Transcript Blood pressure measurement

Blood pressure measurement
PHCL 326 (1+1)
Clinical skills for pharmacists
Overview
• JNC VII classification.
• Blood Pressure measurement techniques.
• Pulse measurement techniques.
JNC VII classification
BP classification
SBP (mmHg)
DBP (mmHg)
Normal
< 120
And < 80
Prehypertension
120 – 139
Or 80-89
Stage 1
Hypertension
140 – 159
Or 90 – 99
Stage 2
Hypertension
>= 160
Or >= 100
Blood Pressure measurement
• Office BP measurement:
Two readings, 5 minutes apart, sitting.
• Ambulatory BP monitoring:
For white coat hypertension.
• Self-measurement of BP:
Information on response to therapy, may improve
adherence to therapy.
• Devices: Aneroid. Mercury. Electronic.
Blood Pressure measurement
Devices
• Features:
1- Ease of use.
2- Cost.
3- Accuracy.
4- Memory.
Electronic > Aneroid > Mercury
Electronic > Mercury > Aneroid
Mercury > Aneroid > Electronic
Electronic only.
Time of measurement
• Use multiple readings at different times
during the waking hours of the patient.
• For patient taking antihypertensive
medications monitoring of blood
pressure should be done before taking
the scheduled dose.
Factors that affect BP measurement
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Smoking.
Caffeine.
Cuff size.
Pain.
Medication use.
Patient position
• BP should be measured in sitting
position. Patient should sit for 5 minutes
before measuring BP.
• In elderly, supine and standing position
can be used to detect postural
hypotension.
Measurement of BP in the clinic
From www.images.md
Selecting the most accurate blood
pressure cuff
From www.images.md
Selecting the most accurate blood
pressure cuff
Blood pressure cuff sizes, arm circumference ranges, and bladder widths and lengths
CUFF SIZES
ARM CIRCUMFERENCE RANGE BLADDER WIDTH, cm
AT MIDPOINT, cm
BLADDER LENGTH, cm
Newborn
Infant
Child
Small adult
Adult
Large adult
Adult thigh
>6
6-15
16-21
22-26
27-34
35-44
45-52
6
15
21
24
30
38
42
3
5
8
10
13
16
20
From www.images.md
Selecting the most accurate blood
pressure cuff
• The length of the bladder should
be at least 80% of the
circumference of the upper arm.
• The width of the bladder should be
approximately 40% of the
circumference of the upper arm.
Where to listen for blood pressure
sounds
1- Locate the antecubital fossa of
the patient’s arm and palpate the
brachial artery. This location is
the point over which the
stethoscope is placed to listen for
Korotkoff sounds later.
2- Wrap the cuff approximately
2.5 inch above the antecubital
fossa.
From www.images.md
Determining the palpated systolic
pressure and the maximum inflation level
3. While palpating the radial
pulse, inflate the cuff until
you feel the radial pulse
disappear.
Note the pressure on the
manometer at this point and
rapidly deflate the cuff.
From www.images.md
Measurement of BP
4- Place the stethoscope lightly over the brachial
artery and inflate the cuff to a pressure 30 mm Hg
greater than estimated systolic pressure.
5- Deflate the cuff slowly at a rate of 2 mm Hg per
heartbeat.
6- Systolic pressure equal the pulse first heard by
auscultation
Measurement of BP
7- Deflate the cuff until the sounds become muffled
and then disappear. The disappearance of
sound estimate the diastolic pressure.
8- Record the blood pressure reading in even
numbers. Note patient’s position, cuff size, and
arm used for measurement.
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