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Blood Pressure

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  1. Blood Pressure

  2. Blood Pressure is… • The force exerted against blood vessel walls • Responsible for the flow of blood • The result of: • Pumping action of the heart • Resistance of the blood vessels • Volume of blood

  3. Pumping action of the heart… • Systolic phase • Systole • Ventricles contract • Blood Flows out of the heart

  4. Pumping action of the heart • Diastolic phase • Diastole • Heart relaxes

  5. Blood pressure is recorded… • As a fraction ie. 120/80 • Systolic pressure is the numerator • The first sound heard • Diastolic pressure is the denominator • The change of sound or the last sound heard

  6. Blood pressure sounds are… • Auscultated through a stethoscope • Sounds are correlated with the readings on a sphygmomanometer • Blood pressure is recorded in millimeters of mercury (mm Hg)

  7. Blood Pressure Variations… • Determine baseline • From medical record • Systolic palpated pressure • Hypertension • High blood pressure • Hypotension • Low blood pressure • Orthostatic hypotension • Decrease in B/P with position change (from supine to erect)

  8. Aneroid Sphygmomanometer • Use proper cuff width • Width should be approximately 80% of arm circumference • Place stethoscope under cuff at the brachial pulse location

  9. Mercury sphygmomanometer

  10. Korotkoff Sounds • Sounds auscultated while assessing BP • 5 phases • Phase I: first sound, sharp tapping sound – systolic pressure • Phase II: soft swishing sound • Phase III: rhythmic tapping sound • Phase IV: muffling/fading of tapping sound • Phase V: point at which all sounds disappear – diastolic pressure

  11. Trouble-shooting • False high reading • Cuff too small • Cuff too loose • Slow cuff deflation • Column or dial not at eye level • Poorly timed (anxiety, exercise, after eating) • Take BP first in infant or small child

  12. Trouble-shooting • False low reading: • Incorrect position of arm or leg • Position at heart level • Failure to notice auscultatory gap • Sounds fade out for 10 to 15 mm Hg then return • Inaudibility of low volume sounds • Column or dial not at eye level

  13. Normal, Low & High BP • Normal blood Pressure: Top number is consistently under 120 and bottom number under 80 • Low BP (hypotension): Top number lower than 90 or 25mm Hg lower than usual • Pre-high BP (pre-hypertension): Top number is consistently 120 – 139 or the bottom number reads 80 – 89 • Stage 1 high BP (hypertension): Top number is consistently 140 – 159 or the bottom number reads 90 – 99 • Stage 2 high BP (hypertension): Top number is consistently 160 or over or the bottom number reads 100 or over

  14. Blood pressure readings… • Use same arm for readings • Do not take BP on arm with: • An IV • Paralysis • Injury • A-V shunt • Edema

  15. Causes of high BP • Modifiable Risk Factors • Lack of exercise • Obesity • Excessive sodium • Tobacco • Alcohol • stress • Non-Modifiable Risk factors • Age (men over 45, women over 55) • Race • heredity