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Blood Pressure

Blood Pressure. Bell Work. What would you call a pulse rate that is difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood? Pulse rate in excess of 100 bpm is called? What is the normal range for O2 saturation?

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Blood Pressure

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  1. Blood Pressure

  2. Bell Work • What would you call a pulse rate that is difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood? • Pulse rate in excess of 100 bpm is called? • What is the normal range for O2 saturation? • What is the normal range of respirations? • How long do you take an apical pulse?

  3. Review • TPR • O2 Sats/Pain Scales • Abbreviations/Medical Terminology

  4. Important Terminology • Blood Vessels - a tubular structure carrying blood through the tissues and organs; arteries, veins, and capillaries are all blood vessels. • Arteries – Carry blood away from the heart • Veins – Carry blood back to the heart • Capillaries – Tiny blood vessels, where exchange of materials occurs, connects an artery and a vein

  5. Medical Therapeutics Standard 10) Demonstrate an understanding of basic medical terminology in order to monitor patient/client status through:      a. History and Physical including but not limited to: family, environmental, social, and mental history     b. Brief Head to Toe Assessment noting normal vs. abnormal findings     c. Vital Signs Assessment (VS)    d. Height/weight, BMI /Calculation    e. Specimen Collection 

  6. Objectives By the end of class students will be able to: • Explain the purpose of blood pressure • Know correct supplies and method to obtain a patient’s blood pressure • Understand the Blood pressure Dial

  7. Blood Pressure Blood Pressure is “the measurement of the pressure that the blood exerts on the walls of the arteries during various stages of heart activity”.

  8. Blood Pressure • Force /surface area = Blood Pressure • Measured in Millimeters of Mercury (mmHg), ex 120/80 • Measuring the Brachial Artery from your arm • Systole – top Number (heart is squeezing/contracting) • Diastole – Bottom number (heart is refilling/relaxing)

  9. Understanding Blood Pressure • https://www.khanacademy.org/science/health-and-medicine/circulatory-system#blood-pressure-ddp

  10. Taking A Blood Pressure Materials you will need: • Blood Pressure Cuff (sphygmomanometer) • Stethoscope

  11. BLOOD PRESSURE • Measured using device called sphygmomanometer and a stethoscope. • Upper number (numerator) called the Systolic blood pressure. • Lower number (denominator) called the Diastolic blood pressure.

  12. Sphygmomanometer dial Larger lines represent values of 20mmHg Medium lines represent values of 10mmHg Each small line is 2mm Hg Cannot have odd numbers on manual pressure

  13. MEANING IN PARTS • “sphygmo” – pulse • “mano”- pressure • “meter”- measure

  14. Three types • Mercury- a calibrated glass cylinder that contains mercury • Aneroid- a calibrated dial with a needle that points to numbers on the face of the dial ;pressure increases - needle moves around the dial to a higher number • Electronic-digital display

  15. Step by Step Step 1 - Choose the right equipment: 1. A quality stethoscope 2. An appropriately sized blood pressure cuff . Step 2 - Prepare the patient: The patient should sit upright with their upper arm positioned so it is level with their heart and feet flat on the floor. Remove excess clothing that might interfere with the BP cuff or constrict blood flow in the arm. Be sure you and the patient refrain from talking during the reading.

  16. Preparing the Patient • Make sure all equipment is clean. • Wash hands. • Identify patient • Position arm so it is comfortable and close to level of the heart. • Roll up patient sleeve, wrap cuff around upper arm.

  17. Step by Step Step 3 - Choose the proper BP cuff size: Most measurement errors occur by not taking the time to choose the proper cuff size. Wrap the cuff around the patient's arm and use the INDEX line to determine if the patient's arm circumference falls within the RANGE area. Otherwise, choose the appropriate smaller or larger cuff. 2 fingers should fit underneath.

  18. Step by Step Step 4 - Place the BP cuff on the patient's arm: Palpate/locate the brachial artery and position the BP cuff so that the ARTERY marker points to the brachial artery.  Wrap the BP cuff snugly around the arm. Step 5 - Position the stethoscope: On the same arm that you placed the BP cuff, palpate the arm at the antecubital fossa (crease of the arm) to locate the strongest pulse sounds and place the bell of the stethoscope over the brachial artery at this location.

  19. Palpate then Listen • Find brachial artery with fingertips. Place stethoscope over artery. • Put earpieces in ears. • AUSCULTATION=LISTENING WITH STETHOSCOPE

  20. Using your Stethoscope • Stethoscope • Chest piece: end to patient • Diaphragm: flat side • Bell: curved side (not present on all types) • Earpieces: one in each ear of person taking blood pressure. • Should be pointed forward • Tubing: Should be free of kinks

  21. Step by Step Step 6 - Inflate the BP cuff: Begin pumping the cuff bulb as you listen to the pulse sounds. When the BP cuff has inflated enough to stop blood flow you should hear no sounds through the stethoscope. The gauge should read 30 to 40 mmHg above the person's normal BP reading. If this value is unknown you can inflate the cuff to 200 mmHg. (If pulse sounds are heard right away, inflate to a higher pressure.)

  22. Taking Blood Pressure • Close valve on rubber bulb of cuff • Inflate cuff to 200 mmHg for an adult. • Open bulb valve SLOWLY so air escapes gradually.

  23. Step by Step • Step 7 - Slowly Deflate the BP cuff: Begin deflation. The AHA recommends that the pressure should fall at 2 - 3 mmHg per second, anything faster may likely result in an inaccurate measurement.  • Step 8 - Listen for the Systolic Reading: The first occurrence of rhythmic sounds heard as blood begins to flow through the artery is the patient's systolic pressure. This may resemble a tapping noise at first.

