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7/27/2019 Measurement of Blood Pressure.ppt
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Measurement of Blood
Pressure
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Blood Pressure
Definition:The force exerted by
the blood against the blood
vessel wall. The highest
pressure in the cycle is the
systolic blood pressure and thelowest is the diastolic.
BP = Heart Rate x Total
Peripheral Resistance*
* blood volume, viscosity,
vessel elasticity
sympathetic activity,
kidney function
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Blood pressure
Blood Pressure is the force of blood
pushing against the walls of the arteries
as the heart pumps out blood.
When this pressure rises and stays
that way over time, it can damage the
body in many ways.
Pressure occurs when the flow is met
by resistance from blood vessel walls
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Laminar Flow
Blood flows faster in the
center of a blood vessel,
because the blood near the
sides are hitting the walls of
the vessels.
Is caused by the friction
(resistance) between the
blood and the vessel walls.
Value depends on 3 factors:
cardiac output
diameter of arteries
the quantity of blood
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Blood Flow
Normal blood flow velocity 0,5 m/s 1 m/s (Systolic, large vessel)
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Diastolic Systolic
Definition
It is the pressure that is exerted
on the walls of the various
arteries around the body in
between heart beats when theheart is relaxed.
It measures the amount of
pressure that blood exerts on
arteries and vessels while theheart is beating.
Normal range
60 80 mmHg (adults); 65
mmHg (infants); 65 mmHg (6 to
9 years)
90 120 mmHg (adults); 95
mmHg (infants); 100 mmHg (6 to
9 years)
Importance with age
Diastolic readings are
particularly important in themonitoring blood pressure in
younger individuals.
As a person's age increases, so
too does the importance of theirsystolic blood pressure
measurement.
Blood Pressure
Diastolic represents the
minimum pressure in the
arteries.
Systolic represents the maximum
pressure exerted on the arteries.
Ventricles of the heart Fill with blood Left ventricles contract
Blood Vessels Relaxed Contracted
Blood Pressure
reading
The lower number is diastolic
pressure.
The higher number is the systolic
pressure.
Etymology
"Diastolic" comes from the
Greek diastole meaning "a
drawing apart."
"Systolic" comes from the Greek
systole meaning "a drawing
together or a contraction."
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Systolic Pressure
Systolic pressure is the maximum pressureexerted by the blood against the artery walls.
It results when the ventricles contract.
Normally, it measures 120 mm Hg.
Systolic
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Diastolic Pressure
Diastolic Pressure is the lowest pressure in the
artery.
It result when the ventricles are relaxed and is
usually around 80 mm Hg.
Diastolic
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Types of Measuring
Invasive
Non-Invasive
Blood Pressure Blood Flow
Palpatory Method(Riva-Rocci Method)
Auscultatory Method
Ultrasonic Method
Oscillometric Method
Tonometry
Extravascular Sensor
Intravascular Sensor
Ultrasound Doppler
Laser Doppler Flowmetry
Dye Dilution Method
Thermal Dilution Method
Strain Gage Plethysmography
Electric-Impedance Plethysmogr.Photoelectric Plethysmography
Radioisotopes
Thermal Convection Probes
General on
System Parameters
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Equipment
Aneroid
Oscillometric
Hybrid
Mercury (used only for accuracycheck in MI)
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Continuing MedicalImplementation 3
RECOMMENDED BLOOD PRESSURERECOMMENDED BLOOD PRESSURE
MEASUREMENT TECHNIQUEMEASUREMENT TECHNIQUE
2.
The cuff must be level with heart.
If arm circumference exceeds 33 cm,a large cuff must be used.
Place stethoscope diaphragm over
brachial artery.
2.2. The cuff must be level with heart.The cuff must be level with heart.
If arm circumference exceeds 33 cm,If arm circumference exceeds 33 cm,a large cuff must be used.a large cuff must be used.
