Blood Pressure

1
Blood Pressure

• Mm/hg

2
What is Blood Pressure?

• The force of the blood, as it is being pumped
  from the ventricles, as it pushes against the
  walls of your arteries.

3
Two important numbers

• Systolictop number
• Diastolicbottom number
• 120/80
• Systolecontraction of the heart
• Diastolerelaxation of the heart

4
Systolic

• Represents the force of the blood as it pushes
  against the wall of the arteries.
• When the ventricles contract.
• Blood is forced out of the aorta and pulmonary
  artery.
• Pressure in the arteries is highest during
  systole.

5
Diastolic

• Force of the blood in the arteries when the
  ventricles are relaxing.
• Blood flows back into the two ventricles and
  dilates them therefore, pressure in the arteries
  is lower.

6
So What?

• Systolic readings tell the MD about the condition
  of your left ventricle.
• Diastolic readings tell the MD about the
  resistance of your blood vessels.
• Resistance how much give there is.
  Remember..arteries are supposed to be pliable.

7
Systolic vs. Diastolic

• Diastolic is typically more of a concern because
  it tells us what type of strain your arteries are
  under.
• If, during diastole, the pressure is supposed to
  be lower in the arteries, but it isnt, then the
  arteries really are not getting a break. They are
  taking a constant pounding.

8
Diastolic continued.

• The condition of your peripheral vessels also
  plays a part in the diastolic pressure.
• If you have arteriosclerosis, how pliable are
  your arteries? Not very.
• People with arteriosclerosis have higher BP.

9
Pulse Pressure

• The numeric difference between systolic and
  diastolic.
• 120/80pulse pressure is 40
• 180/90pulse pressure is 90
• Pulse pressure is indicative of the tone of your
  arteries.
• 40 is normal.

10
Factors that determine BP

• Pumping action of the heart (60-80 bpm or 100,000
  times a day)
• Volume of blood within the vessels (we have six
  quarts)
• Peripheral resistance of vessels to the flow of
  blood.
• Elasticity of the walls of the main arteries.
• Viscosity of the blood.

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Vocabulary

• Page 86

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Hypertension

• Benign Slow onset, asymptomatic
• Secondary We can find a cause for it (kidney
  disease).
• Malignant Rapid onset. Can be fatal.
• Essential Idiopathic. Occurs in the absence of
  kidney disease. most common.

13
Hypotension

• Orthostatic hypotension (postural)
• Postural hypotension (orthostatic)
• Orthostatic BP

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Normal for adults

• Textbook perfect 120/80
• Ranges for systolic 90-140 mm/hg
• Ranges for diastolic 60-90 mm/hg
• Remember In older adults due to vascular
  changes, decreased peripheral resistance,
  arteriosclerosis, these numbers may go up.

15
Up and Down

• Up Exercise, stress, arteriosclerosis, increased
  peripheral resistance, increased weight, smoking,
  pain, kidney disease, drugs, etc.
• Down Cardiac failure, MI, shock, dehydration,
  sleep, approaching death, etc.

16
The Silent Killer

• Hypertension

17
Hypertension

• One visit to the MD with HTN does not mean you
  have HTN.
• You have to have 3 consecutive readings that are
  above the normal limit.
• Borderline 140/90

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Damage

• If HTN goes untreated, a wealth of problems can
  occur without the patient being aware until it is
  too late.
• Damage to kidneys, heart, eyes, arteries, etc.

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Prevention Detection

• All adults, 18 or over, with a diastolic BP of
  110 mm/hg or over---see MD immediately.
• All people with BP between 160/100-179/109 mm/hg
  should have it confirmed within 1 month.
• All people with BP between 140/90-159/99 mm/hg
  should be checked every two months.
• All others, annually.

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Evaluationwhere to start

• Nothing beats a good History.
• Followed by a Physical Exam.
• Followed by Basic Lab Tests.
• Always include your patient in the Plan of Care.

21
Myths

• If I had high blood pressure, I could feel
  it.
• I feel fine so I am not going to take my
  medication today.

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Equipment Needed

• Blood pressure cuff (NOT CUP)
• Sphygmomanometer (yes..spelling counts).

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Labeling the equipment (cuff)

• Cuff
• Pressure control valve
• Gauge pressure indicator
• Inflation bulb

24
Labeling the stethoscope

• Earpieces
• Binaurals
• External spring
• Tapered tubing
• Diaphragm
• Chestpiece

25
The Phases of Blood Pressure (V)

• Phase I First series of faint but clear
  tapping. Gradually increases in intensity.
• Phase II As you deflate the cuff, the sounds
  change to a swish. Sound might disappear but
  reappear (ausculatory gap)
• Phase III Sounds crisp and loudas you reopen
  the artery.
• Phase IV Sounds become dull and muffledthis is
  first diastole.
• Phase V The sound disappearsrecord this number.

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When you cant use the arm!

• Palpating a BP.
• Using the leg.
• You cant use the arm when (1) mastectomy, (2)
  IV, (3) cast, (4) stroke affected side.

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Obtaining the BP and Orthostatic BP.

• Call for volunteer.

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FinallyHeight and Weight

• Practice with the old and put together the new.
• Convert lbs. to kilograms and kilograms to
  pounds.
• Convert inches to feet and feet to inches.

29
Pass Off Mondayall day!

• Bring a partner
• Wear your uniform
• Do NOT ask me on Monday if you are doing it
  right.
• Do NOT tell me you havent practiced because you
  have had open lab time.