this is a detailed study on blood pressure measurement on clinical watching , methods , equipment's , common problems ,and all major aspects of blood pressure measurement is mentioned in detail . please comment thank you

1. PREPARED BY
MARTIN SHAJI
PHARM D
Blood pressure
measurement| methods | calculations
|common problems | kortkoff sign –
a detailed medical study

2. Blood pressure (BP) is a measure of the force that the
circulating blood exerts against the arterial wall.
What is blood pressure ?

3. • Martin

4. Disease attributes to hypertension

6. Systolic pressure is the maximum pressure exerted by the
blood against the arterial walls.
It results when the ventricles contract (systole)
Systolic pressure

7. • Diastolic Pressure is the lowest pressure in the artery.
• It result when the ventricles are relaxed (diastole)
Diastolic pressure

8. British hypertension society classification of
blood pressure levels

9. -Office BP measurement: Two readings, minutes apart,
sitting.
-Ambulatory BP monitoring: For white coat
hypertension.
- Self-measurement of BP: Information on response to
therapy, may improve adherence to therapy.
Blood pressure measurements

11. Use multiple readings at different times during the
waking hours of the patient.
. For patient taking antihypertensive medications
monitoring of blood pressure should be done before
taking the scheduled dose.
Time Of Measurement

12. BP should be measured in sitting position.
Patient should sit for minutes before measuring BP.
. In elderly, supine and standing position can be used to
detect postural hypotension.
Patient position

13. Selecting the most accurate blood pressure cuff
The length of the bladder should be at least 8O% of the
circumference of the upper arm.
The width of the bladder should be approximately 40% of
the circumference of the upper arm.

14. I — Locate the ante cubical fossa.
The patients arm and palpate the
brachial artery. This location is the
point over which the stethoscope
is placed to listen for Koroikoff
sounds later.
2— Wrap the cuff approximately
2.5 inch above the ante cubical
fossa .
Where to listen for blood pressure sounds

15. 3. while palpating the radial pulse. inflate the cuff until you
feel the radial pulse disappear.
Note the pressure on the
manometer at this point
and rapidly deflate the cuff.
Determining the palpated systolic pressure

16. Measurement of BP
4- Place the stethoscope lightly over the brachial artery and
inflate the cuff to a pressure 30 mm Hg greater that
estimated systolic pressure
5- Deflate the cuff slowly at a rate of 2 mm Hg / heartbeat.
6- Systolic pressure equal the pulse first heard by
auscultation

17. 7- Deflate the cuff until the sounds become muffled and
then disappear. The disappearance of sound estimate the
diastolic pressure.
8- Record the blood pressure reading in even numbers.
Note patient’s position, cuff size, and arm used for
measurement.

18. These noises are produced from under the distal half of the BP cuff
between systole and diastole because the artery collapses
completely and reopens with each heartbeat As the artery wall
rapidly opens it causes a snapping or tapping sound (like the sail of
a boat snapping in the wind). As the cuff pressure falls below the
diastolic pressure, the sound disappears as the vessel wall rio
longer collapses but gently expands with each beat. The first
appearance of the sound (phase i.) indicates systole. As the
pressure is reduced, the sounds muffle (phase 4) and then
disappear (phase 5). Inter-observer agreement is better for phase
and this is recorded as diastolic BR Occasionally muffled sounds
persist (phase 4) and do not disappear; in this case, record phase
4as the diastolic pressure.
Korotkoff signs

21. - OP different in each arm: A difference >i.e. mmHg suggests
peripheral vascular disease arid raises the possibility of renal
artery stenosis as theca use of hypertension. Record the highest
pressure arid treat this.
- Wrong cuff size: A cuff of i.2.5 23 cm is suitable for only 6o94i of
Europearis. The bladder should encircle between 8o % and 1oo %
of the arm. In obese patients with large arms a normal-sized cuff
will overestimate BP arid the error is greater when the center of
the cuff is not over the brachial artery. Therefore for obese
patients a larger cuff must be used. Using too large a cuff produces
only a small under- estimation of BP (2-3mm in systolic BP)
Commons problems in BP measurements

22. - Auscultatory gap: Up to 2O1lb of elderly hypertensive patients
have phase a Korotkoff sounds which begin at systolic pressure
but then disappear for varying lengths of time, reappearing
before diastolic pressure. If the first appearance of the sound is
missed, the systolic pressure will be recorded at a falsely low
level. Avoid this by palpating the systolic pressure first
- - Excess pressure of stethoscope: Excess pressure can artificially
lower the diastolic reading by 10 mmHg. The systolic pressure is
not usually affected

23. - - Patients arm at the wrong level: The patient’s elbow should
be level with his heart. Hydrostatic pressure effects mean
that if the arm is 7 cm higher, both systole and diastole
pressures will be 5mrnHg lower. If the arm ¡s 7 cm lower
than the heart, they will be about 6 mm higher

24. - Postural change: When a healthy person stands, the pulse
increases by about 11 bpm and stabilizes after . min. The BP
Stabilizes after 1-2 min. Check the BP after a patient has been
standing for 2 min ; a drop of 20 mmHg on standing is
postural hypotension
- - Abnormal pulse pressure: The pulse pressure is the
difference between the systolic and diastolic pressures. A
pulse pressure of 8o mm Hg suggests aortic regurgitation,
while a low pulse pressure may occur in aortic stenosis.

25. For a detailed study on auscultation points
• Click here
https://www.slideshare.net/martinshaji/auscultation-sites-images