Blood Pressure Fundamentals PDF

 Vital signs objectives Students able to: Describe the procedure used to assess blood pressure. Identify factors that can influence blood pressure. Identify equipment routinely used to assess blood pressure Be able to understand and interpret values. Accurate document the blood pr...

 Vital signs objectives Students able to: Describe the procedure used to assess blood pressure. Identify factors that can influence blood pressure. Identify equipment routinely used to assess blood pressure Be able to understand and interpret values. Accurate document the blood pressure.  Establish a baseline for future assessments. Ensure equipment is functional well. Arterial blood pressure Definition: Is the force of the blood against arterial walls (when left ventricle of the heart pushes blood through the aortic). It is recorded as two readings: the systolic blood pressure (the top number) occurs during cardiac contraction and the diastolic blood pressure or resting pressure (the bottom number), occurs when the heart is not actively contracting.  Blood pressure is measured by millimeters of mercury (mmHg). Normal range 120/80±20/15 mmHg. – Appearance of sound (phase I Korotkoff) = systolic pressure – Disappearance of sound (phase V Korotkoff) = diastolic pressure  pulse pressure The pressure difference between the systolic and diastolic pressures. Measured in millimeters of mercury (mmHg).  Classification of blood pressure for adults Normal 120/80 ±20 /15 mmHg. Stage I(mild) 140-159 / 90-99mmHg. Stage II (moderate) 160-179 /100-110mmHg. Stage III(severe) 180-209 /110-119mmHg. Stage IV(very severe) >210 />120 mmHg.  Regulations of blood pressure (1)peripheral resistance :( arteries, arterioles, capillaries & veins , venules). Arterioles….is very small elastic tube that can contract or dilate ……to regulate the distribution of blood to various organs , tissues or cells.  (2)pumping action of the heart: When ↑CO…….↑arteries distend ……↑blood pressure. When ↓CO…….↓arteries distend……↓blood pressure. (3)blood volume : when blood volume is low i.e. hemorrhage or dehydration …..blood pressure is low because there is decreased fluid that creating pressure on arterial wall. (4)viscosity of blood : is state of being sticky or gummy …depend on proportion blood cell to plasma ,increase viscous ….↑blood pressure because the heart needs more forceful to move concentrate fluid through circulatory system. 5)elasticity of vessel walls :arteries have quantity of elastic tissue that allows them to stretch , distend and recoil (called compliance). Pressure not drop to zero.  Variations in blood pressure (1)age :older ↓ elasticity of arteries ↑ peripheral blood pressure. (2)normal fluctuations :blood pressure is usually lowest in the morning , ↑5-10 mmHg. by afternoon gradually falls again during sleep. (3)sex :woman have lower blood pressure than male.  (4)eating :↑ blood pressure after eating food (5)exercise:↑systolic blood pressure during exercise & strenuous activity. (6) Body built : ↑blood pressure in obese than who are thin.  (7)emotions: anger, fear , pain & excitement ….↑blood pressure but pressure falls to normal when situation passes. (8)position :tend to ↓blood pressure in prone or supine position than when sitting or standing. (9)race : ↑ blood pressure in African men & woman. (10)drugs :oral contraceptives cause mild increase in blood pressure for many woman.  The palpatory methods Taking the radial pulse while inflating the cuff till the cuff pressure cuts off the pulse ( no pulse can be felt). Advantage : reduce discomfortable to patient Limitations: cannot measure diastolic pressure  Orthostatic hypotension Blood pressure falls more than 20mmHg when change position from recumbent to sitting or standing. Syncope ( fainting): inability to stand accompanied with loss of consciousness Occurrence when person stand suddenly after prolonged bedridden or ambulate the first time after surgery ….the blood pools in the lower legs.  Definition of hypertension Called silent killer , it is defined as a persistent elevation of the systolic blood pressure ( SBP) at a level of 140 mmHg or higher and diastolic blood pressure ( DBP) at a level of 90 mmHg or higher. hypertension can cause damage to vital organs, such as kidney , heart, eyes & brain.  Risk factors Non modifiable risk factors: Family history – age – gender. Modifiable risk factors : Stress – obesity- life style- smoking – hypertension- un control blood sugar- diet  Clinical manifestations In early stages : no clinical manifestations , patient will remain unaware that their blood pressure is elevated if case is left undiagnosed , the client will c/o persistent headache , fatigue , dizziness , palpitations , flushing , blurred or double vision or epistaxis. Also changes in level of consciousness, seizures, coma , nausea , vomiting , renal failure , heart failure , pulmonary edema , blind & stroke.  The goal of management (1)lifestyle modifications (2)diet (3)exercise (4)stop smoking , alcohol & caffeine. (5)potassium supplementation. (6)pharmacologic intervention.  Stroke volume: is the quantity of blood forced out of the left ventricle with each contraction.The average amount of blood per contraction is 70 ml in an adult.  Cardiac output : is the amount of blood pumped per minute. This volume is determined by using the following formula: cardiac output = stroke volume x pulse rate. Is about 5000ml.  Knowledge check Significant elevation in blood pressure measurements from one day to the next could be attributed to: 1- A decrease in cuff size 2-An increase in cuff size 3-New onset of pain or anxiety 4- 1 and 3  Hyperthermia : increase body temperature than normal level. Hypothermia: decrease body temperature than normal level. Hypertension:increase blood pressure than normal level. Hypotension:decrease blood pressure than normal level.  Tachycardia: increase heart rate than normal level. Bradycardia : decrease heart rate than normal level. Tachypnea : increase breathing rate than normal level. Bradypnea : decrease breathing rate than normal level. Eupnea : normal breathing pattern.  references Patricia,K.,& Sue,C.,(2018):Fundamentals of nursing standards&practice,international thomson publishing company ITP,New york,p.p327-360. Jeanne, C.etel,(2020);Introductory medical surgical nursing,J,B.Lippincott company,London,p.p.350-375. Daniels ,R.,etal(2018);Nursing fundamentals,Thomson com.United states,p.p.557-580.