Place stethoscope diaphragm overPlace stethoscope diaphragm over
brachial artery.brachial artery.
1.
The patient shouldbe relaxed and the
arm must besupported.
Ensure no tight
clothing constricts
the arm.
1.1. The patient shouldThe patient should
be relaxed and thebe relaxed and the
arm must bearm must besupported.supported.
Ensure no tightEnsure no tight
clothing constrictsclothing constricts
the arm.the arm.
3.
The column ofmercury must be
vertical.
Inflate to occlude thepulse. Deflate at 2 to
3 mm/s. Measure
systolic (first sound)and diastolic
(disappearance) tonearest 2 mm Hg.
3.3.
The column ofThe column ofmercury must bemercury must be
vertical.vertical.
Inflate to occlude theInflate to occlude thepulse. Deflate at 2 topulse. Deflate at 2 to
3 mm/s. Measure3 mm/s. Measure
systolic (first sound)systolic (first sound)and diastolicand diastolic
(disappearance) to(disappearance) tonearest 2 mm Hg.nearest 2 mm Hg.
StethoscopeStethoscope
MercuryMercury
machinemachine
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Korotkoff Sounds First Phase
A clear tapping sound; onset of the soundfor two consecutive beats is considered
systolic
Second Phase
The tapping sound followed by a murmur
Third Phase
A loud crisp tapping sound
Fourth Phase
Abrupt, distinct muffling of sound,
gradually decreasing in intensity
Fifth Phase
The disappearance of sound, is
considered diastolic blood pressure- two
points below the last sound heard
200180160140120100
806040200
No sound
Clear sound
Clear sound
Muffled sound
No sound
Phase 1
Phase 3
Phase 4
Phase 5
Muffling Phase 2Auscultator
y gapNo sound
mm Hg
Korotkoff sounds
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Steps for Measuring BP
Seated for 5 minutes Patient Position
Expose Upper arm
Center of upper arm at heart level
Cuff applied 1 inch above crease at elbow
Locate brachial artery
Palpate radial pulse
Inflate cuff until pulse disappears
Let air out
Place stethoscope on brachial artery
Pump up cuff to 20-30 above point of obliteration
Let air out at 2 mmHg per second
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cont.
Note 1st and 5th Korotkoff sounds
Chart:
#s
Position
Arm used
Cuff size
Normal, pre-hypertension, stage 1 hypertension, orstage 2 hypertension
Recommendations of whats next
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Common errors made inblood pressure measurement:
Choosing wrong size cuff
Taking only 1 reading
Deflating cuff too quickly
Gauge not at eye level Not obtaining Estimated Systolic
Not hearing true sounds/distracted
Cuff not applied correctly
(e.g.. over sleeve) or client position incorrect
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BP Categories for
Diagnosis and Treatment
* Taken from JNC 7, (JAMA, 2003;289:2560-2572)
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Also consider the ABCS
Aspirin
Cholesterol
Blood Pressure
No Smoking
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Aspirin
Recommend the use of aspirin formen ages 45 to 79 years old whenthe potential benefit due to a reduction in MI (myocardial infarction)outweighs the potential harm due to an increase in gastrointestinalhemorrhage.
Recommend the use of aspirin forwomen ages 55-79 years when thepotential benefit of a reduction in ischemic stroke outweighs thepotential harm of an increase in gastrointestinal hemorrhage.
MQIC April 2011
http://www.uspreventiveservicestaskforce.org/uspstf09/aspirincvd/aspcvdsum.htm
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Cholesterol
Total cholesterol level- optimal level is less than 200 mg/dl
LDL (bad cholesterol) optimal level is less than 100 mg/dl
HDL (good cholesterol) optimal level is more than 40mg/dl
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BP Lowering Tactics
Stop Smoking
Reduce Weight
Exercise
Low salt
Low protein No caffeine
Mild sedation
Sufficient rest
Dont oversleep
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Thank You