1.2b BP Guidelines Flashcards
When should blood pressure be checked?
When starting the program (check left and right; record highest; check 3x)
If patient has a change in medications (check 3x)
If the patient reports currently or recently not feeling well
If patient has had a recent event and/or hospital visit
Should you worry is systolic BP is below 95?
No - remember that a lower BP is healthy, so try to avoid over fixation on lower values when patient is asymptomatic
When should you worry about low systolic blood pressure?
when symptomatic - question ability to drive
What is the target blood pressure for someone with diabetes or CKD?
130/80
What is an emergency situation in terms of blood pressure readings?
systolic BP of 180+
diastolic BP of 110+
symptoms of possible organ damage
What are symptoms of possible organ damage?
chest pain
shortness of breath
back pain
numbness/weakness
change in vision, difficulty speaking
When would blood pressure present as a contra-indication to exercise?
> 180/110
What 3 factors should you consider when deciding what action to take with a patient?
symptoms
patient’s previous history
absolute blood pressure value
Is strength or resistance training enough for an individual with hypertension?
No, not recommended as the only form of exercise training because, with the exception of circuit weight training, it has not consistently been shown to lower BP
Exercise at what intensity appears to lower resting BP as much as, if not more than exercise at higher intensities?
40-60% of VO2max
What should be the initial goal for exercise programming (kcal/week)?
Long-term goal?
700 kcal/wk
long-term goal: >2000kcal/week
What is considered mild, moderate, severe, uncontrolled, or dangerous hypertension?
mild: 140/90
moderate: 150/95
severe: 160/100
uncontrolled: 170/100
dangerous/no ex.: >180/110
What is the FITTR principle for managing hypertension?
F: daily
I: 40-65% METs
T: aerobic
T: 30-60 min
R: resistance training with BP over 160/100 is not recommended
At what BP is resistance training not recommended?
> 160/110
What can happen if the blood pressure cuff used on a patient is too small?
BP reading may be artefactually high
may be thought to be hypertensive when they actually are not
What can happen if the blood pressure cuff used on a patient is too big?
the BP reading may be artefactually low, so existing hypertension may be missed
What is the adult size cuff?
for arm circumference of 27-34 cm
How should the blood pressure cuff be placed?
The centre of the sphygomomanometer bladder should be placed over the brachial artery that is situated down the medial aspect of the upper arm.
The lower portion of the cuff should be around 2 cm proximal to the antecubital fossa.
The cuff should be firmly wrapped around the arm.
Why should you inflate the sphygmomanometer quickly?
If the cuff is inflated slowly, the korotkoff sounds will become more faint. This may result in a false reading with the systolic value being too low and the diastolic reading being too high. This is because a slow inflation causes venous congestion which can cause the sounds to be faint.
What is the issue with rapid deflation of the sphygmomanometer in the presence of bradycardia?
Can result in a falsely low systolic reading and a falsely high diastolic reading. This is because it was deflated too quickly to catch the sounds.
What is the true diastolic measurement?
The disappearance of sound represents the diastolic blood pressure. If you get a 10mm/Hg gap between muffling and disappearance, the muffling is probably closer to the true diastolic reading. If you are unsure, it is a good idea to record both.
What is an ausculatory gap? What can this result in?
The absence of korotkoff sounds for a brief interval while taking the blood pressure.
One of the errors that can result from an ausculatory gap is the failure to diagnose systolic hypertension.
How can you try to prevent an ausculatory gap?
by inflating the sphygmomanometer to at least 220mmHg
Why do we check BP in both arms in initial assessment?
because often higher in one arm, usually right
