BLOOD PRESSURE BY JAYA.R

1. R.Jaya Bsc nursing
Lecture
Ganga college of nursing

2.  Blood pressure is the pressure of circulating blood
against the walls of blood vessels. Most of this
pressure results from the heart pumping blood
through the circulatory system.
 Sphygmomanometer has three parts: a cuff that can
be inflated with air, a pressure meter (manometer)
for measuring air pressure in the cuff, and. a
stethoscope for listening to the sound
the blood makes as it flows through the brachial
artery (the major artery found in your upper arm).

3.  The blood pressure is recorded for a number
of reasons
 To acquire a baseline
 To monitor for fluctuation in blood pressure;
 To aid in diagnosis of disease
 To aid in assessment of the cardiovascular
system
 To monitor medication e.g. anti-
hypertensive drugs.

4.  Systolic pressure is the pressure of the blood in the
arteries when the heart pumps. It is the higher of
two blood pressure measurements; for example, if
the blood pressure is 120/80, then 120 is the systolic
pressure.
 Diastolic pressure is the pressure of the blood in the
arteries when the heart is filling. It is the lower of
two blood pressure measurements; for example, if
the blood pressure is 120/80, then 80 is the diastolic
pressure.

5.  Physiology of arterial blood pressure
 Blood pressure reflect the interrelationships of cardiac
output. peripheral vascular resistance, blood volume,
blood viscosity, and artery elasticity.

6.  The amount of blood the heart pumps through the
circulatory system in a minute. The amount of blood
put out by the left ventricle of the heart in one
contraction is called the stroke volume.
The stroke volume and the heart rate determine the
cardiac output. A normal adult has a cardiac output of
4.7 liters (5 quarts) of blood per minute.

7.  Peripheral Resistance is defined and measured in
terms of the force required to maintain blood flow
from the root of the aorta to the venous exit into
the
 Blood volume refers to the total amount of fluid
circulating within the arteries, capillaries, veins,
venues, and chambers of the heart at any time.
 The components that add volume to blood include
red blood cells (erythrocytes), white blood cells
(leukocytes), platelets, and plasma.

9.  Viscosity, resistance of a fluid (liquid or gas) to a
change in shape, or movement of neighboring
portions relative to one another. Friction
 The hematocrit, also known by several other names,
is the volume percentage of red blood cells in blood,
measured as part of a blood test. The measurement
depends on the number and size of red blood cells. It
is normally 40.7%–50.3% for males and 36.1%–
44.3% for females

10.  Elasticity is the ability to recoil or bounce back to the
muscle's original length after being stretched.

11. AGE BLOOD PRESSURE [MM of Hg]
New born 40(mean)
1 month 85/54
1 year 95/65
6 year 105/65
10 to 13 years 110/65
14to 17 years 119/75
18 years and older <120/<80

12.  Advice to patient sits on a chair with the lower arm
supported as before. The blood pressure cuff is placed
on the patient right arm, allowing 1 inch between the
bottom of the cuff and the crease of the elbow.
 The brachial pulse is palpated just above the angle of the
elbow (the "antecubital fossa"). then place on a
stethoscope, with the earpieces on the headpiece angled
forward.
 The recording end of the stethoscope is twisted, so that
the diaphragm and not the bell is activated. This can be
tested by tapping lightly on the diaphragm.

13.  The diaphragm is placed over the brachial artery in the
space between the bottom of the cuff and the crease of
the elbow. At this point no sounds should be heard.
 The cuff pressure is inflated quickly to a pressure about
30 mm Hg higher than the systolic pressure determined
by the method of palpation.
 Then the air is let out of the cuff at a rate such that cuff
pressure falls at a rate of about 5 mm Hg/sec.
At some point the person listening with the stethoscope
will begin to hear sounds with each heartbeat.
 This point marks the systolic pressure.

15.  The sounds are called Korotkoff sounds.
 As the pressure is lowered further, the character of the
Korotkoff sounds should change. At some point, the
sounds will disappear.
The pressure reading at this point gives the diastolic
pressure.
 The patient should now lie on his or her back for five
minutes. The systolic pressure and diastolic

16.  1. First sound heard, sharp thud - systolic pressure
 2. Soft, tapping, intermittent
 3. Loud (not as loud as phase 1)
 4. Low, muffled, continuous: start - 1st diastole
 5. Disappears - 2nd diastole.

