STA: BP

describe how you find the brachial pulse

Palpate. On pinky finger/fifth finger side of the antecubital side of the elbow. Take hand, go down from fifth finger and usually on the outer aspect of that area, but can be on medial (middle) part of elbow instead of out to the side

Korotkoff sounds III (Korotkoff sounds)

crisp, loud sounds as blood flows through an opening artery

clinical depression (factors that decrease blood pressure)

decreases blood pressure. Personn that experiences this can have decrease in blood pressure

auscultatory gap

this may occur in latter part phase I and during phase II. Is absense of Korotkoff sounds noted in some patients after intial systolic blood pressure. Gap may cover range as wide as 40 mm/Hg. Failure recognize this may lead to major errors in measure blood pressure

when recording BP, what does the top number and the bottom number of the reading represent?

top number: systolic blood pressure bottom number: diastolic blood pressure

pain (factors that increase blood pressure)

when in pain, blood pressure increases

measuring blood pressure

when taking blood pressure of patient do not ever use arm with IV, arteriovenus/AV shunt indicating patient is hemodialysis patient which how access cardiovascular system through shunt, cast difficult hear through cast and palpate pulse If patient had previous brease surgery, take on other side. Patient may have difficulty with circulation in arm of side where had surgery and swelling so if had surgery on breasts must take BP on opposite side of the breast the surgery took place on. Differ to what told by physcian because patient's most educated on arm use and information needed on which arm to use so doesn't skew the results room should be quiet especially when beginning so can clearly hear diastolic and systolic blood pressure support arm at heart level blood pressure usually assessed in arm at brachial artery When get stethoscope, will palpate arter they will ausculate. When use stethoscope are ausculating/listening. Can't hear brachial pulse without blood pressure cuff that's pumped up to hear blood flow at point Systolic reading is first sound heard as air released, loudest. Diastolic blood pressure is last sound heard as air released, quiet. May hear sound go away. Also, may be when cahnges to soft muffled sound and won't be as loud. Record diastolic BP at point change is heard. Is point when goes away/muffles

age (factors that increase blood pressure)

with age, elasticity in arteries decrease; this peripheral resistance, leading to higher blood pressure as person advances in age, arteries not as pliable. Become tougher/get harder (hardening of the arteries). Not as bendable as used be because older. Heart pumps heart to get blood through arteries. As age increases, blood pressure increases.

name the location you place the BP cuff on the arm

1 inch above the brachial artery

If you need to repeat the procedure, how long will you wait?

1 minute then take again with stetoscope after estimating through palation. If need to recheck the whole thing, still wait at least one minute

List the 5 impotant steps that are performed prior to any patient procedure.

1. Introduce yourself. 2. Perform hand hygeine and put on PPE, if indicated. 3. Identify the patient. 4. Close the curtains around the bed and close the door the the room, if possible. Discuss the procedure with the patient and asses patient's ability to assist with the procedure. Validate that the patient has relaxed for several minutes. 5. Put on gloves, if indicated.

how do you inflate the cuff?

About 30 above the estimated (don't forget about this because important to do and have to do this). If do 20-40 above estimated, that's good, so don't have to pump it more than necessary or needed

some meds/chemicals (factors that increase blood pressure)

Coffee: chemical in coffee is caffeine which will increase blood pressure; another chemcial, nicotine, will increase blood pressure decongestants will increase blood pressure; hormones possibly could increase BP. Oral contraceptives cause increase in blood pressure in some women

How does the nurse determine the appropriate size of BP cuff to use for a patient and why is this important?

Cuff sizes range from neonate to adult thigh sizes. Width of cuff should be at about 40% of circumference of extremity being used and bladder of cuff be about 60%-80% of curcumference of extremity being used. If cuff is too small, reading can be erroneously high - common source error is using normal size cuff on overweight person. Conversely, if cuff too large, reading can be erroneously low.

Define the normal BP range for adults.

Systolic: less than 120 mm/Hg Diastolic: less than 80 mm/Hg

Where is the most common site for assessing BP?

Upper arm at brachial artery

Korotkoff sounds IV (Korotkoff sounds)

a distinct, abrupt muffling sound

systole/systolic blood pressure

action happening - is contracting, pumping period of heart muscle *contraction* - heart is working/pumping/contracting/action happening systolic pressure is highest pressure represents amount of force takes *pump* blood out of heart into arteries. very first sound here when listening to blood pressure. When hear first swish shows heart working and contraction peak of the pressure wave. Top number.

factors that increase blood pressure

age strong emotions pain exercise some disease conditions some meds/chemicals gender race weight circadian rhythm head injury increase blood volume food intake

strong emotions (factors that increase blood pressure)

anxiety, fear, anger, and excitment. See increase in blood pressure/causes blood pressure to rise until emotion passes

palpation

assessment by feeling with the hand/fingers. By touch. Using pads of fingers, not tips of fingers, to push down.

