VITAL SIGNS / CARDINAL SIGNS

baseline information determined to monitor changes in body functions

WHEN TO ASSESS 1. 2. 3. 4. Upon or on admission As ordered Before and after pre-op meds (invasive procedure/surgery) Before and after administration of blood (to monitor change) • stop infusion!!! – chilling, allergic reaction

5. Before and after any nursing intervention 6. When (+) for chest pain or any ABN sensation occurs 7. Before and after administration of medication that affects the Cardiovascular or Respiratory systems 4 RULES IN TAKING VITAL SIGNS 1. Place patient in a comfortable position 2. Inform the patient about the procedure 2 important protocols in institutions - check dr.’s orders - verify your patient 3. Report any ABN reading to your baseline data 4. Frequency depends on the Dr.’s order and the institution

BODY TEMPERATURE
Body Temperature - reflects the balance between the heat produced and the heat lost from the body, and is measured in heat units called degrees 2 kind of BT 1. Core Temperature – 2. Surface Temperature is the temperature of the deep tissues of the body, Such as the cranium, thorax, abdominal and the pelvic cavity. remains relatively constant at 37°C - skin, subcutaneous tissues, fats - 20°C to 40°C or 68°F to 104°F

Hypothalamus - center for thermoregulation a. Anterior H – controls heat loss and vasodilation b. Posterior H – controls heat production and vasoconstriction 1

Alterations / ABN Fever / Pyrexia / Hyperthermia - BT ↑ normal – 36.5 to 37.5°C - > 37.8°C (oral) - > 38°C (rectal)

Hyperpyrexia – BT ↑ 41°C - convulsions, seizures - possible brain damage Hypothermia - ↓ normal = < 35.5°C in adults * normal BT in infants = 35.5°C to 36.5°C = underdeveloped hypothalamus, small body surface

Mechanisms of Heat Loss
1. Evaporation/Vaporization – continuous evaporation of moisture from the respiratory tract and from the mucosa of the mouth and from the skin a. insensible heat loss b. insensible water loss – continuous and unnoticed heat loss - accounts for 10% of basal heat loss – continuous and unnoticed water loss

2. Conduction – transfer of heat from one molecule to a molecule of lower temperature, e.g. TSB and ice pack 3. Radiation – Transfer of heat from the surface of one object to the surface of another without contact between the 2 objects, e.g. infrared rays 4. Convection – dispersion of heat by air currents

FACTORS THAT AFFECT HEAT PRODUCTION
1. BMR – rate of energy utilization in the body required to maintain essential activities such as breathing 2. Muscle Activity – increases metabolic rate 3. Thyroxine output – increased thyroxine output increases the cellular metabolism – chemical thermogenesis-the stimulation of heat production in the body through increased cellular metabolism 4. Epinephrine, norepinephrine and sympathetic stress response 5. Fever

Clinical signs of fever (Healthcare Lecture)
1. ↑ PR 2. ↑ RR 3. Shivering 2

7. IVF as ordered by physician 7. 5. √ Skin Color – (+) cyanosis 4. skin darkening. Independent nursing intervention 2.promotes salivation 8.4. Dependent nursing intervention – with Dr. cold skin Complaints of feeling cold Cyanotic nail beds “Gooseflesh” appearance of the skin Cessation of sweating Absence of chills Skin that feels warm Photosensitivity Glassy-eyed appearance Increased pulse and respiratory rates Increased thirst Mild to severe dehydration Drowsiness. delirium or convulsions Herpetic lesions of the mouth 3 Course (Plateau Phase) . √ Vital signs 3. Remove excessive clothing / blanket – for heat loss 5. 9. restlessness. 6. Cold skin Body malaise Cyanotic nail beds Herpetic lips prone to severe dehydration cessation of sweating NURSING INTERVENTION / MANAGEMENT /CARE OF Px WITH FEVER 1. Promote Rest 9. 8. Provide adequate nutrition – monitor Intake-output 6. lukewarm water w/o alcohol (dry skin. Promote good hygiene – good nursing care Good oral hygiene – enhances appetite . Tepid Sponge Bath – running. can be an irritant) – never rub (friction) 2. Administer anti-pyretic drugs as ordered 2 TYPES OF NURSING INTERVENTION 1. Provide full circulation of air through electric fan (convection) 10.prevents spread of infection .’s orders Clinical signs of fever (Kozier) Onset (Cold or chill phase) Increased heart rate Increased respiratory rate and depth Shivering Pallid.

