Transcript Pulse and Blood Pressure

Pulse and Blood
Pressure
Vital Signs
• Vital Signs (VS) are the most
important measurements you
will obtain when you evaluate
or assess a client’s condition.
Chapter 9
2
• Abbreviation for temperature,
pulse, respirations is TPR
• Abbreviation for vital signs is VS
PULSE
• The wave of blood created by the
heart pumping, that travels along
the arteries.
Chapter 9
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Pulse Points
• Points where the
artery is between
the finger tips and a
bony area
• Felt with 2-3 fingers,
but never the thumb
A.
E.
B.
F.
C.
G.
D.
H.
Name these pulses.
Chapter 9
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Pulse Sites (Answers)
A. Temporal
B. Femoral
C. Popliteal
D. Posterior tibial
E. Carotid
F. Brachial
G. Radial
H. Dorsalis pedis
Back
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Pulse (cont.)
• Pulse sites most
commonly used:
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–
Radial pulse – located
inside the wrist, near the
thumb.
Brachial pulse – found in
the antecubital space of
the arm (the bend of the
elbow) in adults.
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Pulse (cont.)
• Pulse Sites (cont.)
–
Apical pulse –
auscultated with a
stethoscope on the
chest wall. The
pulse is found at
the apex of the
heart.
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Characteristics of a pulse
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•
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•
Rate
Rhythm
Volume
Bilateral Presence
Chapter 9
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Pulse Rate
• Pulse norms are 60 - 100 beats
per minute
• Pulses between 90 - 100 are in a
gray area - high normal
• Faster than 100 - tachycardia
• Slower than 60 - bradycardia
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Pulse Rhythm
Pulse Rhythm – the pattern
of the heartbeats.
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•
A client with an irregular
heartbeat (arrhythmia or
dysrhythmia) must be
measured a full minute to
determine the average rate.
When documenting pulse
rhythm, record as regular or
irregular.
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Pulse Volume (strength)
–
Pulse volume, or strength of the
pulse, can be measured with the
following scale:
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•
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0 – absent, unable to detect.
1 – thready or weak, difficult to palpate,
and easily obliterated by light pressure
from fingertips.
2 – strong or normal, easily found and
obliterated by strong pressure from
fingertips.
3 – bounding or full, difficult to obliterate
with fingertips.
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Pulse Volume
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•
A thready or weak pulse may
indicate decreased
circulation.
A bounding pulse may
indicate high blood pressure.
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Pulse
Bilateral Presence – pulses should
be found within the same areas on
both sides of the body and have
the same rate, rhythm, and
volume.
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WHAT AFFECTS PULSE
RATES AND QUALITY
• Body Temperature
• Emotions
• Activity Level
• Health of the Heart
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Blood Pressure
(abbreviation B/P)
• Blood pressure is the force
of blood against the arterial
walls.
• Responsible for the flow of
blood.
• Blood pressure is the result
of:
- The pumping action of the
heart.
- Resistance of the blood
vessels.
- Volume of blood.
Blood pressure also depends on:
• Distance from the heart.
Would B/P in the legs be lower or higher
than in the arm?
Pumping Action of the Heart
• Systolic PhaseSystole
• Atria and
Ventricles
Contract
• Blood flows to
the body
Pumping Action of the Heart
• Diastolic Phase
– Diastole
• Heart relaxes
Blood Pressure is Elevated by:
• Sex and age of the
patient.
• Exercise, eating,
emotions
• Stimulants
• Obesity
• Arteriorsclerosis
• Diabetes
• Pain
• Heredity factors
• Some drugs
Blood Pressure is lowered by:
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Fasting
Rest
Depressants
Weight loss
Loss of blood or shock
Diuretics
Equipment for taking Blood
Pressure
–
Blood pressure is measured using a
sphygmomanometer, also called a
BP cuff, or cuff.
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Blood Pressure
–
Types of
Sphygmomanometers
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•
•
Mercury – has a calibrated glass
tube containing mercury.
Aneroid – has a calibrated dial
with a needle that points to
numbers on the face of the dial.
Electronic – uses a digital
display and usually includes the
pulse rate.
Chapter 9
Mercury
Aneroid
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Electronic
B/P measurement
• Measurement is done by listening for two
sounds with a stethoscope – the first
sound and the change in sound/or in some
instances the last sound.
