Measuring blood pressure pulse rate Technique Greeting the

Measuring blood pressure & pulse rate

Technique Ø Greeting the patient , stand on his right side , introduce yourself , explain the procedure. Ø Assist the patient to pronate and slightly flex the arm on his chest. Ø Use the right hand to palpate the patient left radial artery and vice versa. Ø Place the tips of middle three fingers on the radial artery. Ø Press gently till you feel the pulse. Ø Comment on the pulse. Ø Measure the pulse in 1 minute if pulse is regular , in 3 minutes if pulse is irregular pulse. Ø Thank the patient.

comment on the pulse should include; 1. 2. 3. 4. 5. 6. 7. 8. The rate in beats per minute. The rhythm of pulse The force. The volume Special characters of the pulse Equality on both sides The condition of the vessel wall Peripheral pulsations

Ø Rate: Normally : 60 -100 beat /minute abnormal: bradycardia < 60 or tachycardia>100 Ø Rhythm: Normally: the distance between each two consecutive waves are equal abnormally : irregular pulse(regular irregularity , irregularity ) Ø Force: • It is amount of pressure exerted by the proximal finger till the middle finger feels no pulsation. • It signifies the systolic pressure. • The force is either normal , weak , forceful. Ø Volume: • It the amount of expansion of the artery with each pulsation. • It signifies the pulse pressure (difference between systole and diastole) average ; 30 -40 mm. Hg

Ø Special character of pulse: It is better assessed in big arteries as carotid , brachial , Femoral. Normally : gradual ascend , gradual descent , dicrotic notch , pulse pressure (30 -40 mm. Hg). Abnormally : Water hammer pulse (collapsing pulse) sudden rise , sudden collapse and wide pulse pressure >60 mm. Hg it occurs in aortic regurge. It is detected by raising the patient arm above the level of the heart.

Ø Arterial wall : Normally : not felt. abnormal: felt in arteriolosclerosis. Ø Equality on both sides: Normally: the rhythm is equal on both sides. abnormal : inequality as in Obstructive arterial diseases , most commonly atherosclerosis , Aortic dissection , Aortic aneurysm , Takayasu arteritis (pulseless disease), cervical rib and mediastinal tumor. Ø Other peripheral pulsations: 1. Temporal 2. External maxillary (facial) 3. Carotid 4. Brachial 5. Radial 6. Femoral 7. Popliteal 8. Posterior tibial 9. Dorsal pedis

Blood Pressure

Rules in blood pressure measure Ø Greeting the patient , stand on his right side , introduce yourself , explain the procedure. Ø the patient is in sitting position for 5 minutes rest. Ø Use appropriate fitting cuff size with its lower border 5 cm above the cubital fossa. Ø The cuff should not be wrapped very tight or very loose, The 2 rubber tubes should be in the middle of the cubital fossa. Ø The manometer is placed at same level of the observer eye and the carotid level. Ø The diaphragm of the stethoscope should be place over the brachial artery. Ø Start with palpatory then auscultatory method. .

What is blood pressure? § Blood pressure refers to the force exerted by circulating blood on the walls of blood vessels. § The pressure of the circulating blood decreases as blood moves through arteries, arterioles, capillaries, and veins. § Blood pressure values are reported in millimetres of mercury (mm. Hg). § Blood pressure is recorded as systolic over diastolic e. g. 120/60.

Systole is the contraction of heart chambers, driving blood out of the chambers. The chamber valves are closed.

Diastole is the period of time when the heart fills with blood after systole (contraction). The chamber valves are open. The heart is at rest.

§ High blood pressure (or hypertension) is defined in an adult as a blood pressure greater than or equal to 140 mm Hg systolic pressure or greater than or equal to 90 mm Hg diastolic pressure. § High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially when it's present with other risk factors. § High blood pressure is the most important preventable cause of premature ill-health.

Risk factors for developing hypertension § Obesity § Physical inactivity § High consumption of alcohol § High intake of dietary sodium § Low intake of dietary potassium § Stress § Increasing age § Cigarette smoking § Increased blood cholesterol § Patients with systemic diseases including: Diabetes mellitus; renal disease; peripheral vascular disease § Family history of hypertension, CHD or stroke

Ø Palpatory method: 1 -the cuff is inflated gradually until radial artery is no longer felt by palpation. 2 -take the reading and deflate the cuff , proceed to auscultatory method Ø Auscultatory method: 1 -inflate the cuff for 30 mm. Hg above the palpatory reading 2 -the cuff pressure is slowly reduced to hear the 5 Korotkoff sounds §Phase I: clear tapping sound (SBP) §Phase II: murmurous sound( Auscultatory gap) §Phase III: Loud slapping sound §Phase IV: sudden muffling of sound §Phase V: disappearance of sound (DBP The value of palpatory method is to avoid under estimation of sever HTN due to auscultatory gap. In lower limbs the SBP is higher by 10 -30 mm. Hg, A difference of 10 mm. Hg occurs in 25% of healthy individuals between both arms.

Blood Pressure Measurement With Electronic Blood Pressure Monitors §If checking an electronic device against a mercury or aneroid sphygmomanometer the blood pressure may differ slightly between devices. §It is good practice to occasionally check the monitor against a aneroid sphygmomanometer or another validated device. §It is important to have a monitor calibrated according to manufacturer’s instruction. §These devices should not be used for people with an irregular heart beat (Atrial Fibrillation) or heart rate lower than 50 beat/min