a brief discussion about RR and BP. a continuation of RetDem Discussion

1. VITAL
SIGNS
TAKING
( R E S P I R AT I O N )
J H O N E E B A L M E O

2. RESPIRATION
• Respiration is the act of breathing.
Inhalation or inspiration refers to the
intake of air into the lungs.
Exhalation or expiration refers to
breathing out or the movement of
gases from the lungs to the
atmosphere.
• Ventilation is also used to refer to
the movement of air in and out of
the lungs

3. RESPIRATION
• Observe the rate, rhythm, depth, and effort
of breathing.
• Count the number of respirations in 1
minute either by visual inspection or by
subtly listening over the patient’s trachea
with your stethoscope during your
examination of the head and neck or chest.

4. CASE ANALYSIS?
• What if Expiration is longer than Inspiration?
• What could be the problem?

5. There are basically two types of breathing:
• costal (thoracic) breathing and
diaphragmatic (abdominal) breathing.
1. Costal breathing involves the external
intercostal muscles and other
accessory muscles, such as the
sternocleidomastoid muscles. It can be
observed by the movement of the
chest upward and outward.
2. By contrast, diaphragmatic breathing
involves the contraction and relaxation
of the diaphragm, and it is observed by
the movement of the abdomen, which
occurs as a result of the diaphragm’s
contraction and downward movement

6. MECHANICS AND REGULATION OF BREATHING
• Respiration is controlled by
(a) respiratory centers in the medulla oblongata
and the pons of the brain and
(b) chemoreceptors located centrally in the
medulla and peripherally in the carotid and
aortic bodies.
These centers and receptors respond to
changes in the concentrations of oxygen (O2),
carbon dioxide (CO2), and hydrogen (H) in the
arterial blood. See Chapter 50 for details

7. ASSESSING RESPIRATIONS
• Before assessing a client’s respirations, a nurse should be aware of the
following:
• ■ The client’s normal breathing pattern
• ■ The influence of the client’s health problems on respirations
• ■ Any medications or therapies that might affect respirations
• ■ The relationship of the client’s respirations to cardiovascular function.

8. ASSESSING RESPIRATIONS
• The rate, depth, rhythm, quality, and effectiveness of respirations should
be assessed.
• The respiratory rate is normally described in breaths per minute

9. FACTORS AFFECTING RESPIRATIONS
• Several factors influence respiratory rate.
• Those that increase the rate include exercise
(increases metabolism),
• stress (readies the body for “fight or flight”),
• increased environmental temperature, and
• lowered oxygen concentration at increased
altitudes.
• certain medications (e.g., narcotics)

11. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING
NORMAL

12. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

13. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

14. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

15. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

16. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

17. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

18. ABNORMALITIES IN RATE AND RHYTHM
OF BREATHING

19. NORMAL RANGE!

20. EXPIRATIONS IS THE NUMBER OF
BREATHS PER MINUTE
• A. TRUE
• B. FALSE

21. THE TERM EUPNEA IS?
• A. ABSENCE OF BREATH
• B. NORMAL BREATH
• C. END OF BREATH SOUND
• D. INCREASE BREATH

22. ANA IS A 24Y/O CLIENT WITH A
RESPIRATION OF 26BPM. THIS
IS?
• EUPNEA
• BRADYPNEA
• TACHYPNEA
• APNEA

23. YOUR CLIENT IS EXPERIENCING
PAIN ON HER ABDOMEN, YOU ARE
MORE LIKELY TO GET A RESPI OF?
• EUPNEA
• BRADYPNEA
• TACHYPNEA
• APNEA

24. BLOOD PRESSURE
• Blood pressure is a measure of
the force that your heart uses
pump blood around your body.

25. BLOOD PRESSURE
• Because the blood moves in
waves, there are two blood
pressure measures. The systolic
pressure and the diastolic
pressure.

26. DETERMINANTS OF BLOOD PRESSURE
Blood Pressure is the result of several factors:
1. the pumping action of the heart,
2. the peripheral vascular resistance (the resistance
supplied by the blood vessels through which the blood
flows), and
3. the blood volume and
4. viscosity

27. CASE ANALYSIS
• What do you think will happen in
your Blood Pressure in the event of
rapid intravenous infusion?

28. CASE ANALYSIS
• What does smoking do to
the blood pressure?

29. CHOOSING THE CORRECT BLOOD
PRESSURE CUFF (SPHYGMOMANOMETER)
• Two types of blood pressure devices are currently used: aneroid and electronic.

30. CHOOSING
THE
CORRECT
BLOOD
PRESSURE
CUFF
(SPHYGMOM
ANOMETER)

31. CASE ANALYSIS
• In the event
of amputated
arm, where
would you
get BP of
your client?

32. NOW YOU ARE READY TO MEASURE
THE BLOOD PRESSURE.
• With the arm at heart level, center the inflatable bladder over the
brachial artery.
• The lower border of the cuff should be about 2.5 cm above the
antecubital crease.
• Secure the cuff snugly. Position the patient’s arm so that it is slightly
flexed at the elbow

33. NOW YOU ARE READY TO MEASURE
THE BLOOD PRESSURE.
• to determine how high to raise the cuff pressure, first estimate the
systolic pressure by palpation.
• As you feel the radial artery with the fingers of one hand, rapidly inflate
the cuff until the radial pulse disappears.
• Read this pressure on the manometer and add 30 mm Hg to it.