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Blood Pressure
• The first sound is called the Systolic
blood pressure (SBP) –that is, the
pressure exerted on the arteries during
the contraction phase of the heartbeat.
• The change in sound/or the last sound
heard is the Diastolic blood pressure
(DBP) – the resting pressure on the
arteries as the heart relaxes between
contractions.
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Blood Pressure is:
• Recorded as an improper fraction. 120/80
• Numerator equals systolic pressure, the
first sound you will hear.
• Denominator equals diastolic pressure, the
last sound you will hear.
Blood Pressure Sounds are:
• Auscultated through a stethoscope
• Sounds are correlated with the readings
on a sphygmomanometer.
• Blood pressure is recorded in milligrams of
mercury. (mm HG)
Blood Pressure
• Expected Blood Pressure Values
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Expected SBP – 100 to 140 mm Hg.
Expected DBP – 60 to 90 mm Hg.
Hypotension – when the blood pressure
drops below expected levels.
Hypertension (high blood pressure) – SBP
greater than 140.DBP greater than 90
Prehypertension – classified by the American
Heart Association as SBP 120 to 139 mm Hg
or DBP 80 to 89 mm Hg.
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Blood Pressure
• Sites for Blood Pressure Assessment
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Brachial – taken on the upper arm; most
common site.
Radial – taken on the lower arm; possible site
for infants or clients who have very large
upper arms.
Popliteal – taken on the thigh.
Dorsalis pedis and posterior tibial – taken on
the lower leg.
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Equipment
Stethoscope
Stethoscope
Aneroid Sphygmomanometer
Aneroid Sphygmomanometer
•
•
•
Use the proper size cuff
Undersized cuff artificially raises blood
pressure
Oversized cuff artificially lowers blood
pressure
• The "ideal" cuff should have a bladder
length that is 80% and a width that is at
least 40% of arm circumference (a lengthto-width ratio of 2:1).
Mercury Sphygmomanometer
Positioning for BP
• Ideally have the
patient seated and
their arm at heart
level. Make sure that
they do not have any
tight clothing which
may constrict their
arm.
Locate the brachial pulse
• Palpate in the
antecubital fossa
for the point of
maximal pulsation
of the brachial
artery.
Positioning of Blood Pressure
Cuff
•
Cuff applied directly
over skin (not through
clothes)
–
•
•
Clothes artificially raises
blood pressure
Center inflatable
bladder over brachial
artery
Position lower cuff
border 1 inch above
antecubital space
Estimation of systolic pressure
• The examiner should
assess the estimated
systolic pressure. To do
this, palpate the patient’s
radial pulse. Now inflate
the cuff until you feel the
exact point when the
pulse disappears. The
point on the manometer
at this moment
represents the estimated
systolic pressure.
Assessment of systolic & diastolic
pressure
• Place your
stethoscope over the
brachial artery area.
Now inflate an extra
30mmHg worth of
pressure above the
estimate systolic
pressure (e.g. if the
estimate systolic
pressure was
120mmHg – inflate
the cuff to
150mmHg).
Korotkoff Sounds
• Now slowly release the pressure in the
cuff by using the valve.
• The pressure should be reduced at a rate
of 2-3mmHg per second. The point where
consecutive tapping noises (i.e. Korotkoff
phase 1) occur you should read off the
pressure on the manometer – i.e. the
systolic pressure.
• When the consecutive heart
beat sounds finally disappear
(i.e. Korotkoff phase 5), read
off the measurement on the
manometer. This represents
the diastolic pressure.
Trouble-shooting
• False high reading
- Cuff too small
- Cuff too loose
- Slow cuff release
- Column or dial not at eye level
- Anxiety or recent exercise
• False low reading
- Incorrect position of arm…be sure
to position at the level of the heart
- 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
Blood pressure values
• Systolic normal range 90 – 140
mm Hg
• Diastolic normal range 60 – 90
mm Hg
• Pulse pressure: difference
between
systolic & diastolic pressure,
approximately 40 mm Hg
• Blood pressure
readings…
• Use same arm for
readings
• Do not take B/P on
arm with:
• – An IV
• – Paralysis
• – Injury
• – A – V shunt
• – Edema