Pulse Pressure

1. Differentiate the effect of sympathetic and parasympathetic nervous

systems on pulse rate.

Stimulation of the parasympathetic nervous system (dominant activation during

resting states) results in a decrease in the pulse rate. Normally, parasympathetic
nervous system input slows the pulse rate below 100 beats per minute.
Conversely, stimulation of the sympathetic nervous system results in an
increased pulse rate. Sympathetic nervous system activation occurs in response
to a variety of stimuli, including pain, anxiety, exercise, fever, ingestion of
caffeinated beverages, and changes in intravascular volume.

2. When palpating for the carotid pulse, why is it that it should be never
done bilaterally?

Always palpate the carotid artery in the lower half of the neck to avoid
stimulating the carotid sinus. Never palpate bilateral carotid pulses
simultaneously because this can seriously impair cerebral blood flow.

3. Is auscultation of the pulse necessary? Yes or No? Explain why?

Auscultation of the apical pulse provides the most accurate assessment of the
pulse rate and is the preferred site when the peripheral pulses are difficult to
assess or the pulse rhythm is irregular.

Blood Pressure
1. What is orthostatic hypertension?

Inadequate reflex compensation upon position change results in orthostatic

hypotension. Symptoms of orthostatic hypo- tension are those related to
decreased cerebral perfusion, such as dizziness, weakness, blurred vision,
syncope, and marked changes in blood pressure and heart rate. Orthostatic
blood pressure changes may indicate hypovolemia, a failure of the autonomic
ner- vous system protective reflexes.

Orthostatic hypotension is a drop in systolic pressure of at least 25 mm Hg or a

drop in diastolic pressure of at least 10 mm Hg when moving from lying to sitting
or standing.
 2. Tabulate the common errors in blood pressure reading according to: (give
minimum of 3 per category)
a. Equipment errors
b. Procedural errors
c. Patient-related errors

EQUIPMENT ERROR PROCEDURAL ERROR PATIENT-RELATED ERROR

• Cuff is improper size. • Patient’s arm is not • Patient is nervous or

The cuff bladder should
be 20 percent wider
than the diameter of the
extremity where the cuff
is placed. Large cuffs for
obese arms and small
cuffs for children should
be available in all
offices.
• Air leaks in the cuff
bladder delay the
inflation rate and could
give a false high
reading. Air leaks may
also occur along the
tubing if it is old or worn.
uncovered, and reading anxious, resulting in a
is obtained through false high reading (such
clothing. as “white coat
syndrome”).
• Medical assistant is too
far away from • Patient’s arm is too
manometer to large for accurate
accurately read gauge. reading with available
equipment.
• Cuff is improperly
applied (too loose or too
small).
• Cuff is not centered
over the brachial artery,
1 to 2 inches above the
antecubital space.

• Sphygmomanometer is • End of the cuff is not

not properly calibrated. secured tightly.

• Velcro on the cuff may • Part of stethoscope

be worn and does not tubing or chest piece
hold. touches the blood
pressure cuff while
taking the pressure
reading.

• Failure to locate
brachial pulse before
placing stethoscope in
position.
 • The rubber bladder in
the cuff was not
deflated completely
before beginning the
procedure.

• Valve on bulb is not

completely closed
before beginning to
pump air into cuff.

• Cuff was not inflated

to a level 20 to 30 mmHg
above the palpated or
previously measured
systolic
pressure or 200 mmHg.

• Deflation occurs too

rapidly to accurately
determine the sounds.

• The arm used for the

reading is not at the
same level as the heart.

• Failure to wait 1 to 2
minutes before taking
second reading.

• Failure to notice the

auscultatory gap.

3. How can the following affect the blood pressure? Give example for each.
a. Volume of blood
Increase of blood volume increases the BP. Decrease of blood volume
decreases BP. Example: Hemorrhage (excessive bleeding) causes volume and
BP to drop.

b. Peripheral resistance
Relates to the size of the lumen (the cavity or space) within blood vessels and
amount of blood flowing through it.
Example: The smaller the diameter of the lumen, the greater the resistance to
blood flow. Fatty cholesterol deposits result in high BP as a result of narrowing
of the lumen.

c. Condition of heart muscle

Strength of the heart muscle affects volume of blood flow. The pumping
action of the heart and how efficiently it circulates blood affect the BP.
Example: A weak heart muscle can cause an increase or decrease in BP.

d. Elasticity of vessels
The ability of blood vessels to expand and contract decreases with age.
Example: Nonelastic blood vessels, as in arteriosclerosis, cause an elevated BP.