Fundamentals of Nursing | 2nd Sem - Prelim tissues and function in the exchange of nutrients and

A.Y. 22-23 gases.

CARDIOVASCULAR SYSTEM
BLOOD PRESSURE
cardio = related to the heart, vascular = related to the
blood vessels DEFINITION: A specialized body fluid that flows through
the blood vessels. COMPOSITION: It is composed of the
COMPOSITION: fluid part known as plasma and blood cells.

Heart Plasma is mostly made up of water and also contains

proteins, salts and other substances.
Blood vessels
Blood cells: are of 3 types:
Blood - the cells and plasma Red blood cells (responsible for the transport of
respiratory gases) - due to hemoglobin pigment
MAIN FUNCTION: Maintains the circulation of life giving
White blood cells (responsible for immunity against
blood to all parts of our body which is necessary for
diseases)
delivery of nutrients, removal of wastes and exchange of
Platelets (responsible for blood clotting.)
oxygen and carbon dioxide.
1. BLOOD PRESSURE
THE HEART
Blood pressure is the measurement of force applied to
artery walls

Composition: Muscular organ Refers to the measurement of force exerted by circulating

blood the walls of blood vessels, and constitutes one of
Parts: It has four chambers - ATRIA - 2 upper chambers the principal vital signs
known as atrial (receives blood) and
2. BLOOD PRESSURE
VENTRICLES - 2 lower ones known as ventricles (pumps
blood to the various parts of our body and the lungs). Refers to arterial pressure, i.e., the pressure in the larger
arteries, the blood vessels that take blood away from the
Location: Chest between the two lungs, slightly to the heart
left' protected by the rib cage.
Hypertension: Abnormally high blood pressure over 140
Function: It pumps blood to the various parts of our body mm Hg systolic and or about 90mm Hg diastolic for at
by repeated rhythmic contractions. It beats 72 times in a least two consecutive readings
minute.
ARTERIAL PRESSURE
Cardiac Cycle: Two parts:
The pressure of blood as a result of the contraction of the
SYSTOLE- contraction phase (ejection of blood from atria ventricles (100- 140mm Hg)
and then both ventricles) initiated by SA Node.
SYSTOLIC
DIASTOLE- resting, relaxation phase both atria and Above 140
ventricles The pressure when the ventricles are at rest (60-90mm
Hg)
BLOOD VESSELS --the tubes that carry the blood. DIASTOLIC
Above 90
They are of 3 types:
PULSE PRESSURE:
Arteries - carry blood from the heart to different parts of
DIFFERENCE BETWEEN THE SYSTOLIC & DIASTOLIC
our body
PRESSURE (Normal: 30-40mmHg)
Veins - carry blood from the different parts of our body
Hypotension: Abnormally low blood pressure, systolic
back to our heart
pressure below 100/60 mm Hg
Capillaries - small, thin walled vessels that form a
network between the arteries and veins in the
Orthostatic hypertension: A blood pressure that falls
when the client sits or stands
Factors affecting Blood pressure
Age. Decreased elasticity of blood vessels
increases BP.
Exercise. Increases cardiac output
Stress. SNS stimulation causes increase in BP.
Obesity. BP is elevated among overweight and obese
people.
Sex. Males before age 65 have higher BP; females have
higher BP after 65
Disease process. DM, Renal failures, Hyperthyroidism.
NORMALBP: ADULT
NORMAL VITAL SIGNS
Korotkoff sound-are sound heard during measurement
of blood pressure
Phase 1 SHARP TAPPING SOUND
Phase 2 SWISHING/SWOOSHING SOUND
Phase 3 THUMP SOFTER THAN THE TAPPING IN PHASE 1
Phase 4 A SOFTER BLOWING MUFFLED
SOUND THAT FADES
Phase 5 SILENCE -The pressure level wherein the sound
disappear
METHODS OF TAKING BP
A. DIRECT METHOD
•Requires the use of sphygmomanometer and
stethoscope for auscultation and palpation as needed
•Most common site: client's arm over brachial artery
Other sites: Leg site over popliteal artery (behind the
knee)
B. INDIRECT METHOD
An invasive procedure
An intravenous catheter with an electronic sensor is
inserted into an artery and the artery-transmitted
pressure on an electronic display unit is read
PURPOSES
To have a baseline blood pressure measurement
To evaluate client's condition after treatment, therapies
and medications
To evaluate the cardio-vascular states of the client
EQUIPMENTS NEEDED:
Sphygmomanometer
Stethoscope
Cotton balls with alcohol
Watch or clock with second hand
EQUIPMENT
1. SPHYGMOMANOMETER
An instrument for measuring arterial pressure
3 Types of Blood Pressure Apparatus
(Sphygmomanometer)
MERCURY GRAVITY MANOMETER / MERCURIAL
- has a mercury filled cylinder or tube calibrated in
millimeter
ANEROID MANOMETER/ ANEROIDAL
- has a cuff that is attached to a round calibrated dial with
a pointer that indicates pressure
ELECTRONIC BLOOD PRESSURE Gather, assemble, and appropriate size for the client
MEASUREMENT/sunzheng DIGITAL - electrically prepare equipment or to ensure accuracy Accurate
operated/battery operated articles needed. measurements depend on
functional equipment.
PARTS: Select a cuff appropriate for
the client. Measure with
a. Mercury Gauge / Aneroid/Digital (Pressure Gauge) a tape, the
circumference of the
bare upper arm at the
midpoint between the
b. Pressure cuff (velcro or hook) w/ rubber bladder. Note: shoulder (acromonion)
Inside the cuff in an elastic cloth covering - Airtight, and the elbow
flat and inflatable (olecranon). It should
cover 2/3rds of the
C. Pressure source Pressure control bulb Pump bulb upper arm.
Rubber bulb Hand bulb
Check the equipment and
supplies. Make sure
d. Handle
they work.
e. Rubber Tubing (2)
Procedure Establishes rapport and trust
f. Release valve (screw) 1. Introduce yourself and Encourages client's
verify client's identity. participation and reduces
2. STETHOSCOPE
client's anxiety
Explain to the client what
Used to auscultate the sound heard directly over the you are going to do, why it is Readings taken at different
artery as the pressure in the cuff is released necessary, and how the client times can be objectively
can cooperate. Have the compared when all are
Parts: client rest at least 5 minutes assessed with client at
(PHN 2007) before rest
A. Ear tips/Ear pieces measurement.
B. Metal tubing - Neck / Binaurals (Metal) 3. Perform hand hygiene, Reduces transmission of
and observe other microorganisms.
C. Rubber tube appropriate infection control
procedures.
D. Chest pieces / Stems - diaphragm; bell
4. Provide for client privacy. Minimizes or avoids
IMPLEMENTATION OF PROCEDURE ASSEMBLE THE embarrassment on the client.
EQUIPMENTS

