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Blood pressure


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it is a procedure coming under vital signs which is basic procedure in fundamentals of nursing,1st year...

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Blood pressure

  1. 1. Blood pressure Prepared by : Christian Raveina
  2. 2. Definition Blood pressure is the force exerted by the blood against the wall of blood vessel
  3. 3. Two measurements: • Systolic blood pressure : is force exerted by arterial walls during systole. It is the maximum pressure during ventricle contraction • Diastolic blood pressure : is the force exerted by blood against arterial wall during diastole. It is the maximum pressure when the ventricles are relaxed
  4. 4. • Unit of measuring blood pressure is (mmHg) millimeters of mercury • Normal blood pressure is 120/80 mm of Hg • Here , systolic pressure is 120 mmHg & diastolic pressure is 80 mmHg • Pulse pressure is the difference between systolic & diastolic pressure • Normally, The pulse pressure is 40 mmHg
  5. 5. Physiology of blood pressure Cardiac output : It is the amount of blood ejected by heart in 1 minute Stroke volume : It is the amount of blood ejected by heart in 1 cycle. Normally heart eject 70-80 ml blood in 1 cycle Cardiac output = stroke volume Χ heart rate
  6. 6. Peripheral vascular resistance : It is the resistance to the blood flow determined by the tone of vascular muscle’s & the diameter of blood vessels ,smaller the lumen greater the resistance ,ultimately blood pressure raises. That is why vasoconstriction leads to elevation of blood pressure
  7. 7. Blood volume : as soon as the blood volume increases, pressure exerted against arterial wall also increases. That is why giving intravenous fluid in hypotension increases the blood pressure .with hemorrhage & bleeding , blood volume decreases & automatically Blood pressure falls
  8. 8. Blood pressure basically depends upon cardiac output & the peripheral vascular resistance Blood pressure = cardiac output + peripheral vascular resistance Here cardiac output is stroke volume × heart rate So If client has 72 heart rate , then cardiac out put is 70 × 72 = 5040ml Blood pressure may increase with increase in blood volume in blood vessel as well as by increase in heart rate
  9. 9. Factors affecting the blood pressure
  10. 10. Age : blood pressure varies throughout the age. As age increases, BP also raises. Infant blood pressure: 65-115/42-80 mm Hg 7 year child : 87-177/48-64 mmHg Normal adult : 120/80 mmHg Older people, systolic pressure rises with decreased elasticity Body size/obesity : It is observed that as the body size increases, BP also fluctuates. Heavier & taller child have higher BP than the smaller child of same age
  11. 11. Emotions/stress : anxiety , fear , pain , stress, sympathetic nervous system get activated, causing vasoconstriction , increases heart contraction & ultimately raises blood pressure Gender : After puberty , male have higher blood pressure than females. But after menopause , women tend to have high BP than male of same age Ethnicity : African – Americans have higher incidence of high blood pressure than European- Americans
  12. 12. Diet : people taking diet rich in salt & unsaturated fatty acids, having higher blood pressure. Cocaine use also increases blood pressure. Caffeine intake also increases blood pressure. Smoking : due to nicotine blood pressure increases Exercise : Regular exercise, decreases the blood pressure. Helps in keeping BP normal
  13. 13. Diurinal variations : usually, person have low BP in early morning & gradually rises & peaks in evening Medications : medications such as opioid analgesics, antihypertensive drugs have greater effect on BP Chemicals : such as epinephrine , ADH , Angiotensin II cause vasoconstriction , thus elevating BP. Histamine,kinens cause vasodilation , thus decrease BP.
  14. 14. Regulation of blood pressure Vasomotor centers has main role in regulating blood pressure Chemo receptors & baro receptors located throughout the arterial system are sensitive to the blood volume & its chemical composition These receptors send impulses to vasomotor center which may cause vasodilation or vasoconstriction to keep BP in normal limits
  15. 15. Alteration in blood pressure Hypertension : Elevated systolic pressure or diastolic pressure at least for 3 consecutive visits . Ex: 190/140 mmHg Hypotension : BP falls below normal limits of client. Generally,systolic pressure falls to 90 mmHg or below Orthostatic hypotension /postural hypotension : suddenly BP fall of normotensive client while rising to upright position
  16. 16. Blood pressure monitoring Measured by : Invasively ( Direct method ) : insertion of catheter inside the artery Non-invasively (Indirect method ) : palpation & auscultation It is best for nurse to measure blood pressure by auscultation
  17. 17. Articles required : Sphygmomanometer Stethoscope Bowl with alcohol swab , paper bag Pen , record form
  18. 18. Preliminary assessment Collect the patient’s data about factors posing client at risk for BP changes. It includes medical history ( cardiac problem , renal problem , diabetic , blood transfusion , surgery , exercise , coffee intake , smoking, medication , emotions , pain . Avoid exercise , coffee , smoking at least 30 minutes before checking BP
  19. 19. Assess symptoms of hypertension like headache , furnishing of face nasal bleeding , weakness , fatigue Assess symptoms of hypotension like dizziness , mental confusion , pale , restlessness , cyanoted skin , cool extremities
  20. 20. Procedure
  21. 21. Collect all the articles Wash hands Explain procedure to the client. Ex: you are going to monitor his BP Provide comfortable position. Ex : sitting , supine while keeping his upper arm at heart level ,palm up Ensure that mercury level of sphygmomanometer is at zero
  22. 22. Ensure cuff width against client’s arm Ensure mercury meniscus is at your eye level Palpate brachial artery pulse Ensure no air in the cuff & wrap it evenly around client’s arm centering arrow over brachial artery Place lower edge of cuff about 1 inch above antecubital fossa Tuck the end of wrap under cuff
  23. 23. Ensure that connecting tubings are free of each other. Estimate systolic pressure by palpating the artery with finger tips of one hand while inflating cuff, rapidly to pressure 30 mmHg above point when pulse reappears. Deflate cuff fully & wait for 30 secs Place earpiece of stethoscope in ears & bell/diaphragm on brachial artery
  24. 24. Close valve of pressure bulb clockwise until tight Rapidly inflate cuff to 30mmHg above palpated systolic pressure Slowly release the pressure bulb valve & allow the mercury to fall at rate of 2-3 mmHg/sec Listen & watch mercury level drop. when first clear :”tap tap” (karot koff) Sound is heard , note the systolic blood pressure
  25. 25. Continue to deflate the bulb & when sound disappears , note the diastolic blood pressure Listen for 10-20 mmHg after the last sound & then escape air quickly Remove cuff Inform client of his BP reading as needed Reposition client comfortably Record reading immediately
  26. 26. Replace articles : Clean earpiece & bell/diaphragm of stethoscope with alcohol swab Discard used alcohol swabs Place articles to their correct place Wash hands
  27. 27. Recording vital signs As record is a legal document, It protects the hospital as well as client. Nurse must document the reading of vital signs & any deviations While documenting vital signs, she should follow organizations policies procedure Vital sign can be documented on graphic sheet notes in case of abnormality detected. Such as elevated temp, tachycardia, shortness of breath. Also document the actions taken for identified problems Vital signs are documented on vital chart as well as graphic sheet.