  24. Step by Step • Step 9 - Listen for the Diastolic Reading: Continue to listen as the BP cuff pressure drops and the sounds fade. Note the gauge reading when the rhythmic sounds stop. This will be the diastolic reading. • Step 10 - Double Check for Accuracy: The AHA recommends taking a reading with both arms and averaging the readings. To check the pressure again for accuracy wait about five minutes between readings. Typically, blood pressure is higher in the mornings and lower in the evenings.

  25. Taking a Blood Pressure • Note gauge reading when first sound is heard. This is SYSTOLIC pressure. • Continue to release air slowly. DIASTOLIC pressure in adults= point where sound becomes very faint/stops. • Rapidly release remaining air.

  26. Systolic and Diastolic Blood Pressure • Systolic: pressure that occurs in the walls of the arteries when the left ventricle is contracting and pushing blood into the arteries. • Normal SBP is <120. • Diastolic: constant pressure in the walls of the arteries when the left ventricle is at rest. Blood has moved to the capillaries and veins. • Normal DBP is <80.

  27. MEASURING BLOOD PRESSURE

  28. Taking a Blood Pressure • Documentation: • Systolic / Diastolic • “Sky-over-dirt” • Should always document date, time, and include signature of who read it, and their title (RN, CNA, LPN, etc) • Evaluation: Is this within normal range? Why or Why not?

  29. Practice Video https://www.youtube.com/watch?v=bHXvhOQ0hYc

  30. Exit Ticket • 1. What is blood pressure measuring? • 2. Tell me what the top number and bottom number mean. • 3. Something you need more clarification on/don’t understand

  31. Bell Work 1. What is the heart doing in systolic pressure? 2. What is the heart doing in diastolic pressure? 3. When taking BP, when is the systolic pressure heard? 4. When taking BP, when is the diastolic pressure heard?

  32. Blood Pressure: Day 2 Objectives • Charting Blood Pressure • BP ranges • Influencing factors, Hypertension vs. Hypotension

  33. Documentation • Blood pressure is recorded as a fraction. It is written systolic reading/diastolic reading.

  34. CHARTING • Chart in order: temperature - pulse – respiration – blood pressure. • Do not write T =, etc. • Number for temp with no route designation=oral

  35. Blood Pressure Ranges • Hypotension is 90/60 or below • Normal 120/80 up to 139/89 • Hypertension 140/90 and up

  36. Blood Pressure Variations • Hypotension: low blood pressure, < 90/60 • Influencing factors: • Sleep • Depressant drugs • Shock • Excessive blood loss • Fasting • Hypertension: high blood pressure, > 140/90 • Influencing factors: • Anxiety • Stimulant drugs • Exercise  • Eating • Smoking

  37. CAUSES & S/S HYPOTENSION • Causes may include: • Medications • Illness • Injury  • dehydration • Signs & symptoms may include: • Dizziness / light-headedness  • Lethargy / fatigue / generalized weakness • might faint

  38. CAUSES & S/S HYPERTENSION • Hypertension is called the silent killer because there are often no symptoms.  • Causes may include:  • family history / high salt diet / overweight • emotional upset /physical pain • illness / medications / fluid overload • Some people might experience: • Headache / Pressure in the head / Tinnitis • General feeling of malaise

  39. CAUSES OF HTN-(CON’T) • Genetics: More prevalent in African Americans than other ethnicities • Age: More prevalent in middle-aged and elderly people than younger people • Body size: More prevalent in obese people than thinner people • Lifestyle: More prevalent in heavy drinkers than moderate to non-drinkers • Co-morbidities: People with diabetes, gout or kidney dx .

  40. Influencing Factors • Factors that influence blood pressure- • Force of heartbeat • Resistance of arterial system • Elasticity of the arteries • Volume of blood in the arteries

  41. blood pressure SHOULD NOT be taken on a particular arm • Blood clots: blood clot can form in veins. These clots usually develop in the lower leg, thigh, or pelvis, but they can also occur in the arm. • AV Shunt: abnormal connection or passageway between an artery and a vein. Used in kidney dialysis patients • Mastectomy: Removal of breast tissue d/t cancer

  42. Summary • Vital signs are major indications of body function. • Healthcare workers must use precise methods to measure vital signs to produce the most accurate results. • Healthcare workers need to be alert for abnormal findings so that they may report them to the correct team member.

  43. Scenario: Slide 1 A couple in their 50s is shopping in a mall, where a health fair is set up. You are a nurse participating at a booth offering blood pressure readings. After much coaxing, the woman persuades her husband to have his blood pressure taken. You obtain a reading of 168/94 mm Hg. The wife reacts strongly, saying, “I told you that your lack of exercise and overeating would catch up with you one day. How am I going to manage being a widow at such an early age?” The husband responds by saying, “Don’t worry about me. I’m just as healthy as ever, and I plan to live until I’m 99 years old. I’m sure there’s something wrong with that machine.” Both of them turn to you. The wife says, “Tell him it’s not the machine and that he isn’t taking care of himself!”

  44. Scenario Slide 2 • Identify possible interpretations of an isolated blood pressure reading of 168/94 mm Hg. List factors that may have affected the reading’s accuracy. • Analyze the man’s reaction to this situation. Indicate the teaching points about blood pressure that may be appropriate at this time. • Outline potential ways to deal therapeutically with the wife’s anxiety, describing possible verbal and nonverbal interactions.

  45. BLOOD PRESSURE STATIONS Work out BP in HALL (30 minutes) • TAKE two people’s blood pressure in hall

  46. EXIT TICKET 1. What is something you learned today? 2. Something you need more clarification on/don’t understand 3. Tell me the Ranges of BP HYPOTENSION NORMAL HYPERTENSION

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