.lack of activity and . Hypotension 7.3°C to 0. DIURNAL VARIATIONS ↑ 1600 to 1800 hours ↓ 0400 to 0600 hours (by as much as 1° C or 1. . norepi.low BT . toes) 6. Decreased body temperature.they are also sensitive to extremes in the environmental temp. Lack of muscle coordination 9.8° F EXERCISE HORMONES Can increase BT up to 38. cold.Defervescence (Fever abatement/Flush Stage - Loss of appetite (if the fever is prolonged) Malaise.underdeveloped Hypothalamus Children – more variable than adults before puberty Older people – at risk for hypothermia due to . Progesterone secretion at the time of ovulation raises the BT by about 0.inadequate diet. fingers.reduced thermoregulatory efficiency . pulse and respirations 2. Frostbite (nose. weakness and aching mucsles Skin that appears flushed and feels warm Sweating Decreased shivering Possible dehydration CLINICAL MANIFESTATIONS OF HYPOTHERMIA 1. Feelings of cold and chills 4. Drowsiness progressing to coma FACTORS AFFECTING BODY TEMPERATURE AGE Infant – greatly influenced by temp of the environment .rectal Women > hormone fluctuations than men. Disorientation 10. waxy skin 5.5 to 1°F) May increase production of epi-.3°C to 40°C (101°F to 104°F) .6°C (0. Decreased urinary output 8. Pale. Severe chilling (initially) 3. Extremes in environmental temp may affect a person’s BT 4 STRESS ENVIRONMENT .loss of subcutaneous fat.

Temporal artery thermometers – uses a scanning infrared thermometer that compares the arterial temp in the temporal artery of the forehead to the temp in the room and alculates the heat balance to approximate the core temp of the blood in the pulmonary artery * 2 types of oral thermometer that can be glass or elctronic 1. Remittent – wide range of temp.5°C Common types of Fever 1. 5. only.FEVER FEBRILE . (101°F to 102°F) Types of thermometers Mercury in glass – used for oral and axillla Blue colored / Red colored – rectal Disposable – single use Electronic – 2 to 60 secs Temperature sensitive tape– surface temp. 2. forehead and abdomen Infrared – sense body heat in the form of infrared energy given by a heat source.5 to 37. Hypothermia thermometers – have a greater low range 81 to 108 F 1.have warm.do not sweat Heat exhaustion . 6.result of excessive heat and dehydration . fainting.6°F) occurs over a 24hour period. CONVERSION Celsius = (F -32) 5/9 Fahrenheit = (1.1 F intervals and is for fertility purposes 2. dizziness. fluctuations more than 2°C (3. w/c is in the ear canal 7. Constant/Sustained – the BT fluctuates minimally but always remains above normal. Fever spike – temp that rises to fever level rapidly following a normal temp and then returns to normal within a few hours Heat stroke – generally have been exercising under hot weather . vomiting. febrile periods of a few days are interspersed with periods of 1 or 2 days of normal temp. flushed skin . 3. 4.signs include paleness. nausea. 5. 4. and a moderately increased temp.8 C) +32 5 . Relapsing – short. all above normal 3.6°C AFEBRILE – 36.↑ 37. Intermittent – the BT alternates at regular intervals between periods of fever and periods of normal or subnormal temp. 2. Basal thermometer – calibrated with 0.

Food . ovulation raises BT by 1 C Hormones 1. 2. Hyperthyroid – high T4 and T3 – high BT .Condition of client . 5.Envronment .Gender – Female higher BT than males after puberty. Hypothyroid – low T4 and T3 – low BT – endomorphic 2. Thermometer Thermometer sheath or cover Water soluble lubricant for rectal temperature Disposable gloves Antiseptic wipes Towel for axillary temperature 6 . use water based lubricant (KY Jelly) – oil based may irritate mucous membranes • • Equipment: 1.As Per RLE Lecture Factors Affecting BT . 6.ectomorphic Cleaning Thermometer – cleanest to dirtiest For Rectal. 3. 4.Circadian Rhythm .

