Lecture for undergraduate Nursing students

1. Vital Signs
Blood Pressure and
Glucose Testing
Prepared by:
Dr. Zuhair Rushdi Mustafa
lecturer
University of Duhok/College
of nursing

2. Blood Pressure (BP)
# refers to the force of the blood
against arterial walls.
# Because the blood moves in waves, there are two BP
measurements. The systolic pressure is the pressure of
the blood as a result of contraction of the ventricles, that
is, the pressure of the height of the blood wave.
The diastolic pressure is the pressure when the
ventricles are at rest, Diastolic pressure, then, is the
lower pressure.

3.  The difference between the systolic and the diastolic pressures
is called the pulse pressure.
 A normal pulse pressure is about 40 mmHg
 A high pulse pressure (e.g., 100 mmHg) occurs during
exercise. A consistently elevated pulse pressure occurs in
arteriosclerosis
 A low pulse pressure (e.g., less than 25 mmHg) occurs in
conditions such as severe heart failure.
 BP is measured in millimeters of mercury (mmHg) and
recorded as: systolic pressure over /the diastolic pressure.

4.  CATEGORIES FOR BLOOD PRESSURE LEVELS IN
ADULTS (AGES 18 AND OLDER)
Category Systolic
mm Hg
Diastolic
mm Hg
Normal <120 <80
Prehypertension 120–139 80–89
Hypertension, stage 1 140–159 or 90–99
Hypertension, stage 2 >160 >100

5. Factors affecting BP
1- Age: blood pressure tends
to rise with age as a result of
arteriosclerosis (a process in
which arteries lose their elasticity and become more
rigid), and atherosclerosis (a process in which
arteries become narrowed with fat deposits).
The rate of these conditions depends on heredity and
lifestyle habits such as exercise and diet.

6. 2- Circadian rhythm: BP tend to lowest after midnight, beings
rising in the morning, and peaks during late morning or early
afternoon.
3- Gender: women tend to have lower BP than men of the same
age.
4- Exercise and activity: BP rises during exercise, when the
heart pump more blood. Regular exercise, however, maintain
BP within normal levels.
5- Emotions and pain: strong emotional experiences and pain
tend to increase BP from sympathetic nervous system.

7. 6- Miscellaneous factors:
A- Obesity, smoking, alcohol cause the BP to increase.
B- BP also seems to rise somewhat when the urinary bladder is
full.
C- BP increase when legs are crossed.
D- BP increase when a person is cold.
E- Drugs that stimulate the heart such as nicotine, caffeine, and
cocaine also tend to constrict the arteries and raise BP.
F- a person has lower BP when lying down than when sitting or
standing.
G- Hemorrhage, cause the BP to decrease.

8. Assessing BP
Korotkoff sounds: are sounds that result from the
vibration of blood within the arterial wall.

9. BP Assessment sites
BP usually assessed
over the brachial artery at the
inner aspect of elbow.
It is also possible to use the lower
arm and radial artery.
When the client's arms are missed, or client has had
vascular surgery, in these circumstances, BP is
measured over the popliteal artery behind the knee.

10. Types of Sphygmomanometer:
1- Aneroid Gauge
2- Mercury gauge manometer
3- Electronic monitor

11. 4- Doppler Ultrasound Device
5- Automated blood pressure devices

12.  General Considerations
 In initial nursing assessment of a patient, the nurse
should take the BP on both arms.
 It is normal to have a 5- to 10-mm Hg difference in
the systolic reading between arms.
 Use the arm with the higher reading for subsequent
BP measurements.
 Automated BP devices in public areas are
generally inaccurate and inconsistent.

13. Abnormal BP measurements
1- High Blood Pressure
Hypertension refers to a persistent systolic pressure
greater than 140 mm Hg and a diastolic pressure
greater than 90 mm Hg.
 For a diagnosis of hypertension to be made, the client
must have a sustained elevation in blood pressure (in
3 occasions) over a period of time.
 High blood pressure can cause serious problems such
as heart failure, kidney failure, heart attack, and
stroke.

14. Causes of Hypertension
The exact causes of high blood pressure are not known, but several things may
play a role, including:
1) Smoking
2) Obesity
3) Lack of physical activity
4) Too much salt in the diet
5) Too much alcohol consumption
6) Stress
7) Older age
8) Family history of high blood pressure
9) Chronic kidney disease
10) Adrenal and thyroid disorders
11) Sleep apnea

15. 2- Low Blood Pressure
Hypotension a condition in which arterial blood
pressure is abnormally low. Having a consistently low
pressure, For example, systolic less than 100 and
diastolic less than 60 mm Hg.
Causes of Hypotension
1. after excessive fluid loss (e.g through diarrhea, burns, or
vomiting).
2. following severe blood loss ( hemorrhage)
3. Myocardial Infarction
4. pulmonary embolism
5. sever infections
6. allergic reactions
7. Shock

16. Measuring Oxygen saturation
 There are many tests to measure oxygenation
status.
 Pulse oximetry is an noninvasive technique
that measures the oxygen
saturation (SpO2)
of arterial blood by using
light waves.

17.  A sensor, uses a beam of red and infrared light
that travels through tissue and blood vessels.
Sensors are available for use on a finger, a toe,
a foot (infants), an earlobe, forehead, and the
bridge of the nose.

18.  A range of 95% to 100% is considered normal
SpO2
 values less than 90% are abnormal, indicate
that oxygenation to the tissues is inadequate,
and should be investigated for potential hypoxia
or technical error.

19.  Indications of Pulse Oximetry :
1. monitoring patients receiving oxygen therapy
2. monitoring those at risk for hypoxia
3. postoperative patients.
Note: Pulse Oximetry does not replace arterial blood
gas analysis.

20. Obtaining a Capillary Blood Sample for Glucose
Testing
** To measure the amount of glucose
in the blood.
** Avoid fingertips,
because they are more
sensitive and painful.
** Rotate sites to prevent skin damage.
Pediatric Patient
• Heel and great-toe can be used, especially on infants;
warming the area with a warm cloth will increase blood
flow.

21. Common Investigation for DM
- Adult Fasting blood sugar (FBS)= 65-110 or <110
mg/dl
- Random blood sugar (RBS)= 70-140mg/dl
F.B.S levels greater than ˃126 mg/dL on two or more
times typically indicates diabetes.
F.B.S greater than 120 may predispose client to DM in
future.
R.B.S levels of greater than 200 mg/dL may indicates of
DM.

22. Common Investigation for DM (con’t)
- Hemoglobin A1C test (HbA1c)
Is a measurement of blood glucose that is bound to
hemoglobin.
HbA1C is a reflection of how well blood glucose levels
have been controlled during the prior 3 to 4 months.
- Normal Ranges:
The normal range is 4.0% to 5.5 % for non diabetic
patients.
- 5.7- 6.5 % for Diabetes with good control.
- > 6.5 % for poor control Diabetes.

23.  Calculating HbA1C
HbA1C-6*2+6= daily average of blood glucose
Example: If HbA1C is 8, what is the daily average of
blood glucose level.
8-6*2+6= 10 mmol/dl
We have to convert mmol to mg/dl we multiply by 18.
10*18= 180 means the daily average of blood glucose
level is 180.

24. GLUCOSE TOLERANCE TEST (GTT)
After an overnight fast (8 -12hrs) , the patient is
given a 75-g oral glucose then blood glucose is
checked.
Normal range
Fasting: < 126 mg/dL
one hour after taking glucose: <200 mg/dL
two hour after taking glucose : <140 mg/dL