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.