VITAL SIGN : BLOOD PRESSURE AND ITS ALTERATIONS

Prepared By Mrs Bemina JA

Assistant Professor
ESIC College of Nursing
Kalaburagi
LEARNING OBJECTIVES

Define blood pressure

Explain the physiology of blood pressure
List out the factors affecting blood pressure
Discuss the alterations in blood pressure
Explain the measurement of blood pressure
INTRODUCTION
 Blood pressure is the result of two sets of forces
 – the force of the heart and the resistance of the
vessel walls
 – coming together to push the blood through the
body's circulatory system.
 As the heart beats, it exerts force on the blood,
increasing the overall blood pressure.
 As the heart relaxes between beats, there is less
force exerted onto the vessels and the blood
pressure lowers.
DEFINITION :
 It is the force exerted by circulating volume
of blood on walls of the blood vessels.

 The blood pressure decreases as blood moves

the arteries, arterioles, capillaries and veins.

 Generally it is the arterial pressure.

 Blood pressure: is the force required by the heart
to pump blood from the ventricles of the heart
into the arteries.
 It is measured in systolic and diastolic pressure.
Systolic pressure : it is known as the force to
pump blood out of the
Diastolic pressure: it is known as relaxation
period of the heart pump (ventricles ).
BLOOD PRESSURE

 SYSTOLIC PRESSURE: The peak of maximum

pressure exerted on the blood vessels during the
contraction of heart is known as systolic blood
pressure.
 DIASTOLIC PRESSURE: The minimum pressure
exerted on the blood vessel during the relaxation of
heart is known as diastolic blood pressure.
 PULSE PRESSURE: The difference between the
systolic and diastolic pressure is the pulse pressure.
 UNIT The standard unit for measuring blood pressure
is millimeters of mercury. (mm of Hg)
 The systolic and diastolic blood pressures together form
a patient's blood pressure, and blood pressure is written
as a ratio of systolic to diastolic pressure:
 120/80=systolic blood pressure /diastolic blood pressure
 These words, systole and diastole, refer to phases of the
cardiac cycle.
 Systole is the phase when blood is pushed out of the
heart and to the rest of the body (hence the higher blood
pressure), and diastole is the period in the heart when
the heart refills with blood.
PHYSIOLOGY OF BLOOD
PRESSURE
Cardiac output( CO)
 The amount of blood pumped by the heart ,
during one minute.
Stroke volume
 Volume of blood pumped by the ventricle of the
heart in one contraction.
Heart rate
 The rate at which blood is pumped by the heart.
 Cardiac output is equal to the stroke volume
multiplied by the Heart rate.
Peripheral resistance (R)
 • It is the resistance to blood flow.
 • It is related to the size as well as the smoothness of the blood vessel
walls.
 • The higher the resistance the higher the blood pressure.
Blood volume -500 ml
 As volume increases, pressure exerted on the blood vessels also will
increase.
Blood viscosity
If the blood gets thicker – the blood pressure also rises.
In Anemia - low RBC concentration- viscosity reduces.
Elasticity
• Normally the walls of the artery are elastic and distensible.
• Arterial distensibility prevents much fluctuation in blood pressure.
 Factors increasing blood pressure :
 1. Age: in older adults, the diastolic pressure often increase
as a result of the reduced compliance of the arteries.
 Age varies through out the life.
 AGE BLOOD PRESSURE
 Newborn 40 (mean)
 One year 95/65
 Six years 106/65
 10 -13 yrs 110/65
 14 -17 yrs 120/75
 Middle adult 120/80
 Older adult 140/90
Factors increasing blood pressure :
 2. Exercise: physical activity increase both the
cardiac output and hence blood pressure, thus, a rest
of 20 to 30 minutes following exercise is indicated
before the blood pressure can be reliably assessed.
 3. Stress: stimulation of the sympathetic nervous
system increases cardiac output and vasoconstriction
of the arterioles, thus increasing the blood pressure
reading, however, severe pain can decrease blood
pressure greatly and cause shock by inhibiting the
vasomotor center and producing vasodilatation.
 4. Obesity.
Factors increasing blood pressure :

 5. Sex: No difference ,after puberty , females usually have

lower blood pressure than males of the same age, this difference
is thought to be due to hormonal variations. After menopause ,
women generally have higher blood pressure than before.
 6. Medications: many medications may increase or decrease the
blood pressure.
 7. Disease process: any condition affecting the cardiac output,
blood viscosity, and or compliance of the arteries has a direct
effect on the blood pressure.
 8. Race Higher in African Americans
 Diurnal variation Lowest in early morning , gradually rises by
afternoon and peaks at evening.
ALTERATIONS IN BLOOD PRESSURE

