Blood Pressure Procedures:

1. Allow patient to relax prior to taking BP

2. Make sure the manometer is properly calibrated (that is, it reads "0" when there is not air in the cuff)

3. Make sure the cuff fits snugly around the person's arm before inflating it.

4. Do not place the cuff over a person's clothing

5. Do not take BP on an arm where an intravenous (IV) line is placed, or on an arm that is injured or in a cast.

6. In a person with a mastectomy, do not take a BP on the arm this is on the same side of the body as the breast was removed.

7. Do not partially deflate the cuff and then reinflate it while taking a BP measurement. If you make a mistake, release all of the air from the cuff and wait at least 30 seconds before trying again.

8. If you are unable to hear the Korotkoff sounds (missing sounds), make sure the room is quiet and check your equiptment.

9. Make sure the diaphragm of the stethoscope is active by gently tapping on it.

10. Make sure the diaphragm of the stethoscope is placed directly over the brachial puls.

11. Make sure the earpieces of the stethoscope are seated properly in your ears.

Hypertension -(high blood pressure) ranges: 140/90

Normal ranges:

Adult - 100-140 Systolic 60-90 - Diastolic

Adolescent - (12 -20) 94-140 Systolic 62-88 Diastolic

School age children-  (5-12) 84-120 Systolic 54-80 Diastolic

Preschooler - (3-5) Systolic 82-110 50-78 Diastolic

Toddler - (1-3) 80-112 Systolic 50-80 Diastolic

Infant -(0-1year) 74-100 Systolic 50-70 Diastolic

A decrease that is generally 20/10

90/60 or lower

Lowest in the Morning can increase as much as 10mmHg later in the day

Lower when the person is lying down, as to compared to sitting or standing

BP is usually slightly higher after a meal, especially a meal with high salt content

Exercise will temporaily increase the "systolic" BP

Stress, anxiety, fear, and pain will also temporarily raise a person's BP

The force of blood pushing against arterial walls is know as "Blood pressure". There are two pressure levels that are measured when taking a person's blood pressure measurement.

1. Systolic - is the pressure that is caused by the blood when the heart muscle contracts, sending a wave of blood through the artery.

2. Diastolic - occurs when the heart muscles relaxes. Although the heart is relaxed, there is still pressure as the blood flows through the arteries.

Blood pressure is measured in millimeters of mercury (mm Hg) and is recorded as a fraction. systolic which is higher is recorded first. Diastolic is lower and recorded second.

The difference between the two is call the pulse pressure

A heart rate that is slower than normal (that is, a pulse rate of less than 60 beats per minute) is called Bradycardia. Certain illnesses or conditions can cause bradycardia.

1. A physically fit person/athlete

2. Infiltrative deseases: sarcoidosis: development of granulomatous lesions (cause unknown) in the heart, bones, lungs

3. Collagen vascular disease: lupus, a chronic disease involving multiple organs like the skin, connective tissues in chronic disease.

4. Rheumatoid arthritis: chronic inflammation of the joints and some organs.

5. Scleraderma; chronic inflammatory process causing severe increase in connective tissue in organs, skin

6. Mytopic muscular dystrophy (abnormal inherited disease of muscles, with faulty development of degeneration of muscles)

7. Surgical trauma: valve replacement, correction of congenital heart disease, heart trauma.

8. Familial diseases (inherited)

9. Infectious diseases: Chagas' disease, a chronic wasting disease caused by a parasite (Trypanosoma Cruz), prevalent in Central and South America

10. Endocarditus: secondary to dental procedures causing infection in the blood stream, illicit drug injections into veins.

11. Carotid-sinus hypersensitvity: from vagus innervation hypertonicity

12. Situational disturbances: coughing, micturation, defacation, vomiting

13. Drugs; B-Adrenergic blockers: ideral, atenolol

14. Calcuim-channel blockes: procardia, verapamil

15. Clonidin: for hypertension

16. Digoxin: for heart failure, atrial fibrillation

17. Antiarrhythmic agents: pronestyl, quinidine

18. Hypothyroidism (abnormally low thyroid hormone in the blood stream)

19. Hypoterhmia

20. Neurologic disorders (affecting autonomic nervous system)

21. Hypokalemia: low potassium

22. hyperkalemia: High potassium

1. Smoking

2. Being overweight or obese

3. Lack of physical activity

4. too much salt in the diet

5. Too much alcohol comsumption (more than 1 or 2 drinks per day)

6. Stress

7. Older age

8. Genetics

9. Family history of high blood pressure

10. Chronic kidney disease

11. Adrenal and thyroid disorders.

1. Pregnancy -circulatory sysem expans rapidly during pregnancy, blood pressure is likely to drop.

2. Heart Problems - low heart rate (bradicardia), heart valve problems, heart attacks and heart failure. these conditions may cause low Bp because they prevent your body from being able to circulate enough blood.

3. Endocrine Problems - underactive thyroid (hypothyroidism) can cause low BP. Adrenal insufficiency (Addison's disease), low blood sugar (hypoglycemia) and, in some cases, diabetes, can trigger low BP.

4. Dehydration - your body loses more water than it takes in. Even mild dehydration can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diurectics and strenuous exercise can all lead to dehydration.

5. Blood loss - losing a lot of blood from a major injury or internal bleeding reduces the amount of blood in your body, leading to severe drop in BP.

