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

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

Pulse Points Name these pulses. A. B. D. E. F. C. G. H. Points where the artery is between the finger tips and a bony area Felt with 2-3 fingers, but never the thumb Name these pulses. . Chapter 9

Pulse Sites (Answers) A. Temporal B. Femoral C. Popliteal D. Posterior tibial E. Carotid F. Brachial G. Radial H. Dorsalis pedis Back Chapter 9

Pulse (cont.) Pulse sites most commonly used: 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. Chapter 9

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. Chapter 9

Characteristics of a pulse Rate Rhythm Volume Bilateral Presence Chapter 9

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 Chapter 9

Pulse Rhythm Pulse Rhythm – the pattern of the heartbeats. 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. Chapter 9

Pulse Volume (strength) Pulse volume, or strength of the pulse, can be measured with the following scale: 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. Chapter 9

Pulse Volume A thready or weak pulse may indicate decreased circulation. A bounding pulse may indicate high blood pressure. Chapter 9

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. Chapter 9

WHAT AFFECTS PULSE RATES AND QUALITY Body Temperature Emotions Activity Level Health of the Heart Chapter 9

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 Phase-Systole 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: 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. Chapter 9

Blood Pressure Types of Sphygmomanometers Mercury Aneroid Electronic 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. Mercury Aneroid Electronic Chapter 9

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. Chapter 9

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. Chapter 9

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 SBP – 100 to 140 mm Hg. Expected Blood Pressure Values 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. Chapter 9

Blood Pressure Brachial – taken on the upper arm; most common site. Sites for Blood Pressure Assessment 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. Chapter 9

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 length-to-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 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

systolic & diastolic pressure, 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