Blood pressure

BLOOD PRESSURE BY JAYA.R

1. BLOOD PRESSURE R.Jaya Bsc nursing Lecture Ganga college of nursing

2. Blood pressure is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system.  Sphygmomanometer has three parts: a cuff that can be inflated with air, a  pressure  meter (manometer) for  measuring  air  pressure  in the cuff, and. a stethoscope for listening to the sound the  blood  makes as it flows through the brachial artery (the major artery found in your upper arm). DEFINITION

3. The blood pressure is recorded for a number of reasons To acquire a baseline To monitor for fluctuation in blood pressure; To aid in diagnosis of disease To aid in assessment of the cardiovascular system To monitor medication e.g. anti-hypertensive drugs. Recording the blood pressure

4. Systolic pressure  is the  pressure  of the  blood  in the arteries when the heart pumps. It is the higher of two  blood pressure  measurements; for example, if the  blood pressure  is 120/80, then 120 is the  systolic pressure . Diastolic pressure  is the  pressure  of the  blood  in the arteries when the heart is filling. It is the lower of two  blood pressure  measurements; for example, if the  blood pressure  is 120/80, then 80 is the  diastolic pressure . Systolic pressure and Diastolic pressure

5. Physiology of arterial blood pressure Blood pressure reflect the interrelationships of cardiac output. peripheral vascular resistance, blood volume, blood viscosity, and artery elasticity. Physiology of arterial blood pressure

6. The amount of blood the  heart  pumps through the circulatory system in a minute. The amount of blood put out by the  left ventricle  of the heart in one contraction is called the  stroke volume . The  stroke  volume and the heart rate determine the cardiac output. A normal adult has a cardiac output of 4.7 liters (5 quarts) of blood per minute. CARDIAC OUTPUT

7. Peripheral Resistance  is  defined  and measured in terms of the force required to maintain blood flow from the root of the aorta to the venous exit into the  Blood volume  refers to the total amount of fluid circulating within the arteries, capillaries, veins, venues, and chambers of the heart at any time. The components that add  volume  to  blood  include red  blood  cells (erythrocytes), white  blood  cells (leukocytes), platelets, and  plasma .

8. Viscosity , resistance of a  fluid  (liquid or gas) to a change in shape, or  movement  of neighboring portions relative to one another.   Friction The hematocrit, also known by several other names, is the volume percentage of red blood cells in blood, measured as part of a blood test. The measurement depends on the number and size of red blood cells. It is normally 40.7%–50.3% for males and 36.1%–44.3% for females

9. Elasticity  is the ability to recoil or bounce back to the muscle's original length after being stretched.

10. AGE BLOOD PRESSURE [MM of Hg] New born 40(mean) 1 month 85/54 1 year 95/65 6 year 105/65 10 to 13 years 110/65 14to 17 years 119/75 18 years and older <120/<80 Average Optimal Blood Pressure

11.   Advice to patient sits on a chair with the lower arm supported as before.  The blood pressure cuff is placed on the patient right arm, allowing 1 inch between the bottom of the cuff and the crease of the elbow.    The brachial pulse is palpated just above the angle of the elbow (the "antecubital fossa"). then place on a stethoscope, with the earpieces on the headpiece angled forward. The recording end of the stethoscope is twisted, so that the diaphragm and not the bell is activated.  This can be tested by tapping lightly on the diaphragm . Blood Pressure -Auscultatory Method

12. The diaphragm is placed over the brachial artery in the space between the bottom of the cuff and the crease of the elbow. At this point no sounds should be heard.  The cuff pressure is inflated quickly to a pressure about 30 mm Hg higher than the systolic pressure determined by the method of palpation.  Then the air is let out of the cuff at a rate such that cuff pressure falls at a rate of about 5 mm Hg/sec.  At some point the person listening with the stethoscope will begin to hear sounds with each heartbeat.  This point marks the systolic pressure. 

