level, not at angle

PULSE OXIMETERS P.334

• Used to measure O2 saturation of blood

• Finger clip

• Don’t use on same arm as BP cuff

• May use arm with injuries or other tubes

• Report any reading below 95% to nurse ASAP

CAN’T USE ARM FOR BP WHEN

• When there is an IV line

• Implants

• Dialysis shunt

• Arm injury/ fracture, surgery

• Mastectomy side

• Oximeter

• Paralyzed or affected arm

HOW TO MEASURE BP P.3311. Position pt arm with palm up at heart level, exposing upper arm – measure directly

on skin NOT over clothing!!• Do not use an arm with

• IV, pulse oximeter, dialysis access or any other tubes attached• Burns, fractures, injuries, edema, paralyzed, paresis• On same side as mastectomy or surgical upper body procedure

2. Feel for brachial artery on inner aspect of arm at bend of elbow

3. Apply cuff snugly directly over brachial artery (1 inch above antecubital area)

4. Put stethoscope into ears, position diaphragm over brachial artery

5. Inflate cuff to between 160 mm Hg and 180 mm HG

6. Deflate cuff slowly, listen for first regular sound heard (systolic pressure), note reading

7. Listen for very last sound heard (diastolic pressure), note reading; be mindful of auscultatory gap (sound goes away for 10-15 mm HG and then comes back)

8. If rounding is needed, round UP to the nearest 2 mm HG

9. Record BP reading like a fraction ex. 126/82

Procedure 40 p. 335

Homework:

Read Unit 20 in Textbook p. 329-338

Workbook: p. 123 read Unit summary, Nursing assistant alert,

Do questions: 17 (readings) all, True/False (all)