measurement of blood pressure.ppt

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

measurement of blood pressure.ppt

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