13. Auscultatory Method

14. The sounds are called Korotkoff sounds.  As the pressure is lowered further, the character of the Korotkoff sounds should change.  At some point, the sounds will disappear.  The pressure reading at this point gives the diastolic pressure.   The patient should now lie on his or her back for five minutes.  The systolic pressure and diastolic Sounds

15. 1 . First sound heard, sharp thud - systolic pressure 2. Soft, tapping, intermittent 3. Loud (not as loud as phase 1 ) 4. Low, muffled, continuous: start - 1 st   diastole 5. Disappears - 2 nd  diastole. Sounds

16. Hemoreceptors are sensitive to arterial levels of oxygen, carbon dioxide (CO2), and pH, and are located in the same region as the arterial Baroreceptors , in the carotid and aortic bodies and travel to the CNS via the same nerve bundles as the arterial baroreceptors . Hemoreceptors &Baroreceptors

17. Hormonal regulation

18. what are the hormones that regulate blood pressure? Epinephrine and nor epinephrine, hormones secreted by the adrenal medulla, raise blood pressure by increasing heart rate and the contractility of the heart muscles and by causing vasoconstriction of arteries and veins. Hormonal regulation

19. What is the most powerful hormonal regulator of blood pressure? Angiotensin II is a powerful vasoconstrictor, greatly increasing blood pressure. It also stimulates the release of ADH and aldosterone , a hormone produced by the adrenal cortex. Aldosterone increases the reabsorption of sodium into the blood by the kidneys. Hormonal regulation

20. Smoking. Being overweight or obese. Lack of physical activity. Too much salt in the diet. Too much alcohol consumption (more than 1 to 2 drinks per day) Stress. Older age. Genetics. Factors That Influence Blood Pressure

21. Hypertension is defined as blood pressure above 140/90, and is considered severe if the pressure is above 180/120. High blood pressure often has no symptoms. Over time, if untreated, it can cause health conditions, such as heart disease and stroke. Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure. Hypertension

22. Hypotension  is low blood pressure. Your blood pushes against your arteries with each heartbeat. And the pushing of the blood against the artery walls is called blood pressure. Having a lower blood pressure is good in most cases (less than 120/80). But low blood pressure can sometimes make you feel tired or dizzy. Hypotension

23. It is also referred to as postural hypotension Orthostatic hypotension  is a sudden drop in blood pressure when you stand from a seated or prone (lying down) position. You may feel dizzy or even faint.  Orthostatic  means an upright posture.  The systolic or diastolic pressure is drop( 20mmof hg) Orthostatic hypotension

24. Measurement of blood pressure

25. If Possible, the patient should be in a prone position. The bladder of the cuff should be about 40% of the circumference of the  thigh , and the length should be about 75% to 80% of this circumference. Normally, the systolic  blood pressure  in the legs is usually 10% to 20% higher than the brachial artery  pressure The cuff should be placed 2.5 cm(1inch)above the popliteal surface. Lower extremity blood pressure

26. Analog Blood Pressure and aneroid BP apparatus

27. Explain to the patient what you are about to do - even if the patient is unconscious. Ensure that the patient is comfortable, as relaxed as possible and not distressed. Note if the patient has had any medication that may alter the blood pressure. Any tight or restrictive clothing should be removed from the patient’s arm . The position of the patient is not as important as the position of the arm; this should be supported and should be level with the heart Procedure

28. Apply the cuff (inside the cuff is the bladder), make sure that the cuff is empty of air before applying; ensure the correct size cuff is used on the patients arm. The width of cuff should cover at least 40% of the arm circumference and the length should cover at least two-thirds of the arm (The centre of the cuff should cover the brachial artery . Make sure that you can see the sphygmomanometer and that it is in line with the heart. Palpate the brachial pulse and inflate the cuff until the pulse can no longer be felt. This will give an estimate of the systolic pressure. Deflate the cuff and re-inflate to 30mmHg higher than estimated

29. Position the stethoscope over the brachial artery and slowly deflate the cuff at 2-3mmHg per second. The first beating sound should be recorded; this is the systolic pressure. Continue to deflate the cuff; the last sound to be heard is the diastolic pressure. Record the blood pressure on the observation chart. Any abnormalities or irregularities should be documented and reported to the medical team. Before leaving the patient make sure any clothing removed is replaced and that the patient is comfortable. Electronic sphygmomanometer - the same procedure is carried out as above without the use of the stethoscope. Manufacturer’s guidelines should be followed and appropriate training completed.