BLOOD

PRESSURE
TAKING

NCM 103: FUNDAMENTAL OF NURSING

TOPIC: VITAL SIGNS TAKING
BY: JUDY N. VASQUEZ, M.A.N.
 BLOOD PRESSURE

ARTERIAL BLOOD PRESSURE

▪ Is a measure of the pressure exerted by
the blood as it flows through the
arteries
▪ Blood moves in waves
▪ Measured in millimeters of mercury
(mmHg)
▪ Recorded as a fraction
Systolic Pressure
Diastolic Pressure
▪ A typical blood pressure for a healthy
adult is 120 mmHg
80
 2 BLOOD PRESSURE MEASUREMENTS

SYSTOLIC PRESSURE
▪ Pressure of the blood as a result
of contraction of the ventricles,
the pressure of the height of
blood wave
DIASTOLIC PRESSURE
▪ Pressure when the ventricles are
at rest, it is the lower pressure
present at all times in the
arteries
SYSTOLIC AND DIASTOLIC PRESSURE
 PULSE PRESSURE

▪ Is the difference ▪ FORMULA FOR PULSE

between the diastolic PRESSURE
and the systolic ▪ Pulse Pressure = Systolic
pressure Pressure – Diastolic
Pressure
▪ A normal pulse pressure
is about 40 mmHg but ▪ PP = SP – DP
can be as high as 100
mmHg during exercise
 MEAN ARTERIAL PRESSURE

▪ It is useful also to
determine the mean
arterial pressure (MAP)
because this represents
the pressure actually
delivered to the body’s
organs
▪ MAP greater than 65 will
keep all organs perfused
 4 DETERMINANTS OF
BLOOD PRESSURE

1. PUMPING ACTION OF THE HEART

▪ When the pumping action of the heart

is weak, less blood is pumped into
arteries ( lower cardiac output), and the
blood pressure decreases
▪ When the heart’s pumping action is
strong and the volume of blood pumped
into the circulation increases ( higher
cardiac output), the blood pressure
increases
 DETERMINANTS OF BLOOD PRESSURE

2. PERIPHERAL VASCULAR RESISTANCE

❑Increase blood pressure
❑The smaller the space within a vessel,
the greater the resistance
❑ Increase vasoconstriction (smoking)
raises the blood pressure, whereas
decrease vasoconstriction lowers the
blood pressure
❑If elastic and muscular tissues of the
arteries are replaced with fibrous
tissue, the arteries lose its ability to
constrict and dilate thus is known as
ARTERIOSCLEROSIS
 DETERMINANTS OF BLOOD PRESSURE

3. BLOOD VOLUME
▪ When the blood volume
decreases (hemorrhage or
dehydration), the blood
pressure decreases because of
decrease fluid in the arteries.
▪ When the blood volume
increases ( rapid intravenous
infusion), the blood pressure
increases because of greater
fluid volume within the
circulatory system
 DETERMINANTS OF BLOOD PRESSURE

4. BLOOD VISCOSITY
❑ Blood pressure is higher when
the blood is highly viscous (thick),
that is, when the proportion of
red blood cells to the blood
plasma is high, this proportion is
referred to as the HEMATOCRIT.
❑ The viscosity increases when the
hematocrit is more than 60% -
65%
 FACTORS AFFECTING BLOOD PRESSURE

1. AGE
❑ Newborns have a systolic BP of 75
mm Hg, the pressure rises with age
❑In older adult elasticity of the
arteries is decreased, this increases
the systolic BP, due to the walls no
longer retracting as flexibly the
diastolic BP may also be high
 FACTORS AFFECTING BLOOD PRESSURE

2. EXERCISE
❑ Physical activity increases the cardiac output and blood pressure
❑ For reliable assessment of resting blood pressure, wait 20 to 30 minutes following
exercise
 FACTORS AFFECTING BLOOD PRESSURE

3. STRESS
❑ Stimulation of the
sympathetic nervous
system increases
cardiac output and
vasoconstriction of the
arterioles, increasing
the blood pressure
reading
 FACTORS AFFECTING BLOOD PRESSURE