34. NOW YOU ARE READY TO MEASURE
THE BLOOD PRESSURE.
• Deflate the cuff promptly and
completely and wait 15 to 30
seconds.
• Now place the bell of a
stethoscope lightly over the
brachial artery, taking care to
make an air seal with its full rim.

35. NOW YOU ARE READY TO MEASURE
THE BLOOD PRESSURE.
• Inflate the cuff rapidly again to
the level just determined, and
then deflate it slowly at a rate of
about 2 to 3 mm Hg per second.
• Note the level at which you hear
the sounds of at least two
consecutive beats. This is the
systolic pressure.

36. NOW YOU
ARE READY
TO
MEASURE
THE BLOOD
PRESSURE.

37. NOW YOU ARE READY TO MEASURE
THE BLOOD PRESSURE.
• Continue to lower the pressure slowly until the sounds become muffled
and then disappear.
• To confirm the disappearance of sounds, listen as the pressure falls
another 10 to 20 mm Hg.
• Then deflate the cuff rapidly to zero. The disappearance point, which is
usually only a few mm Hg below the muffling point, provides the best
estimate of true diastolic pressure in adults.

38. NOW YOU ARE READY TO MEASURE
THE BLOOD PRESSURE.
• Read both the systolic and the diastolic levels to the nearest 2 mm Hg.
Wait 2 or more minutes and repeat.
• Average your readings. If the first two readings differ by more than 5
mm Hg, take additional readings.
• Blood pressure should be taken in both arms at least once. Normally,
there may be a difference in pressure of 5 mm Hg and sometimes up to
10 mm Hg.

39. CASE ANALYSIS?
• What do you think will happen if
you place a loose cuff or a
bladder?

40. NORMAL RANGE

41. FACTORS AFFECTING BLOOD
PRESSURE
Among the factors influencing blood pressure are
1. age,
2. exercise,
3. stress,
4. race,
5. sex,
6. medications,
7. obesity,
8. diurnal variations,
9. medical conditions, and
10. temperature.

42. COMMON ERRORS IN ASSESSING
BLOOD PRESSURE

43. SPECIAL SITUATIONS!
Weak or Inaudible Korotkoff Sounds.
• Consider technical problems such as erroneous placement of your
stethoscope, failure to make full skin contact with the bell, and venous
engorgement of the patient’s arm from repeated inflations of the cuff.
Also consider the possibility of shock

44. SPECIAL SITUATIONS!
The Obese or Very Thin Patient.
• For the obese arm, use a cuff 15 cm in width. If the upper arm is short
despite a large circumference, use a thigh cuff or a very long cuff. If the
arm circumference is >50 cm and not amenable to use of a thigh cuff,
wrap an appropriately sized cuff around the forearm, hold the forearm
at heart level and feel for the radial pulse.
• Other options include using a Doppler probe at the radial artery or an
oscillometric device. For the very thin arm, consider using a pediatric
cuff

45. SPECIAL SITUATIONS!
Arrhythmias.
• Irregular rhythms produce variations in pressure and therefore
unreliable measurements. Ignore the effects of an occasional
premature contraction. With frequent premature contractions or
atrial fibrillation, determine the average of several observations and
note that your measurements are approximate.
*Ambulatory monitoring for 2 to 24 hours is recommended

46. SPECIAL SITUATIONS!
Hypertensive Patient With Unequal Blood Pressures in the Arms and
Legs.
• Compare blood pressures in the arms and legs. In normal patients,
the systolic blood pressure should be 5 to 10 mm higher in the

47. Diane is a Pre-Clinical Student who’s
about to take a vital signs of her
client. What are the things she needs
to consider in checking the BP of her
Client?
A. Vary, depending on the time of day your blood pressure is
checked
B. Get lower with high levels of stress
C. Are the same for people of the same age and weight
D. Stay the same throughout the day
E. AOTA

48. WHICH OF THE FOLLOWING FACTORS CAN INCREASE
THE RISK FOR HIGH BLOOD PRESSURE?
a. Obesity
b. Family History
c. Smoking
d. AOTA

49. MARIEL, A NEW NURSE IN THE MEDICAL
WARD WAS ASKED BY HER CLIENT ABOUT
“WHY DOES REDUCING SALT IN YOUR DIET
HELP PREVENT HIGH BLOOD PRESSURE?
MARIEL IS RIGHT IF SHE ANSWERED?
a. Salt prevent fluid build-up in your body
b. It allows vessels to relax
c. It helps your heartbeat steady
d. AOTA

51. REFERENCES
• Audrey Berman . . . [et al.]. – 9th ed. (2012) KOZIER & ERB’S
Fundamentals of NURSING Concepts, Process, and Practice.
• Bickley, Lynn S. -11TH ED. (2013) Bates’ guide to physical
examination and history-taking.