BLOOD PRESSURE - FUNDAMENTALS OF NURSING.pptx

Nursing

1. BLOOD PRESSURE

2. Blood pressure Blood pressure is the pressure exerted by the blood upon the walls of the blood vessels It is usually recorded in the arteries, where it is greater, during the contraction of ventricles than during the period in which the heart is relaxed The measurement indicates the height to which the blood pressure can raise a column of mercury in the sphygmomanometer

3. A blood pressure consists of two measurements Systolic pressure Diastolic pressure

4. The systolic pressure T he maximum pressure to which the arteries are subjected during left ventricular contraction of the heart T h e d i a s t o l i c p r e ss u r e T he r emai n ing p r e ss u r e within t h e ar t er i al system when the ventricles are relaxed & filling with blood The pulse pressure The difference between the systolic & diastolic pressure

5. Factors controlling Blood pressure 1. Blood volume Normally an adult has about 6 liters of blood in the circulatory system An inc r ease of t h e b l o o d v ol u me c a use s a n inc r ease o f b l o o d pressure, while a reduction causes a low blood pressure Loss of blood volume due to dehydration or hemorrhage results in a lowered systolic & diastolic pressure

6. 2. Cardiac out put Ca r d i ac ou t pu t i s t h e amo u n t of b l o o d ejec t ed f r o m t h e he a rt per minute during ventricular contraction Which increase cardiac output such as exercise & fe v er may increase the systolic blood pressure In hear t d isease w h en c a r d i ac ou t pu t de c r eases & s y s t ol i c p r e ss u r e may be lowered

7. 3. Peripheral Resistance Peripheral resistance is best defined as the opposing forces acting on the flow of blood within the blood vessels. Blood pressure, blood viscosity & vessel length have a direct impact on the amount of peripheral resistance.

8. 4 . Elasticity of the Arterial walls Arterial walls have some elasticity & during systole they distend to some extent & during diastole retract Ex : arteriosclerosis is a condition in which that arteries lose much of their elasticity & become rigid as the result, the systolic pressure is elevated

9. Arteriosclerosis

10. Arteriosclerosis The thickening, hardening, and loss of elasticity of the walls of arteries

11. Factors affecting blood pressure E x e r cise – C a r dia c ou t pu t i nc r eases a n d henc e the blood pressure also increases Age – blood pressure increases with the age Ex : Atherosclerosis Sex – women usually have a lowered blood pressure than men Emotional & physical stress – emotions such as anxiety, pain, fear & physical stress can also increases the blood pressure Emotions stimulate the sympathetic nervous system & that results in increased cardiac output & vasoconstriction of the arterioles

12. Factors affecting blood pressure Hor m o ne s – v ar i a t i on s i n bloo d p r es s u r e m a y b e m a n i f e s t ed as person’s ages because of normal alterations Medications – depending on their pharmacological actions certain medication can increase the blood pressure P o si t ion – b l o o d p r es s u r e t en d s t o b e l ow er when i n a p r o n e or supine position than sitting or standing

13. Medications Raise Blood Pressure. NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve fever, pain, and inflammation. - Aspirin, Ibuprofen, Naproxen. Birth control pills with estrogen. Steroids. Decongestants - a type of medicine that can provide short-term relief for a blocked or stuffy nose (nasal congestion).

14. Steroids Synthetics drugs that resemble natural hormones made in the body The type of steroids that are misused are anabolic androgenic steroids (AAS) Which copy the effects of the male hormone, testosterone. People use AAS to build muscle or increase strength.

15. Steroids tablets and liquids – such as prednisolone. inhalers – such as beclometasone and fluticasone. nasal sprays – such as beclometasone and fluticasone. injections (given into joints, muscles or blood vessels) – such as methylprednisolone. creams, lotions and gels – such as hydrocortisone skin cream.

16. Average blood pressure according to the age Age Average BP New born 40mm/Hg – systolic 1 month 85 – 54mm/Hg 1 year 95 – 65mm/Hg 6 year 105 – 65mm/Hg 10 – 13 years 110 – 65mm/Hg 14 – 17 years 120 – 80mm/Hg 18 years 120 – 80mm/Hg

17. Assessing blood pressure For blood pressure measures we used Sphygmomanometer Stethoscope Cuffs Different size cuffs are available. Special attention should be paid to the use of proper cuff width in relation to the size of the arm

18. Sphygmomanometer

19. Cuffs

20. GLOSSARY The bladder is the inflatable bag inside of double layers of material of the BP cuff

21. Tourniquet A device, such as a strip of cloth or a band of rubber, that is wrapped tightly around a leg or an arm to prevent the flow of blood to the leg or the arm for a period of time. A tourniquet may be used when drawing blood or to stop bleeding after an injury.

22. Mid Arm Circumference

23. Preparation for measurement B e f o r e the b l oo d p r es s u r e meas u r eme n t beg i n s t h e f ol lo wi n g conditions should be met Empty the bladder Painful procedures & exercise should not have occurred within one hour Sh o ul d h a v e r em o v ed o u t er g arme n ts & all o t he r tig h t cl o thes upper right arm is bare Blood p r essu r e s houl d b e meas u r ed i n a qui t e r oo m with comfortable temperature Time of the day should have been recorded Record the BP relevant document

24. Position of the patient Measurements should be taken in sitting position so that the arm & back are supported. Feet should be resting firmly on the floor

25. Position of the arm The measurements should be made on the right arm whenever possible The patient’s arm should be resting on the desk so that the ante cubital fossa ( a triangular cavity of the elbow joint that contains a tendon of the biceps, the median nerve, & the brachial artery ) is at the level of the heart & palm is facing up By using a pillow, the patient must always feel comfortable

26. The Ante Cubital Fossa

27. Selection of the cuff Select the correct cuff should be placed on the right arm so that its bottom edge is 2 – 3cm above the ante cubital fossa

28. The pulse rate & the blood pressure measurement The radial pulse is palpated and counted, whether pulse was regular The monometer should be placed so that the scale is at eye level & the column perfectly vertical. Mercury column has to be at zero level

29. Determining the peak inflation level The mercury column has to be at zero level Radial pulse is palpated The cuff is inflated & the level of the top of the mercury column is noted at the point. When the radial pulse disappears. The cuff is immediately deflated by completely opening the value The brachial pulse is located & the bell of the stethoscope ( diaphragm )is placed immediately below the cuff at the point of maximum pulsation

30. The pressure should be reduced steadily at this rate until the occurrence of the systolic level at the first appearance of a clear, repetitive tapping sound, and diastolic level at disappearance of repetitive sounds have been observed Then the cuff should be rapidly deflated by fully opening the value of the inflation bulb The measurements should be recorded

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