4. SEX
❑ After puberty, females
usually have lower blood
pressures than males of the
same age, this difference is
thought to be due to
hormonal variations
❑ After menopause, women
generally have higher blood
pressure than before
 FACTORS AFFECTING BLOOD PRESSURE

5. MEDICATIONS
❑ Many medications,
including caffeine, may
increase or decrease the
blood pressure
 FACTORS AFFECTING BLOOD PRESSURE

6. OBESITY
❑ Both childhood and
adult obesity
predispose to
hypertension
 FACTORS AFFECTING BLOOD PRESSURE

7. DIURNAL VARIATIONS
❑ Pressure is usually lowest
early in the morning, when the
metabolic rate is lowest, then
rises throughout the day and
peaks in the late afternoon or
early evening
 FACTORS AFFECTING BLOOD PRESSURE

8. MEDICAL CONDITIONS
❑ Any condition affecting the
cardiac output, blood volume,
blood viscosity, and/or
compliance of the arteries
has a direct effect on the
blood pressure
 FACTORS AFFECTING BLOOD PRESSURE

10.TEMPERATURE
❑ Fever can increase blood
pressure due to increase
metabolic rate
❑ External heat causes
vasodilation and decreased blood
pressure
❑ Cold causes vasoconstriction
and elevates blood pressure
CLASSIFICATION
OF BLOOD
PRESSURE
 HYPERTENSION

❑ A blood pressure that is persistently above normal

❑ A single elevated blood pressure
reading indicates the need for 2 TYPES OF HYPERTENSION
reassessment
❑ Hypertension cannot be diagnosed
unless an elevated BP is found when ❑ PRIMARY HYPERTENSION – is
measured twice at different times an elevated blood pressure
of unknown cause
❑ The stage of hypertension is
determined by the higher of the two
values. ❑ SECONDARY HYPERTENSION –
is an elevated blood pressure of
Ex. If either the systolic or diastolic known cause
values falls in the stage 2 range, stage 2
hypertension is assigned
 FACTORS ASSOCIATED WITH HYPERTENSION

❑ Thickening of the arterial walls,

which reduces the size of the arterial
lumen
❑ Inelasticity of the arteries
❑ Lifestyle factors as cigarette
smoking, obesity, heavy alcohol
consumption
❑ Lack of physical exercise
❑ High blood cholesterol levels
❑ Continued exposure to stress
 HYPOTENSION

❑ Is a blood pressure that is below ❑ It can also be caused by :

normal
▪ Analgesics ( Demerol/Meperidine
❑ A systolic reading consistently Hydrochloride)
between 85 & 110 mmHg in an
adult whose normal pressure is ▪ Bleeding
higher than this
▪ Severe burns
❑ ORTHOSTATIC HYPOTENSION is a
blood pressure that decreases when ▪ Dehydration
the client sits or stands ❑ It is important to monitor
❑ It is a result of peripheral hypotensive clients carefully to
vasodilation in which blood leaves prevent falls
the central body organs, specially
the brain and moves to the periphery
causing a person to faint
 HYPOTENSION

❑ When assessing for Orthostatic Hypotension:

▪ Place client in a supine position for 10 minutes
▪ Record the client’s blood pressure
▪ Assist the client to slowly sit or stand. Support the client in case od
faintness
▪ Immediately recheck the blood pressure in the same sites
▪ Repeat the pulse and blood pressure after 3 minutes
▪ Record the results, a drop in blood pressure of 20 mmHg systolic or 10
mmHg diastolic indicates orthostatic hypotension
BLOOD PRESSURE APPARATUS
 ASSESSING BLOOD PRESSURE

❑ Blood pressure is measured with a blood

pressure cuff, a sphygmomanometer and
a stethoscope
❑ BP Cuff consists of a bag called a
bladder, that can be inflated with air

❑ 2 tubes – one connects to a bulb that

inflates the bladder
-- the other tube is attached to a
sphygmomanometer
❑ Sphygmomanometer – indicates the
pressure of the air within the bladder
❑ Valve – traps and releases the air in the
bladder
 3 TYPES OF SPHYGMOMANOMETERS