Hypertension
 Persistently elevated blood pressure. Higher
than 140/90 mm of Hg.
Hypotension
 Systolic blood pressure falls to 90 mm of Hg
or below.
Orthostatic Hypotension
 Arterial pressure drops down suddenly when a
person stands up from sitting.
 Discovery of sphygmomanometer

 In 1881, Samuel Siegfried Karl Ritter von

Basch invented the sphygmomanometer.
 How did the sphygmomanometer get its name?
 The word "sphygmomanometer" (pronounced
sfig·mo·ma·nom·e·ter) was put together from the Greek
sphygmos, the beating of the heart or the pulse +
manometer, a device for measuring pressure or
tension.
 Mercury has a specific gravity of about 13.6, i.e. it is 13.6
times denser as compared to water and thus a comparable
water 
Von Basch’s sphygmomanometer
(1881)
Scipione Riva-Rocci and his
sphygmomanometer
Karl Samuel Ritter von Basch. Von Basch introduced
the aneroid manometer, which uses a round dial that
provides a pressure reading.
 A digital sphygmomanometer measures blood
pressure by detecting tiny pressure differences
in the brachial artery that result from systole
and diastole.
 Both mercury and aneroid
sphymomonometers work using the same
underlying principles and are both considered
manual since a practitioner with a stethoscope
is required to use it.
The stethoscope

 The stethoscope was invented in France in

1816 by René Laennec at the Necker-Enfants
Malades Hospital in Paris.
 It consisted of a wooden tube and was
monaural.
 Laennec invented the stethoscope because he
was not comfortable placing his ear directly
onto a woman's chest to listen to her heart.
Explanation on parts of stethoscope
 Diaphragm
 The diaphragm is round and circular in the cross-section.
 Its large and round section allows the medical professional
to hear a wider area of the patient body.
 This diaphragm has better sensing sound quality than a
bell.
 Generally, this diaphragm is made up of steel and directly
touches the body.
 So, there are chances of chill or coldness.
 To overcome this effect, some stethoscope comes with the
feature of no chill.
 This diaphragm allows touching the patient without any
discomfort.
Bell

 The circular section of the chest piece opposite

of the diaphragm is called a bell. It has a smaller
diameter than the diaphragm. Bell is responsible
for detecting low-frequency sounds only.
 It is useful to detect the sound of skinny patients.
 Bell has a non-chill ring which gives more
comfort to the patient when it is placed on a naked
area.
 Tubing

 Tubing is nothing but a soft & flexible line of

stethoscopes.
 It is made of Poly Vinyl Chloride.
 Its function is to transfer the sound of a heartbeat
from the chest piece to the ear of the user.
 Generally, a stethoscope comes with a single tube
and a double-lumen tube.
 The double-lumen tube divides into halves inside,
which create left and right paths. So, the user can
hear that sound with good efficiency and accuracy.
 Stem

 The stem is part of the stethoscope, which

connects tubing to the chest piece.
 Generally, the material of the stem is steel.
 Although, it is a joint of two-part.
 Its function is to allow the user to switch the
diaphragm or bell.
 It is done by simply rotating the chest piece.
Headset

 A headset is a combination of ear tips, ear

tubes, tension springs, & lumen tubing.
 This headset is an important part that ensures
to flow of the sound in a very efficient
manner without any disturbance in sound
quality.
 This headset forms very comfortably to the
user’s ear.
Ear tubes

 Ear tubes are the parts of stethoscopes & generally their

material is steel.
 It connects lumen tubing to the ear tips.
 Its function is to transfer the sound from the chest
piece to the user’s ear.
 The quality of sound is mainly dependent upon the
quality of the ear tube.
 It can accomplish by enhancing the accost design of the
stethoscope.
 The ear tube divides into left and right channels to
get a better sound quality.
Ear tips

 Ear tips are the part of the stethoscope that we

inserted into our ears.
 The material of the ear tips is rubber or silicone.
 These ear tips are connected to an ear tube to
transmit sound.
 Generally, a stethoscope comes with 3-4 different
types of ear tips.
 Choice of correct ear tips is very much
responsible for greater sound accuracy.
 MEASUREMENT OF BLOOD PRESSURE

 Auscultatory method
 Palpatory method
 Oscillometry method
 Invasive method
 Noninvasive method
 Continuous noninvasive techniques (CNAP)
 OSCILLATORY METHOD

 Used in long term measurement.

