1. HOW TO MEASURE BP P.331 1.Position pt arm with palm up at heart level, exposing upper arm – measure directly on skin NOT over clothing!! 2.Feel for brachial artery on inner aspect of arm at bend of elbow 3.Apply cuff snugly directly over brachial artery (1 inch above antecubital area) 4.Put stethoscope into ears, position diaphragm over brachial artery 5.Inflate cuff to between 160 mm Hg and 180 mm HG 6.Deflate cuff slowly, listen for first regular sound heard (systolic pressure), note reading 7.Listen for very last sound heard (diastolic pressure), note reading; If rounding is needed, round UP to the nearest 2 mm HG 8.Record BP reading like a fraction ex. 126/82

2. BLOOD PRESSURE Mod E: Ch. 20

3. BLOOD PRESSURE (BP) P. 329 Measure of force of blood against artery walls Depends on: Blood volume (amount) Strength of heart – force of heartbeat Artery walls: less elastic = higher pressure Distance from heart – BP lower in legs than in arms Systolic: = working pressure; during contraction of ventricles, generally larger number, first sound heard Diastolic: = resting pressure; when ventricles relax, generally smaller number, last sound heard Ex. BP 120/80: Systolic 120, Diastolic 80 Average BP values p. 330! 6-18 years: 83 + (2x age) / 52 + age ex. 17 yr old: 117/69 Over 18 years: up to 120/80

4. WHAT CAN INCREASE BP Gender (male higher than female) Exercise Eating Stimulants: ex. Caffeine, nicotine, medications Emotions: ex. Anger, stress, fear, sexual activity Diseases: arteriosclerosis (hardening of arteries), high cholesterol, diabetes Pain Obesity Age

5. WHAT CAN DECREASE BP (P. 330) Fasting (not eating) Rest / sleep Depressants (sedatives): alcohol, medications, drugs, ex. Valium Weight loss Emotions: grief Fluid loss: dehydration, hemorrhage Shock

6. SPHYGMOMANOMETER P. 330 Used to measure blood pressure; clean before and after every pt use! May be electronic parts: Cuff Fits around patient’s arm Rubber bladder inside; should be 80% of arm circumference (choose correct size) Tubes (2) One is connected to bladder inside cuff Other is connected to pressure control bulb Pressure gauge Aneroid gauge (round) Column of mercury

7. STETHOSCOPE P.330 Magnifies sounds; parts: Bell/diaphragm Tubing Earpieces Clean before and after every patient use!

8. BP READINGS P. 332 Pulse pressure: difference between systolic and diastolic pressure; indicates health of arteries; average is 30-50 mm HG (ex. 120/80: pulse pressure 40) “Normal BP” between 100/60 and 120/80; ex. 115/76 ANY reading besides “Normal” needs to be reported to the nurse right away! Hypotension: under 100/60 ex. 95/42, 98/58 Prehypertension: 120-139 systolic and/or 80-89 diastolic ex. 128/86, 138/78 Hypertension: Stage I: 140-159 systolic and/or 90-99 diastolic ex. 156/96, 138/92 Stage II: >= 160 systolic and/or >= 100 diastolic ex. 168/102, 178/98

9. ORTHOSTATIC HYPOTENSION Also called “postural hypotension” Happens when BP drops due to position change (from lying to sitting and/or standing) Pt may be dizzy, light headed, severe cases loose consciousness Measure BP 3 times Lying Sitting Standing Systolic pressure drops 20 mm HG or more and/or Diastolic drops 10 mm HG or more ex.: lying 140/80, sitting 132/72, standing 108/60

10. CAUSES OF INACCURATE READINGS P.334 Wrong size BP cuff Improperly wrapped cuff Incorrect arm positioning Different arm for different readings Deflating cuff too slowly Mistaking auscultatory gap (sound goes away for 10-15 mm HG and then comes back)as diastolic pressure

11. HOW TO READ GAUGE P.334 Increments of 2 mm HG, long lines 10 mm Hg Mercury gauge: At eye level, not tilted At top of mercury column Aneroid gauge At eye level, not at angle

12. PULSE OXIMETERS P.334 Used to measure O2 saturation of blood Finger clip Don’t use on same arm as BP cuff May use arm with injuries or other tubes Report any reading below 95% to nurse ASAP

13. CAN’T USE ARM FOR BP WHEN When there is an IV line Implants Dialysis shunt Arm injury/ fracture, surgery Mastectomy side Oximeter Paralyzed or affected arm

14. HOW TO MEASURE BP P.331 1.Position pt arm with palm up at heart level, exposing upper arm – measure directly on skin NOT over clothing!! Do not use an arm with IV, pulse oximeter, dialysis access or any other tubes attached Burns, fractures, injuries, edema, paralyzed, paresis On same side as mastectomy or surgical upper body procedure 2.Feel for brachial artery on inner aspect of arm at bend of elbow 3.Apply cuff snugly directly over brachial artery (1 inch above antecubital area) 4.Put stethoscope into ears, position diaphragm over brachial artery 5.Inflate cuff to between 160 mm Hg and 180 mm HG 6.Deflate cuff slowly, listen for first regular sound heard (systolic pressure), note reading 7.Listen for very last sound heard (diastolic pressure), note reading; be mindful of auscultatory gap (sound goes away for 10-15 mm HG and then comes back) 8.If rounding is needed, round UP to the nearest 2 mm HG 9.Record BP reading like a fraction ex. 126/82 Procedure 40 p. 335

16. Homework: Read Unit 20 in Textbook p. 329-338 Workbook: p. 123 read Unit summary, Nursing assistant alert, Do questions: 17 (readings) all, True/False (all)