alcohol wipe (equipment and supplies necessary to take blood pressure)

because sharing stethoscopes wipe of ear piece before and after use of stethoscope because don't know who used it before you

prehypertension

between 120-139 systolic blood pressure and/or between 80-89 diastolic blood pressure pre=before diagnosed with hypertension

food intake (factors that increase blood pressure)

blood pressure increases after eating

gender (factors that decrease blood pressure)

blood pressure more likely to be/is usually lower in woman than men until menopause

weight (factors that increase blood pressure)

blood pressure usually higher in people who are obese

circadian rhythm (factors that increase blood pressure)

blood pressure usually lower in morning and slightly higher in the late afternoon

some disease conditions (factors that increase blood pressure)

can increases blood pressure. EX: Kidney problems

hypertension

elevated blood pressure - elevated because hyper- part word; high or above normal *consistent* (must be taken over time in order to diagnosed with this) BP measurements above normal systolic pressure and/or diastolic pressure. If take BP several times over peiod days, in order to diagnosis this. Do 3 times each week for 2 weeks. Patient write down findings and report to nurse practitioner or physican. Maybe then can be diagnosed with this risk for stroke and lots other health conditions Systolic stage 1: 140-159 mm/Hg, diastolic: 90-99 Systolic stage 2: Greater than 160 mm/Hg, or diastolic: greater than 100 mm/Hg above or equal to 140 systolic pressure and/or above or equal to 90 diastolic pressure measurement in consistent BP measurements.

exercise (factors that increase blood pressure)

from rest-after exercise, blood pressure increases. From rest to after exercise blood pressure increases

diastole/diastolic blood pressure

heart resting/relaxing period of muscle *relaxation*/rest - heart relaxing/resting diastolic pressure is lowest pressure amount of pressure in arteries when heart is at *rest* bottom number of blood pressure measurement, lower number lowest pressure on arterial walls, lower than systolic.

race (factors that increase blood pressure)

hypertension more prevalent in African American men and women

resting/circadian rhythm (factors that decrease blood pressure)

in morning low blood pressure because just waking up. blood pressure usually lower in morning and slightly higher in the late afternoon

head injury (factors that increase blood pressure)

increase intracranial pressure from head injury causes increase in blood pressre

increase in blood volume (factors that increase blood pressure)

increased fluid in cardiovascular increases blood pressure

Korotkoff sounds I (Korotkoff sounds)

initial presentation of faint but clearly audible tapping sounds, which gradually increase intensity to thud/loud tap; first sound recorded as systolic blood pressure. Is recorded as the top number of the fraction

sphygomomanometer (equipment and supplies necessary to take blood pressure)

is dial portion. Attaches to blood pressure cuff by a piece of fabric that attaches to cuff of blood pressure set up can detach from cuff if wish and set down on table if easier to see

Korotkoff sounds V (Korotkoff sounds)

last sound hear before silence. Is the diastolic blood pressure. Is recorded as the bottom number of the fraction. Goes all the way down to zero

blood pressure cuff (equipment and supplies necessary to take blood pressure)

latex free. Is arrow that says artery and should be placed at least an inch above the brachial artery which is located on the inside of the elbow

hemorrhage (factors that decrease blood pressure)

like excessive bleeding to point if there is arterial bleed where blood spurting blood out is this. BP will go down because loss of blood

blood pressure

the amount of force exerted against the walls of an artery by the blood. Just think about amount force against walls of an artery. Nothing to do with the heart. Similar to garden hose. Water pressure is amoutn force exerted against the walls of the hose. Spicket that turn on and off is the heart. Water going through hose similar to blood going through an artery. It's the force against walls of an artery, without thinking about the heart. the force of the blood against arterial walls

hypotenison

low/under normal blood pressure because hypo-= low/under. *Consistent* (over period time) lower period time at 3 low blood pressure. Blood pressure measurement below normal systolic and/or diastolic blood pressures. Below 90 systolic blood pressure and below 60 diastolic blood pressure, or 20-30 mm/Hg below patient's normal BP. Athletes will have lower blood pressure because conditioned body. Athletes will have decrease blood pressure. Someone that takes meds for something other than blood pressure that have lower blood pressure, ex med could make HR decrease. Some people with low blood pressure but is not a concern. Concerning when dizzy/feel faint/change position quickly and feel lightheaded then it's problem. As long as not symptomatic not big issue/problem unless dizzy/faint/lightheaded. Not issue unless have symptoms. doesn't get same attention as hypertension as some just have low blood pressure and that's okay as long as not symptomatic

stethoscope (equipment and supplies necessary to take blood pressure)

make sure ear pieces point away from you because that's how want in your ears. Point ear pieces away anf put into ear canal area/ears. After put into ears, pick up the diaphragm (big side which use with BP) and bell (smaller side) on end stethoscope. Tap diaphram gently to see if can hear taps. Can turn between bell and diaphragm, but in order to get accurate BP reading use diaphram side

some meds and chemicals (factors that decrease blood pressure)

medicines tended to decrease bloood pressure and antihistamines decrease BP

Korotkoff sounds II (Korotkoff sounds)

muffled, swishing sounds

factors that decrease blood pressure

resting gender clinical dpression hemorrhage shock some meds and chemicals

shock (factors that decrease blood pressure)

shutting down of cardiovacular system; person in shock decreases blood pressure

Korotkoff sounds

sounds for which nurse listens when assesig blood pressure. In some adults these sounds are distinct and in other adults beginning and ending sound only heard. Are 5 of them. These sounds are the whole process from systole to diastole to zero Korotkoff sounds I Korotkoff sounds II Korotkoff sounds III Korotkoff sounds IV Korotkoff sounds V

equipment and supplies necessary to take blood pressure

sphygomomanometer blood pressure cuff stethoscope alcohol wipe After taken BP/once done, take and fold cuff back up and put back into black case and put back.

what is the most common equipment used to measure BP?

stethoscope and sphygmomanometer

orthostatic hypotension

sudden drop of 20 mm/Hg is systolic pressure adn 10 mm/Hg in diastolic pressure when patient moves from a lying to sitting to standing position, sudden change in position

normal blood pressure in adult

systolic: <120 mm/Hg diastolic: <80 mm/Hg