Blood pressure, vital signs

1. BLOOD PRESSURE
SKILLS LABORATORY

2. BLOOD
PRESSURE
❖ The pressure that is exerted on
the wall of the arteries when the
left ventricle of the heart pushes
blood into the aorta.
-It is generally reported in
millimeters of mercury
(mmHg) as unit of
measurement.

3. Two pressure measurements:
❏ Systolic pressure
- measure of pressure when left ventricle
contracts
-maximum pressure exerted by blood on
vessel walls during contractions of heart
chambers.
❏ Diastolic pressure
- measure of pressure when heart relaxes
- Minimum pressure exerted against the
artery walls at all times

4. ❏ Recorded as a fraction; e.g.
120/80
SYSTOLIC PRESSURE DIASTOLIC PRESSURE
➢ Contraction of left
ventricle
➢ Top or first number
➢ Normal resting BP in
adult: 90 - 120 mmHg
➢ Heart at rest
➢ Bottom or second
number
➢ Normal resting BP in
an adult: 60 - 80 mmHg

5. Pulse Pressure = difference between systolic and diastolic pressures
Pulse pressure = Systolic BP - Diastolic BP
Normal : 30 to 40 mmHg
Mean arterial pressure (MAP)= is the average pressure over a cardiac
cycle.
MAP can be approximately determined from measurements of the
systolic pressure and the diastolic pressure.
MAP= Diastolic BP + ⅓ Pulse pressure
Normal: 90 to 100 mmHg

6. DETERMINANTS OF BLOOD PRESSURE
The BP is a function of the product of (Cardiac Output ) and
Total Peripheral Resistance (PR)
1. Heart Rate
2. Stroke Volume
CARDIAC
OUTPUT
INCREASE IN HR
INCREASE IN BP
INCREASE IN CO

7. DETERMINANTS OF BLOOD PRESSURE
3. Elasticity or compliance of blood vessels - It refers to the stiffness of the arterial
system which progressively increases from birth until death.
arterial elastic constant: pressure during systole
4. Peripheral resistance: PR= BP and PR = BP
5. Arterial Blood Volume: total blood volume = SBP and DBP
Hemorrhage = blood volume = BP

8. FACTORS AFFECTING BLOOD PRESSURE
PHYSIOLOGICAL VARIATION
Age
Sex/ Gender
Stress Diurnal Variations
temperature
Stress or emotion
Effects of Meals
Sleep
Medications
Effect of posture change
Body built

9. BLOOD PRESSURE ABNORMALITIES
HYPERTENSION
❏ Condition in which blood
pressure is chronically
elevated
❏ High blood pressure
readings
❏ Major contributor to heart
attacks and strokes

10. BLOOD PRESSURE ABNORMALITIES
HYPOTENSION
❏ Low blood pressure (below 100/60
mmHg)
❏ Normal for some people
❏ Severely low blood pressure readings
occur with:
-Shock -Severe Burns
-Heart failure -Excessive Bleeding

11. Orthostatic Hypotension
❏ Drop in systolic pressure of at
least 25 mmHg or a drop in
diastolic pressure of at least 10
mmHg
❏ Indicates fluid loss or malfunction
of cardiovascular system
❏ Vital signs are taken in different
position
❏ Blood pressure becomes low and
pulse increases when the patient
moves from lying to standing

13. TYPES OF SPHYGMOMANOMETER
ANEROID
❏ Circular gauge for
registering pressure
❏ Each line 2 mmHg
❏ Must be checked,
serviced, and
calibrated every 3 to 6
months.

14. Mercury Sphygmomanometer
- Medical device for
measuring blood
pressure that uses
mercury
- Considered to be the
gold standard
- this does not require
calibration

15. ELECTRONIC/DIGITAL SPHYGMOMANOMETER
❏ Provides a digital
readout of the blood
pressure
❏ No stethoscope is
needed
❏ Easy to use
❏ Maintain equipment
according to
manufacturer’s
instructions.

18. For infant, child or frail
adult
For Normal Adult-size
Measure BP on the
leg or arm of an
obese adult

19. STETHOSCOPE
❏ Is a acoustic medical
device for auscultation,
or listening to the
internal sounds of an
animal or human body
❏ Listen to intestines and
blood flow in arteries
and veins

20. PARTS OF
STETHOSCOPE
❏ Earpieces
❏ Binaurals and tubing
❏ Chest Piece
❏ Bell- low- pitched sounds
❏ Diaphragm- High pitched
sounds

21. KOROTKOFF
When a blood pressure cuff changes the flow of blood
through an artery, Korotkoff sounds are produced. A
stethoscope or a doppler, placed distal to the blood pressure
cuff, is used to listen for these sounds.

22. There are five distinct phases of Korotkoff sounds:
Phase 1: A sharp tapping.
This is the first sound heard as the cuff pressure is released. This
sound provides the systolic pressure reading.
Phase 2: A swishing/whooshing sound.
Swishing sounds as the blood flows through blood vessels as the
cuff is deflated.

23. Phase 3: A thump (softer than phase 1).
Intense thumping sounds that are softer than phase 1 as the
blood flows through the artery but the cuff pressure is still inflated
to occlude flow during diastole.
Phase 4: A softer, blowing, muffled sound that fades.
Softer and muffled sounds as the cuff pressure is released. The
change from the thump of phase 3 to the muffled sound of phase 4
is known as the first diastolic reading.
Phase 5: Silence.
Silence that occurs when the cuff pressure is released enough
to allow normal blood flow. This is known as the second diastolic
reading.

24. BE FAMILIAR WITH THE SOUND

26. ASSESSING BLOOD PRESSURE
❏ Listening for Korotkoff sounds with stethoscope
❏ First sound is systolic
❏ Change or cessation of sounds occurs - diastolic
❏ The brachial artery and popliteal artery are
commonly used

28. PURPOSES:
1. To measure the systolic and pulse pressure.
2. To determine certain physiologic changes that may occur.
3. To determine the pumping action of the heart
4. To aid in diagnosis.
5. To evaluate the general condition of the patient.

29. SPECIAL CONSIDERATION
1. Keep patient physically and emotionally rested before taking the blood
pressure.
2. For repeated reading, take the blood pressure in the same arm, in the
same position and time.
3. Take the blood pressure reading as quickly as possible to prevent venous
congestion.
4. Size of cuff should be appropriate to the size of the patient’s arm.

30. PROCEDURE:
1. Washes hands before the procedure.
2. Explain the purpose and the
procedure to the patient.
3. Positions the patient comfortably
with arm supported and the palm
upward.
4. Wraps the cuff correctly around the
arm about 1 inch above the
antecubital fossa.
5. Properly place fingers to locate the
brachial artery.
6. Check the stethoscope and place
properly over the strongest pulsation
of the brachial artery.
7. Inflate the cuff slowly until no
more sound is heard.
8. Using the valve, slowly release air,
notes the first audible sound and last
strong sound is heard.
9. Remove cuff and cleans
equipment properly.
10. Wash hand after the procedure.
11. Record properly on the vital
sheet.

31. REFERENCES:
https://www.ausmed.com/cpd/explainers/korotkoff-sounds
https://www.scribd.com/presentation/18090549/Vital-Signs