Blood Potassium ↓ (Hypokalemia) ↓ . 5. 4.Beta blocker (e.Blood Potassium ↑ (Hyperkalemia) and irregular pulse 7 . 6. 3.Cardiotonics (e. 2. Dyspnea – difficulty in breathing Fatigue Pallor Cyanosis – bluish discoloration of skin and mucous membranes Palpitations Syncope (fainting) Impaired peripheral tissue perfusion (as evidenced by skin discoloration and cool temp.Cardiac Glycoside or Digitalis Glycoside .Calcium channel blockers (verapamil) ELECTROLYTE IMBALANCE PR/HR PR/HR ↑ .g. due to increased metabolic rate ↑ . especially at the AV node ↓ .Narcotics ↓ .g. strength and efficiency PR ↑ PR/HR PR/HR 1. digitalis preparations) ↓ . Thyroxine ↓ . beta blockers. 7. propranolol) ↓ . or calcium channel blockers FACTORS AFFECTING THE PULSE AGE GENDER EXERCISE FEVER MEDICATIONS Age Increase ↑ – Pulse rate decrease↓ < females PR After puberty. in response to the lower BP that results from peripheral vasodilation associated with elevated BT 2.digoxin (Lanoxin) .ASSESING A PERIPHERAL PULSE CLINICAL SIGNS OF CARDIOVASCULAR ALTERATIONS 1.decrease heart rate by prolonging cardiac conduction.Epinephrine. average male’s PR is PR ↑ *rate of increase in athletes is lesser than average person because of greater cardiac size.) FACTORS THAT MIGHT ALTER THE PULSE emotional status activity level medications that affect heart rate such as digoxin.

Blood Calcium ↓ (Hypocalcemia) STRESS PR/HR ↑ • in adults. blood usually pools in dependent vessels of the venous system → pooling results to transient decrease in venous blood return to the heart → reduction in BP results → increased HR Certain diseases such as some heart conditions or those that impair oxygenation can alter the pulse rate PR/HR ↓ .Used during cardiac arrest/shock in adults .Used in conjunction with certain medications .Used to measure blood pressure . pulmonary or renal disease .Readily accessible . anxiety as well as severe pain stimulate the sympathetic system * when a person is sitting or standing.Used during cardiac arrest for infants . norepinephrine) • stress increases the rate as well as the force of the heartbeat • Fear.Hyperglycemia PR/HR ↓ .Blood Calcium ↑ (Hypercalcemia) ↓ .Used to determine circulation to the foot .Used in cardiac arrest/shock .Used to determine discrepancies with radial pulse .Used to determine circulation to the leg .Routinely used for infants and children up to 3 years of age .Used to determine circulation to the foot 8 .Used when radial pulse is not accessible .PR/HR PR/HR HYPOVOLEMIA ↑ .Acute MI PR/HR ↑ . loss of blood results in an adjustment of the heart rate to increase blood pressure as the body compensates for the blood loss • adults may lose 10% of their normal circulating volume without adverse effects PR/HR ↑ • sympathetic nervous stimulation increases overall activity of the heart (epinephrine.Used to monitor clients with cardiac.Hypertensive Heart Disease SITE MOST APPROPRIATE FOR ASSESSMENT POSITION CHANGES PATHOLOGY RADIAL TEMPORAL CAROTID APICAL BRACHIAL FEMORAL POPLITEAL POSTERIOR TIBIAL DORSALIS PEDIS .Used to determine circulation to the lower left leg .Used to determine circulation to the brain .Congestive Heart Failure PR/HR ↓ .

and how the client can cooperate 2.) Palpate and count the pulse 7.verify client’s identity . Watch 9 .****PURPOSE OF ASSESSING A PERIPHERAL PULSE establish a baseline data for subsequent evaluation identify whether the pulse rate is within the normal range determine whether the pulse rhythm is regular and the pulse volume appropriate determine the equality of corresponding peripheral pulses on each side of the body monitor and assess changes in the client’s health status monitor clients at risk for pulse alterations evaluate blood perfusion to the extremeties PROCEDURE: 1.) . 6.Identify yourself . why.) Select the pulse point 5.) Aseptic techniques 3.) Position client in a comfortable resting position.) Privacy 4.explain procedure – what.) Assess the pulse rhythm and volume 8. rhythm and volume PULSE VOLUME LEVEL (0-4) 0 = No pulse/absent 1 = thready 2 = weak 3 = normal 4 = bounding NORMAL VALUES – ADULTS 60 -100 ppm PULSE RHYTHM – Regular or Irregular Equipment: 1.) Document the pulse rate.

also referred to as the Point of Maximal Impulse (PMI) 10 .KOZIER NOTES PULSE – a wave of blood created by the contraction of the left ventricle of the heart PULSE WAVE – represents the stroke volume output or the amount of blood that enters the arteries with each ventricular contraction COMPLIANCE OF THE ARTERIES – ability of the arteries to contract and expand CARDIAC OUTPUT – volume of blood pumped into the arteries by the heart equals the result of the stroke volume (SV) times the heart rate (HR) per minute • In a healthy person the pulse reflects the heartbeat PERIPHERAL PULSE – pulse located away from the heart APICAL PULSE – central pulse. located at the apex of the heart.