6. Severe infection (septicemia)

7. Severe allergic reaction (anaphylaxis) is a severe and potentially life-threatning allergic reaction. Common triggers of this are foods, certain medications, insect venoms and latex. This can cause breathing problems, hives, itching, a swollen throat and a drop in BP

8. Lack of nutrients in your diet - Vitamin B-12 and folate can cause anemia, (body doesn't produce enough red blood cells) causing low BP

9. Medications:

A. diruetics

B. Alpha Blockers

C. Drugs for Parkinson's diesease

D. Certain types of antidepressants 9tricyclic)

E. Sildenafil (Viagra), particularly in combination with the heart medication, nitroglycerine.

Infection

Hormonal

Changes in thyroid

fever

time of day

being very old, or very young

aging

Arthritis

Cancer

1. Blood Pressure -. As the Bp decreases, the pulse will frequently increase

2. Exercise and Muscular activitiy

3. Food intake - Digestion increases the pulse slightly

4. Elevated body temperature - the pulse increases 

5. Emotional Status -Fear, anger, and anxiety will all increase the pulse rate

6. Pain - When the patient is in pain, the pulse rate will increase

High Blood Pressure - is a cardiac medical condition in which the systemic arterial blood pressure is elevated. What that means that the heart is having to work harder than it should to pump the blood around the body.

Persistent hypertension - is one of the risk factors for stroke, myocardial infartion, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure.

Orthostatic hypotension - AKA postural hypotension, orthostasis, and colloquially as head rush or a dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when the person stands up or stretches. The decrease is typically greater than 20/10 mm Hg, and may be more pronounced after resting. The incidence increases with age

Symptoms - after sudden standing or stretching, include dizziness, euphoria or dysphoria, bodily dissociation, distortions in hearing, lightheadedness, nausea, headache, blurred or dimmed vision (possibly momentary blindness), numbness/tingling and fainting.

1. a cuff (a flat, cloth-covered inflatable pouch0

2. A bulb, which is squeezed or pumped to fill the cuff with air

3. A manometer (the device that measures the air pressure in the inflatable pouch)

4. Measure on brachial artery of the upper arm

5. Knee popliteal artery (which can be felt at the back of a person's knee)

Elevated blood pressure

Low blood pressure

Elevated temperature

The scale is made up of words such as "no pain", "mild pain", "moderate pain" "severe", "burning", "throbbing" and so on. The person chooses the words that best describe the pain.

The scale is made up of a series of numbers (usually 0-10 or 0-5) The lowest number on the scale indicates "no pain" and the highest number on the scale indicates "the worst pain imaginable" the person chooses the number that best describes the pain.

The scale is a bar that includes words, color, numbers, or a combination of the three. the person is asked to place a mark on the bar to indicate the intensity of the pain.

0- no hurt

2- Hurts a little bit

4- Hurts a little more

6- Hurts even more

8- hurts a whole lot

10- Hurts worst

Nonverbal signs of pain:

facial expression (such as grimacing or gritting the teeth)

Moaning

Crying

Restlessness

Calling Out

Rubbing area of the body that is in pain

Guarding (avoiding use of) the area of the body that is in pain

Resisting care.

Redness or swelling in an area

Profuse sweating

Changes in the person's vital signs

Changes in the person's behavior

When reporting provide the following:

Location of pain

Characteristics of the pain

Intensity of the pain

Circumstances surrounding the pain

1. Check again in 15 minutes

2. Report findings to the nurse

1. Oral - 97.6 - 98.6

2. Rectal - 98.6 - 99.6

3. Axillary(arm pit) - 96.6 -98.6

A change of one degree increase, or one degree increase can change their temperature.

1. 90/60

2. 120/80

3. 120/80 or 139/89 - is an indication of pre-Hypertension

4. 140/90 or hypertension stage 1.

5. 160/100 stage hypertension stage 2.

6. 90/60 is a sign of hypotension

1. Temperature

2. Respiration

3. Pulse

4. Pain level

1. Let them know that you will have to wait "15 minutes" to take it again, this is so that their temperature is accurate.

2. Come back in 15 minutes and retake their temperature.

3. Ask them to not eat or drink anything else until you take their temperature.

1. Systolic cycle - the heart is working very hard to pump blood through out the body.

2. Diastolic cycle - the heart is resting, it has just finished the complete cycle through the heart.

1. If the patient' had breast cancer on that side

2. If their is an I.V in the patient's arm

1. Check again

2. Report your findings to the nurse ASAP

1. Never more than 1 inch - in an adult, temperature should be 98.6 -99.6

2. Never more than 1/2 inch - for babies or children

1. Brachial Artery - used for (BP) Blood Pressure (on little finger)

2. Carotid Artery - CPR (Cardiopulmonary Resusitation (under neck)

3. Radial Artery -  Pulse - this is the "most common" ( on wrist next to thumb)

1. Cuff - (a flat, cloth covered inflatable pouch)

2. Bulb - which squeeze or pumped to fill the cuff with air

3. A Manometer (the device that measures the air pressure in the inflatable pouch)

Most common place to measure a person's blood pressure is in the (Brachial Artery) of the upper arm.

The popliteal (under the knee) can be used also

The first sound of the pulse, note the reading on the mamometer. This is your "Systolic pressure"

Now continue to listen for the pulse

When the pressure inside the cuff is less than the sound of the pulse will stop, because the artery is no longer under pressure. The last sound that you hear is the "Diastolic" pressure, and is shown by the reading on the manometer.