Practical Nursing Diploma Program Nursing Skills Lab 1

Blood Pressure Week 12

Blood Pressure
The force of the blood against arterial walls Systolic Pressure  The highest point of pressure on arterial walls when the ventricles contract  Diastolic Pressure  The lowest pressure present on arterial walls as ventricles relax Read as systolic number µover¶ diastolic number

^ systolic pressure  Race-hypertension more common in African American  Weight-B/P can be higher in overweight  Emotional state-anger. pain. fear.Factors Affecting Blood Pressure Reading   Age. excitement ^ B/P  Smoking-vasoconstriction. antihypertensives lower B/P .walls of arteries are less elastic-increases peripheral resistance. ^ B/P  Medications-oral contraceptives may ^ B/P. ^ B/P Exercise.

Ranges of Blood Pressure [525]       Optimal= <120/80 Normal=< 130/85 High Normal=130-139 over 85-89 Grade 1 Hypertension (mild) 140-159/90-99 Grade 2 ³ (moderate) 160-179/100-109 Grade 3 ³ (severe) >180/110 Hypotension=90-115 for systolic  may be normal for some but may be due to blood loss or medication effects .

/ Postural Hypotension  change in position leads to low BP. loss of blood Korotkoff Sounds Sounds you hear when taking a blood pressure as blood can flow through the compressed artery. and quickly stop . change tone. prolonged bed rest.  caused by medications. Listen and make note when they start.Orthostatic.

Measuring Blood Pressure Blood Pressure is measured in millimeters of mercury (mm Hg)  Blood Pressure is recorded as a fraction: The numerator is the systolic pressure The denominator is the diastolic pressure Pulse Pressure  The difference between the systolic and diastolic pressure ie. systolic ± diastolic = pulse pressure  .

Methods of Assessing the Blood Pressure  Use a stethoscope and sphygmomanometer Use a Doppler ultrasound Estimate by palpation Assess with electronic or automated devices    .

if too wide. FEEL . LISTEN. reading may be low Ensure accurate limb placement Use recommended deflation rate Correctly interpret the sounds heard ie.How to Ensure an Accurate Blood Pressure Reading      Ensure equipment is in good working order Always use a cuff that is the correct size for the patient. LOOK.if too narrow-reading may be high.

Cuff width 2/3 of arm length .

used to auscultate ie. weak arm from stroke. listen  Sphygmomanometer and cuff (different sizes) + manometer ie. casted/injured arm .Continued. Stethoscope. mercury or aneroid  Ensure reading starts at 0  If using mercury manometer make sure you read at eye level  Always read at top of meniscus  ‡ Do not take the B/P on an arm: ‡ with an IV. on the side of a mastectomy..

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Assessing Brachial B/P     Select the appropriate arm for application of the cuff Have the patient assume a comfortable lying or sitting position with the forearm supported at the level of the heart and the palm of the hand upward Expose the brachial artery by removing garments. above the area where the cuff will be placed Palpate the location of the brachial artery . or move a sleeve. if it is not too tight.

Note the point on the gauge where the pulse disappears Totally deflate the cuff and wait 15 seconds . and fasten it.     Wrap the cuff around the arm smoothly and snugly. Do not allow any clothing to interfere with the proper placement of the cuff (1-2´ above inner aspect) Palpate the pulse at the brachial or radial artery by pressing gently with the fingertips Tighten the screw valve on the air pump Inflate the cuff while continuing to palpate the artery.

but clear. sound appears that slowly increases in intensity. allowing the gauge to drop 2±3 mm per heartbeat Note the point on the gauge at which the first faint.    Place the bell or diaphragm of the stethoscope firmly but with as little pressure as possible over the brachial artery Pump the pressure 30 mm Hg above the point at which the systolic pressure was palpated and estimated. Note this number as the systolic pressure Read this pressure to the closest even number . Open the valve on the manometer and allow air to escape slowly.

Repeat any suspicious reading. Note the pressure at which the sound first becomes muffled/disappears. Deflate the cuff completely between attempts to check the blood pressure . but always wait 30 to 60 seconds between readings to allow normal circulation to return to the limb.   Do not re-inflate the cuff once the air is being released to recheck the systolic pressure reading. This is the diastolic pressure Open the valve and let remaining air to escape quickly.

Other Methods to Determine Blood Pressure  Popliteal Artery Blood Pressure-usually 10-40 higher Patient to assume the prone position Use an appropriate size cuff Place cuff on thigh above popliteal artery Same procedure as for assessing brachial blood pressure .

Estimating by Palpation Only need a sphygmomanometer Pump up cuff same as for brachial blood pressure assessment but using your fingers you feel for the return of pulse You only get a systolic reading Doppler/Ultrasound amplifies sounds .

 Electronic or Automated Devices Determines Blood Pressure by monitoring vibrations Still need to remember to check equipment Place cuff in correct position Ensure to use correct size cuff Check with brachial manual blood pressure to confirm accuracy of automated device .

Nursing Skills Lab 1  Week 13 ‡ Topical Medications ‡ Please review the 3 checks and 6 rights of medication preparation and administration prior to this Lab .