Identify yourself . or calcium channel blockers Equipment: 1.explain procedure – what. 5. Watch with a second hand 2.verify client’s identity .) FACTORS THAT MIGHT ALTER THE PULSE emotional status activity level medications that affect heart rate such as digoxin.) Position client in a comfortable supine or sitting position.) . 2. why. 7.) Locate the apical pulse . and how the client can cooperate 2. 6. Expose the area of the chest over the apex of the heart 5. Stethoscope 3. Dyspnea – difficulty in breathing Fatigue Pallor Cyanosis – bluish discoloration of skin and mucous membranes Palpitations Syncope (fainting) Impaired peripheral tissue perfusion (as evidenced by skin discoloration and cool temp. Antiseptic wipes Procedure: 1. 4. 3.) Auscultate and count heart beats clean earpiece and diaphragm warm diaphragm insert earpiece of the stethoscope tap finger on diaphragm 11 .) Privacy 4. beta blockers.ASSESSING AN APICAL PULSE CLINICAL SIGNS OF CARDIOVASCULAR ALTERATIONS 1.) Aseptic techniques 3.Manubrium → Angle of Louis → slide to the left of the sternum (palpate the 2 nd intercostals space → place your middle or next finger in the 3 rd ICS until you locate the 5th ICS→ move finger toward the MCL 6.

3. Stethoscope 3.) Locate the apical and radial pulse sites 6. Antiseptic wipes Procedure: 1.) Privacy 4.place stethoscope on site of apical pulse if you have difficulty auscultating the apical pulse.) .verify client’s identity . 2.) count the apical and radial pulse rates Two-nurse technique One nurse technique 12 . ask the client to roll ontonhis/her left side or the sitting client to lean slightly forward 7. why. 6. Watch with a second hand 2. 4. and how the client can cooperate 2. Hypotension Pallor Cyanosis Cold. 5.Identify yourself .) Assess Rhythm (regular/irregular) and strength (strong or weak) of heartbeat ASSESSING AN APICAL RADIAL PULSE CLINICAL SIGNS OF HYPOVOLEMIC SHOCK 1.explain procedure – what. 7.) Aseptic techniques 3. clammy skin Thirst Alterations of mental status Suppression of kidney function Equipment 1.) Position the client appropriately 5.

drowsiness. 2.↓ RR (e. Narcotics . Lowered Oxygen concentration altitudes Body Position DECREASE Certain medications (narcotics) Decreased environmental Temp. asthma 6. high Increased intercranial pressure at 13 . fever 2. thereby depressing the RR and the depth.g. 8. pulmonary edema or emboli 8. loss of consciousness Chest movements – retractions between the ribs or above or below the sternum Activity Tolerance Chest pain Dyspnea Medications affecting respiratory rate a. chest trauma or constriction 9. 7. 3. Skin and mucous membrane color – cyanosis or pallor Position assumed for breathing – e. restlessness. morphine.g.monitor abnormal respirations and respiratory patterns and identify changes .monitor clients at risk for respiratory alterations 1.) Factors that affect Respirations INCREASE Exercise Stress Increased Environmental Temp.monitor respirations before or following the administration of a general anesthetic or any medications that influence RR .ASSESING RESPIRATIONS ***PURPOSE . 5. 6. use of orthopneic position Signs of cerebral anoxia – irritability. large doses of barbiturates such as secobarbital sodium depress the respiratory centers in the brain. acute anxiety 4. pain 3. brain stem injury PREPARATION Assess 1.acquire baseline data . 4. respiratory infection 7. COPD 5.

) document the respiratory rate.Tidal volume Deep Shallow Respiratory Rhythm: Regular Irregular Respiratory quality or character amount of effort a client exerts in breathing (e. depth. labored breathing) sound of breathing (e. Increase in the volume of the blood inside the thoracic cavity 2.) .) Observe depth – watch movement of chest rhythm .verify client’s identity .↓ Respiration 1. rhythm and character 1 cycle of respiration = 1 inhalation and 1 exhalation Respiratory Rate Normal values = 16 – 20 cpm Respiratory Depth: Normal (500 ml of air) .Supine .g.) Privacy 4.Identify yourself .regular or irregular character – sound they produce and the effort they require 6. why. compression of the chest Equipment: 1. wheeze) 14 . and how the client can cooperate 2.g.) Observe or palpate RR 5.explain procedure – what. Watch with second hand Procedure: 1.) Aseptic techniques 3.