 It has a electronic transducer fitted to the tubing's to detect the blood flow instead of
stethoscope.
 Requires less skill.
 Oscillometry method
 • The pulsations induced by the artery are different: when the artery is compressed, no
pulsation is perceived by the device, then when the pressure decreases in the cuff, the artery
starts to emit pulsations: the pressure then measured on the device defines the maximal blood
pressure or systolic blood pressure.
 • During the pressure decrease in the cuff, the oscillations will become increasingly
significant, until a maximum amplitude of these oscillations defines the average blood
pressure.
 • Then, the oscillations can still be seen during the decrease of the pressure in the cuff, until
they disappear: the pressure then read on the device defines the minimal blood pressure or
diastolic blood pressure.
 • This method of measurement of the blood pressure is the oscillometric method. It is very
often used in the automatic device for the measurement of the blood pressure because of its
excellent reliability
 INVASIVE MEASUREMENT OF BLOOD PRESSURE

 By placing a needle in an artery.

 Commonly in radial, femoral , dorsalis pedis, or
brachial artery.
 The cannula must be connected to a sterile, fluid-
filled system, which is connected to an electronic
patient monitor.
 The advantage of this system is that pressure is
constantly monitored beat-by-beat, and a waveform
(a graph of pressure against time) can be displayed.
PROCEDURE PRELIMINARY
ASSESSMENT:
 Identify the patient by name
 Know the diagnosis, reason and frequency for
checking BP
 Know the previous measurements
 Assess the patients general and mental status-
postpone checking blood pressure if the
patient is emotionally upset, angry or in
exertion
PRELIMINARY ASSESSMENT:

 Assess the arms on which BP should be taken

 Avoid arms with intravenous infusion, injured
or diseased/edematous, arm with fistula or
shunt and at the side of radical mastectomy.
 Avoid defective apparatus
EQUIPMENTS REQUIRED
PREPARATION OF THE PATIENT

 Explain the procedure and gain the patients

confidence and cooperation
 Place the patient in comfortable position
either lying down with the arm resting on
the bed, keep a little away from the body or
sitting up with the arm supported on a table
at the level of heart.
PROCEDURE FOR MEASURING BP

 Check the working condition of the apparatus

 Wash hands
 Take the equipment to the bedside by placing it at the
forearm. Roll the sleeve of the shirt above elbow about
5 inches.
 Apply deflated cuff evenly over the brachial artery, the
lower edge being 2 inches above the anticubital fossa.
 The two tubes turning towards the palm away from the
anticubital fossa.
 The cuff should snugly fit on the arm
PROCEDURE FOR MEASURING
BP(cont…)
 Feel the radial pulse with finger tips
 Close the valve of the bulb of sphygmomanometer
and pump the air in the cuff at least 20 mm above
the point at which the radial pulsation disappears.
 Open the valve slowly letting the air escape very
slowly.
 Note the reading on the manometer where the
pulsation is first felt.
 This is known as systolic pressure.
 Release the air completely from the cuff.
Charecteristic of korotkoff sound
PROCEDURE FOR MEASURING
BP(cont…)
 Palpate the brachial artery with the finger tips.
 Place the diaphragm of the stethoscope on the
brachial pulse and the stethoscope should
hang freely from the ears taking care that it
doesn’t rub against any objects.
 Once again pump the air into the cuff at least
20 mm of Hg above the point at which the
radial pulsation disappears.
PROCEDURE FOR MEASURING
BP(cont…)
 Open the valve and let the air escape very slowly,
note the number on the manometer where the first
sound is heard – this is systolic pressure.
 Continue to release the air slowly, the sound
becomes louder and clearer.
 Note the point on the manometer where the
sound disappears.
 This is called diastolic pressure.
 Allow the air to escape and the mercury to fall
zero.
PROCEDURE FOR MEASURING
BP(cont…)
 Deflate the cuff completely.
 Disconnect the tubing and keep on the table.
 Then undo the cuff and roll it and keep safely inside
the case by paying special attention to keep the screw of
the bulb facing downwards so that it doesn’t come in
contact with the glass tube of the mercury and break it.
 Repeat the procedure if there is any doubt in the
reading, but not more than 3 times successively on the
same arm.
 Lock the apparatus.
 Document the reading.
 CONCLUSION
 Blood pressure is most accurately measured using
a mercury sphygmomanometer.
 Before measuring BP the patient should avoid
caffeine and tobacco smoke (up to 2 hours prior).
 Early detection of high blood pressure is critical in
the prevention of future cardiovascular and kidney
disease.
 EVALUATION MCQ’s
 1. The difference between the systolic and diastolic pressure
is termed as
• Pulse deficit
• Pulse pressure
• Blood pressure
• Pulses alternans
 2. An instrument placed against a patient's chest to hear both
lung and heart sounds.
• Stethoscope
• Otoscope
• Sphygmomanometer
• Telescope