A. Preparation To accurately assess BP and

Assess the client.
Signs and symptoms of
hypertension, hypotension
Factors affecting blood
pressure: exercise and smoking
(wait for 15 minutes before
taking BP measurements)
Allergy to latex cuff
significance of pressure
changes
Can cause false elevations in
BP
To avoid injuring the client;
helps to determine type of
BP apparatus to be used and
site of BP application
Position the client comfortably and appropriately.
5. Place the client in sitting Helps in the accurate
position, unless otherwise measurement of BP
specified. Both feet should
be flat on the floor.
6. Moves client's clothing away Ensures proper cuff
from upper aspect of arm. application

Condition of client (injury)

Loosen and fold the client's
sleeve. Expose the upper arm.
Assemble equipment. Be sure that the cuff is an
7. Position client's arm at heart If the arm is above the level
level extending elbow with
palm turned upward.
8. Wrap the deflated cuff
around the upper arm. Locate
the brachial artery.
9. Apply the center of the
bladder directly over the
artery.
Adjust the cuff so that the
lower border is approximately
2.5cm (1inch) above the
antecubital space. Proper BP
apparatus would occupy
2/3rds of the upper arm.
11. Locates the brachial artery
in the cubital space with the
fingertips.
If this is the client's initial assessment, perform a preliminary
palpatory determination of systolic pressure.
12. Palpate the brachial (or
radial) artery with the
fingertips at one hand.
13. Close the valve on the bulb.
14. Pump up the cuff until you
no longer feel the brachial
pulse.
15. Note the pressure on the
sphygmomanometer at which
the pulse is no longer felt and
add 30mmHg pressure above
point which pulse disappears.
17. Position the stethoscope appropriately.
18. Place the bell of the
amplifier of the stethoscope
over the brachial pulse
19. Place stethoscope directly
of the heart, the BP
reading will be
erroneously low; while
if the arm is below the
level of heart, the BP
reading will be
erroneously high.
Proper placement ensures
accuracy of result
Identifies approximate
systolic pressure and
determines maximum
inflation point for accurate
reading. Prevents
auscultatory gap
Prevents venous congestion
and false high readings
Avoid transfer of
microorganisms
Proper placement ensures
accuracy of result
on skin. not on clothing over
the site.
a. Cleanse the earpieces with
antiseptic wipe.
b. Insert the ear attachments of
the stethoscope in your ears so
that they tilt
c. Ensure that the stethoscope
hangs
d. freely from the ears to the
diaphragm.
20. Hold the diaphragm with
the thumb and index fingers
21. Auscultate the client's
blood pressure.
Ensures accurate measurement
of systolic pressure.
Too rapid or slow a decline in
mercury level can cause
inaccurate readings.
Pump up the cuff until the
sphygmomanometer is
30mmHg above the point
where the brachial pulse
disappeared.
23. Release the valve on the
cuff carefully so that the
pressure decreases at a rate of
2-3mmHg per second.
24. As the pressure falls,
identify the manometer
reading at Korotkoff phases I,
IV and V.
Note the first clear sound
heard. This indicates systolic
pressure (KI). Note the point at
which the sound changes to a
muffled sound (K IV) the last
sound before silence (KV) is
diastolic pressure.
25. Deflate the cuff rapidly and
completely.
Wait 1-2 minutes before
making further determinations.
(Manual: 20 to 30 minutes-to
allow venous circulation in the
arm to stabilize.

26. Repeat the procedure on

client's other arm.

- Repeating steps once or twice

as necessary to confirm the
accuracy of reading.

27. Remove the cuff. Wipe the Prevents transmission of

cuff with an appropriate microorganism
disinfectant.

Assist client in returning to Restores comfort

comfortable position and cover
upper arm if previously clothed.

Inform client of reading Promotes participation in

care and understanding of
health status.

Wash hands Prevents transmission of

microorganisms.

Document and report pertinent Vital signs should be

assessment data according to recorded immediately to
agency policy. ensure accuracy.