Bradypnea – less than or equal to 15 cpm .Pulse Oximeter – indirectly measures the amount of hemoglobin in the arterial blood that is saturated with oxygen. usually due to a partial obstruction of the upper airway Wheeze – contninuous.Cheyne-Stokes breathing – from very deep to very shallow breathing and temporary apnea Ease or effort: Dyspnea – difficult and labored breathing Orthopnea – ability to breathe in only upright sitting or standing positions Altered Breath Sounds Audible without amplification Stridor – a shrill.Apnea – absence of breathing Volume: Hyperventilation – overexpansion of the lungs characterized by rapid and deep breaths Hypoventilation – underexpansion of lungs. harsh sound heard during inspiration with laryngeal obstruction Stertor – snoring or sonorous respiration.Tachypnea – more than or equal to 21 cpm . high-pitched musical squeak or whistling sound occurring on expiration and sometimes on inspiration when air moves through a narrowed or partially obstructed airway Bubbling – gurgling sounds heard as air passes through moist secretions in the respiratory tract Chest movements Intercostal retraction – indrawing between ribs Substernal retraction – indrawing beneath the breastbone Suprasternal retraction – indrawing above the clavicles Secretions and Coughing Hemoptysis – the presence of blood in the sputum Productive cough – a cough accompanied by expectorated secretions 15 . Altered Breathing Patterns Rate: . provides a digital readout of both the client’s pulse rate and oxygen saturation. characterized by shallow respirations Rhythm: .

CO2 and H+ concentrations in the blood) 16 . harsh cough without secretions KOZIER NOTES Respiration – act of breathing Inhalation/Inspiration – intake of air into the lungs Exhalation/Expiration – breathing out.- Nonproductive cough – a dry. chemoreceptors located centrally in the medulla and peripherally in the aortic and carotid bodies (respond to changes in O2. movement of gases from the lungs to the atmosphere Costal (thoracic breathing) – involves the external intercostals muscles and other accessory muscles such as the sternocleidomastoid muscles. Diaphragmatic (abdominal) breathing – involves the contraction and relaxation of the diaphragm and it is observed by the movement of the abdomen Control of Respiration 1. Respiratory centers in the medulla oblongata and pons 2.

5. the diastolic may also be high KOZIER AGE EXERCISE Increase cardiac output ( let client rest for 20 to 30 mins following 17 . renal disease. 4. rapid infusion of fluids or blood) SIGNS AND SYMPTOMS OF HYPERTENSION 1. Because the walls do not retract as flexibly with decreased pressure. 3. 2. 3. 5. Headache Ringing in ears Flushing of face Nosebleeds Fatigue SIGNS OF HYPOTENSION 1.g. 4. 3. cardiac output. Activity Emotional Stress Pain time client last smoked time client last ingested caffeine Newborn – mean systolic pressure of about 75 mm Hg BP rises with age reaching peak at the onset of puberty and tends to decline somewhat Elders. presence or history of CV disease. 4. determine client’s hemodynamic status (e.g. Tachycardia Dizziness Mental confusion Restlessness Cool and clammy skin Pale or cyanotic skin FACTORS AFFECTING BLOOD PRESSURE LAB 1.ASSESSING BLOOD PRESSURE ***PURPOSE 1. stroke volume of the heart and blood vessel resistance) 3. 2.elasticity of the arteries is decreased – produces an elevated systolic pressure. obtain baseline data 2. 6. identify and monitor changes in BP resulting from a disease process or medical therapy (e. circulatory shock. acute pain. 2. 5.