17.  Hemoreceptors are sensitive to arterial levels
of oxygen, carbon dioxide (CO2), and pH, and
are located in the same region as the arterial
 Baroreceptors, in the carotid and aortic
bodies and travel to the CNS via the same
nerve bundles as the arterial baroreceptors.

20.  what are the hormones that regulate blood pressure?
 Epinephrine and nor epinephrine, hormones secreted
by the adrenal medulla, raise blood pressure by
increasing heart rate and the contractility of the heart
muscles and by causing vasoconstriction of arteries
and veins.

21.  What is the most powerful hormonal regulator of
blood pressure?
 Angiotensin II is a powerful vasoconstrictor, greatly
increasing blood pressure. It also stimulates the
release of ADH and aldosterone, a hormone produced
by the adrenal cortex. Aldosterone increases the
reabsorption of sodium into the blood by the kidneys.

22.  Smoking.
 Being overweight or obese.
 Lack of physical activity.
 Too much salt in the diet.
 Too much alcohol consumption (more than 1 to 2
drinks per day)
 Stress.
 Older age.
 Genetics.

23.  Hypertension is defined as blood pressure above
140/90, and is considered severe if the pressure is
above 180/120.
 High blood pressure often has no symptoms. Over
time, if untreated, it can cause health conditions, such
as heart disease and stroke.
 Eating a healthier diet with less salt, exercising
regularly and taking medication can help lower blood
pressure.

24.  Hypotension is low blood pressure. Your blood
pushes against your arteries with each heartbeat.
And the pushing of the blood against the artery walls
is called blood pressure.
 Having a lower blood pressure is good in most cases
(less than 120/80).
 But low blood pressure can sometimes make you
feel tired or dizzy.

25.  It is also referred to as postural hypotension
 Orthostatic hypotension is a sudden drop in blood
pressure when you stand from a seated or prone
(lying down) position. You may feel dizzy or even
faint. Orthostatic means an upright posture.
 The systolic or diastolic pressure is drop( 20mmof hg)

27.  If Possible, the patient should be in a prone position.
 The bladder of the cuff should be about 40% of the
circumference of the thigh, and the length should be
about 75% to 80% of this circumference. Normally, the
systolic blood pressure in the legs is usually 10% to
20% higher than the brachial artery pressure
 The cuff should be placed 2.5 cm(1inch)above the
popliteal surface.

29.  Explain to the patient what you are about to do - even
if the patient is unconscious.
 Ensure that the patient is comfortable, as relaxed as
possible and not distressed.
 Note if the patient has had any medication that may
alter the blood pressure.
 Any tight or restrictive clothing should be removed
from the patient’s arm.
 The position of the patient is not as important as the
position of the arm; this should be supported and
should be level with the heart

30.  Apply the cuff (inside the cuff is the bladder), make
sure that the cuff is empty of air before applying;
ensure the correct size cuff is used on the patients
arm.
 The width of cuff should cover at least 40% of the arm
circumference and the length should cover at least
two-thirds of the arm (The centre of the cuff should
cover the brachial artery.
 Make sure that you can see the sphygmomanometer
and that it is in line with the heart.
 Palpate the brachial pulse and inflate the cuff until the
pulse can no longer be felt. This will give an estimate of
the systolic pressure. Deflate the cuff and re-inflate to
30mmHg higher than estimated

31.  Position the stethoscope over the brachial artery and
slowly deflate the cuff at 2-3mmHg per second.
 The first beating sound should be recorded; this is the
systolic pressure.
 Continue to deflate the cuff; the last sound to be
heard is the diastolic pressure.
 Record the blood pressure on the observation chart.
Any abnormalities or irregularities should be
documented and reported to the medical team.
 Before leaving the patient make sure any clothing
removed is replaced and that the patient is
comfortable.
 Electronic sphygmomanometer - the same procedure
is carried out as above without the use of the
stethoscope. Manufacturer’s guidelines should be
followed and appropriate training completed.