WEEK OSPAP Programme Undertaking A Manual Blood Pressure

WEEK ? OSPAP Programme Undertaking A Manual Blood Pressure Slide 1 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Learning Outcomes ? By the end of this session you should be able to: • Understand the physiological aspects of blood pressure • Identify factors which can affect blood pressure • Demonstrate a knowledge of the normal values of a blood pressure • Competently undertake a manual blood pressure recording Slide 2 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? What is blood pressure? The pressure exerted by the blood against the walls of the blood vessels. mm. Hg (The most simple indicator of haemodynamic well-being) Marieb & Hoehn (2010) Slide 3 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? What is blood pressure? Why is it important? • Oxygen transport • Tissue perfusion Slide 4 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? What is blood pressure? 2 numbers: Systolic – the highest pressure when the heart beats Diastolic – the lowest pressure in between beats 120/80 Slide 5 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? Physiological Factors Affecting Blood Pressure • The pumping action of the heart • The amount of resistance to the blood within the circulation - systemic vascular resistance/peripheral resistance (relates to the diameter of the blood vessels) • The volume of the blood • The viscosity of the blood • Elasticity of the arteries Slide 6 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Factors affecting blood pressure ? Hypertension Hypotension • • • Hypovolaemia • Lack of sympathetic tone - vasodilatation • Cardiac Arrhythmias • Anaemia Physical activity Strong emotion Obesity Heart Disease Arteriosclerosis Vasoconstriction Circulatory overload Polycythaemia Slide 7 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? Slide 8 of 17 Average “normal” values Age (years) Systolic (mm. Hg) Diastolic (mm. Hg) Newborn 80 46 10 103 70 20 120 80 40 126 84 60 135 89 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? Definitions • Hypertension: – Systolic > 140 mm. Hg – Diastolic > 90 mm. Hg either/or • Hypotension: – Systolic < 90 mm. Hg – Diastolic < 60 m. Hg either/or Blood Pressure Association Slide 9 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Measuring Blood Pressure ? We find the blood pressure by using an instrument called a sphygmomanometer This device consists of an inflatable cuff that is wrapped around the upper arm and a gauge that measures pressure. A stethoscope is used to listen to the different sounds that occur (Korotkoff’s Sounds). Slide 10 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Measuring Blood Pressure ? • Types of sphygmomanometer; 1. Mercury 2. Aneroid 3. Automatic Slide 11 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? Measuring Blood Pressure Upper Arm Blood Pressure Monitor cuff sizes Slide 12 of 17 Measurement (cm) Measurement (inches) Cuff size 18 -22 cm 22 -32 cm 32 -45 cm 7. 1 -8. 7” 8. 8 -12. 8” 12. 8 -18” Small Medium Large MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Pre assessment ? Ask/observe for the following: • Lymphodema • Arteriovenous fistula • Trauma/surgery to arm or axilla • Brachial artery surgery • IV infusion in place Any contraindication… use other arm or if both use lower extremity Slide 13 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK ? Slide 14 of 17 Measuring Blood Pressure MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Measuring Blood Pressure ? Korotkoff’s Sounds • Phase 1 -The first appearance of faint clear tapping sounds which gradually increase in intensity. The systolic pressure is heard for at least two consecutive beats, and this correlates well with intra-arterial pressure. • Phase 2 -The softening of sounds, which may become swishing. • Phase 3 -The return of sharper sounds, which become crisper but never fully regain the intensity of phase 1 sounds. (Neither phase 2 nor phase 3 has any known clinical importance). • Phase 4 -The distinct abrupt muffling of sounds, which become soft and blowing. • Phase 5 -The point at which all sounds disappear completely. http: //www. abdn. ac. uk/medical/bhs/tutorial/q 1. htm Slide 15 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Measuring Blood Pressure ? Examination Sequence • Ensure patient is rested and comfortable (seated if possible) • Support patient’s arm at about the level of the heart (either arm can be used unless otherwise indicated) • Select appropriate cuff size • Apply the cuff to the upper arm • Palpate brachial/radial artery • Inflate the cuff until the pulse is impalpable (rough estimate of systolic) • Inflate cuff 10 -20 mm. Hg further • Place stethoscope over brachial artery • Deflate cuff slowly (2 -3 mm. Hg/sec) until regular sounds are heard – systolic pressure (Korotkoff’s sound Phase 1) • Continue to deflate cuff until sounds disappear completely – diastolic pressure (Korotkoff’s sound Phase 5) Slide 16 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure

WEEK Practice! ? Slide 17 of 17 MPHxx OSPAP Undertaking a Manual Blood Pressure