lesser side effects 6. Angiotensin-converting enzyme (ACE) Inhibitors – dilate arterioles by preventing the formation of Angiotensin II by blocking the action of ACE.use of birth control pills (oral contraceptives) . alpha-betablockers. thiazide diuretic – cause blood vessels to dilate. often by a tumor in one of the adrenal glands d. blood volume. blood viscosity.Caffeine.Smoking – constricts blood vessels – tem increase in BP Predisposed to hypertension BP lowest in early morning where metabolic rate is lowest. Cushing’s syndrome – high levels of cortisol b. Hyperthyroidism – overactive thyroid gland c. Angiotensin II Blockers – directly block angiotensin II. women have higher BP than before OBESITY DIURNAL VARIATIONS DISEASE PROCESS • Antihypertensives 1. Hyperaldosteronism – overproduction of aldosterone. peripherally acting adrenergic blockers) block the effects of the sympathetic division 3. which converts angiotensin I to angiotensin II 5. these agonists inhibit the effect of the sympathetic division 4. thus increasing BP Severe pain can decrease BP greatly by inhibiting the vasomotor center and producing vasodilation African American males over 35 > European American males same age After puberty. Adrenergic blockers – (alpha-blockers.increase PR and BP . may be long term or short term 7.Hormonal disorders a.exercise before taking BP) STRESS RACE GENDER MEDICATIONS Stimulation of Sympathetic Nervous System increases Cardiac Output and vasoconstriction of the arterioles. females BP < BP of males same age (hormonal) After menopause. Centrally acting alpha-agonists – by stimulating certain receptors in the brain stem. Calcium channel blockers – dilate arterioles. compliance of the arteries Check the client for allergy to latex cuff 18 . help kidneys eliminate salt and water. rises throughout the day and peaks in the late afternoon or early evening Any condition affecting cardiac output. Pheochromocytoma ( a tumor that is located in the adrenal gland that produces epinephrine and norepinephrine) . Direct Vasodilators Hypertension . decrease fluid volume throughout the body 2. beta-blockers.

severe heart failure (25 mm Hg) 19 .) position the stethoscope clean the earpieces with antiseptic wipes insert ear piece ensure that the stethoscope hangs freely from the ears to the diaphragm place the bell side over the brachial pulse site place stethoscope directly on skin 8.verify client’s identity .) If this is client’s initial examination. that is.) Auscultate client’s BP 9. Blood pressure cuff.explain procedure – what.) Privacy 4. present at all times in the arteries Pulse pressure – the difference bet. perform a preliminary palpatory determination of systolic pressure 7.Equipment : Stethoscope.arteriosclerosis .) .) Aseptic techniques 3.) If this is the client’s initial exeamination. Systolic and diastolic NV=40 .elevated – exercise = 100 . lower pressure. 6. why. repeat procedure in client’s other arm KOZIER NOTES Arterial Blood Pressure – is the measure of the pressure exerted by the blood as it flows through the arteries Systolic Pressure – pressure of the blood as a result of the contraction of the ventricles.) Position client appropriately 5.) wrap the deflated cuff evenly around the upper arm.low .Identify yourself . and how the client can cooperate 2. Sphygmomanometer PROCEDURE 1. the pressure of the height of the blood wave Diastolic Pressure – pressure when the ventricles are at rest.

viscosity of the blood ↓Smaller space within the vessel → ↑resistance → . 8. Peripheral Vascular Resistance Factors that create resistance in the arterial system a.asymptomatic and often a contributing factor to MI 1.↑BP when blood is highly viscous – the proportion of RBC to blood plasma is high.Vasodilation . 5.↓BP 3. 6.Vasoconstriction . This proportion is called the hematocrit. capacity of the arterioles and capillaries b.DETERMINANTS OF BP 1. Blood Volume – directly proportional to BP ↑BP 4. Viscosity increases when the hematocrit is more than 60% to 65% Classification of Blood Pressure CATEGORY Normal Prehypertension Hypertension Stage 1 Hypertension Stage 2 Hypertension SYSTOLIC BP mm Hg < 120 120-139 140-159 >160 DIASTOLIC BP mm Hg < 80 80 – 89 90-99 >100 – BP that is persistently above normal . 4. Pumping Action of the Heart ↓Pumping action → ↓blood pumped into arteries → ↓cardiac output → ↓BP 2.↑BP (smoking) . 2. compliance of the arteries c. 3. Primary hypertension – elevated BP of unknown cause 2. 7. Blood Viscosity . thickening of arterial walls inelasticity of arteries cigarette smoking obesity heavy alcohol consumption lack of exercise high blood cholesterol levels continued exposure to stress 20 . Secondary hypertension – known cause Factors associated with hypertension 1.

severe burns .caused by peripheral vasodilation in which blood leaves the central body organs.bleeding .Hypotension – BP that is below normal – a systolic reading consistently between 85 to 110 mm Hg in an adult whose normal pressure is higher than this Orthostatic hypotension – BP that falls when a client sits or stands .dehydration 21 .analgesics such as Meperidine HCl (Demerol) . especially the brain. and moves into the periphery Hypotension can also be caused by .

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