DIGITAL/ELECTRONIC
MERCURY ANEROID
 DIGITAL/ELECTRONIC

❑ Eliminates the need to listen for the clients systolic and diastolic BP through a
stethoscope
❑ Should be calibrated periodically to check accuracy
 DOPPLER ULTRASOUND STETHOSCOPES

❑ Used to assess when BP sounds are difficult to hear, such as infants, obese clients,
and clients in shock
❑ Systolic BP may be the only BP obtainable with some ultrasound models
BLOOD PRESSURE CUFF SIZES
 BLOOD PRESSURE ASSESSMENT SITES

❑ Upper arm using the brachial artery and stethoscope

❑ BP is assess on clients thigh in this situations: BP cannot be measured on either
arm ( due to burns or trauma etc.)
 BLOOD PRESSURE IS NOT MEASURED ON
CLIENTS LIMBS IN THE FOLLOWING SITUATIONS

❑ The shoulder, arm, or hand ( hip,

knee, or ankle) is injured or diseased
❑ A cast or bulky bandage is on any part
of the limb
❑ The client has had surgical removal of
breast or axillary (inguinal) lymph
nodes on that side
❑ The client has an intravenous infusion
or blood transfusion in that limb
❑ The client has an arteriovenous fistula
( renal dialysis) in that limb
 2 METHODS IN ASSESSING BLOOD PRESSURE

1. DIRECT (Invasive monitoring)

– involves insertion of a catheter into
the brachial, radial, or femoral
artery
-- arterial pressure is represented by
wavelike forms displayed on a
monitor
-- pressure reading is highly accurate
 2 METHODS IN ASSESSING BLOOD PRESSURE
2. INDIRECT (Noninvasive monitoring)

A. AUSCULTATORY

▪ commonly used in hospitals, clinics and

homes
▪ External pressure is applied on the
artery, then pressure is read from the
sphygmomanometer, while listening for
sounds with a stethoscope
 KOROTKOFF’S SOUNDS PHASES
Phase 1: A sharp tapping.
▪ This is the first sound heard as the cuff
pressure is released. This sound provides
the systolic pressure reading.
Phase 2: A swishing/whooshing sound.
▪ Swishing sounds as the blood flows through
blood vessels as the cuff is deflated.
Phase 3: A thump (softer than phase 1).
▪ Intense thumping sounds that are softer
than phase 1 as the blood flows through the
artery but the cuff pressure is still inflated
to occlude flow during diastole.
Phase 4: A softer, blowing, muffled
sound that fades.
▪ Softer and muffled sounds as the cuff
pressure is released. The change from
the thump of phase 3 to the muffled
sound of phase 4 is known as the first
diastolic reading.
Phase 5: Silence.
▪ Silence that occurs when the cuff
pressure is released enough to allow
normal blood flow. This is known as
the second diastolic reading.
KOROTKOFF’S SOUNDS PHASES
 2 METHODS IN ASSESSING BLOOD PRESSURE
2. INDIRECT (Noninvasive monitoring)

B. PALPATORY ▪ First pulsations of the artery is felt, the

systolic pressure as the pressure in the cuff
▪ Used when Korotkoff’s sounds cannot is release and pressure is read in the
be heard
sphygmomanometer
▪ Or used when electronic devices to
amplify the sounds are not available ▪ A single whiplike vibration, is felt in
addition to the pulsations identifies the
▪ Or during auscultatory gap – temporary point nearing the diastolic pressure.
disappearance of a sound and
reappearance of the sound at a lower
level
▪ Nurse uses light to moderate pressure
to palpate the pulsations of the artery
as the pressure in the cuff is released
 COMMON ERRORS IN ASSESSING BLOOD
PRESSURE
▪ Bladder cuff too narrow
▪ Bladder cuff too wide
▪ Arm unsupported
▪ Insufficient rest before the
assessment
▪ Repeating assessment too
quickly
▪ Cuff wrapped too loosely or
unevenly
▪ Deflating cuff too quickly
▪ Deflating cuff too slowly
▪ Failure to use the same arm
consistently
▪ Arm above level of the heart
▪ Assessing immediately after a
meal or while client smokes or in
pain
▪ Failure to identify auscultatory
gap