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Physical Assessment > 2 - Blood Pressure > Flashcards

2 - Blood Pressure Flashcards

1
Q

Define blood pressure

A

The force of blood as it pushes against the arterial walls

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2
Q

What are the 2 components to blood pressure?

A

Systolic blood pressure

Diastolic blood pressure

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3
Q

Systolic blood pressure

A
  • The highest pressure that is felt on the arteries

- Caused by ventricular contraction (systole)

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4
Q

Diastolic blood pressure

A
  • The lowest (or resting) pressure

- During ventricular relaxation (diastole)

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5
Q

BP measured in ?

A

mmHg

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6
Q

What is cardiac output?

A

Volume of blood ejected by the ventricles per minute

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7
Q

What is CO dependent on?

A

CO = HR x SV

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8
Q

What is stroke volume?

A

amount of blood put out by the left ventricle in one contraction

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9
Q

What is peripheral vascular resistance dependent on?

A

arterial blood viscosity, wall elasticity

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10
Q

High blood pressure often has ?

A

no symptoms

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11
Q

HTN associated with?

A

CV morbidity and mortality

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12
Q

List some BP measurement methods

A

1) Office Measurement (OBPM)
- Oscillometric (electronic) - preferred
- Auscultatory (manual reading with mercury or aneroid)

2) Automatic Office Measurement (AOBP)
- Oscillometric (electronic)

3) Ambulatory Blood Pressure Monitoring (ABPM)
4) Home Blood Pressure Monitoring (HBPM)

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13
Q

Describe an Oscillometric BP Device

A
  • Takes 6 readings at 1-2 minute intervals
  • Clinician in attendance during 1st reading only
  • Patient left alone for subsequent readings
  • Device discards 1st reading and averages next 5 measures
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14
Q

Describe a Mercury Sphygmomanometer

A
  • Traditionally was the gold standard
  • Accuracy depends on proper standardized technique
  • Phasing out of clinics/hospitals
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15
Q

Describe an Ambulatory BP Measurement

A
  • Records for 24 hours
  • Day: Every 20-30 mins
  • Night: Every 30-60 mins
  • Monitors changes throughout day based on activity, drugs, etc.
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16
Q

Describe a Home Blood Pressure Machine

A

Strengths:

  • easy/convenient to use
  • multiple measurements

Limitations:

  • irregular heart rate
  • physical movement (ex. shivering)
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17
Q

Describe Step 1: Preparation

A

1) Equipement

2) Patient seated and comfortable:
- Rest for at least 5 mins
- Tell patient what you are doing
- Back supported
- Feet flat on floor
- Arm slightly bent, palm up
- Arm supported at heart level

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18
Q

List 3 factors that can raise BP?

A
  • Nicotine/Caffeine in last 30 mins
  • Drugs (decongestants, prednisone, NSAIDs)
  • Exercise

*more on page 3

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19
Q

List 3 factors that can lower BP?

A
  • Fasting
  • Depressants
  • Rest
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20
Q

Describe Step 2: Apply Cuff

A

1) Select the appropriate cuff size
2) Palpate the brachial artery along the upper arm
3) Centre the bladder of the cuff over the brachial artery (tubing facing downward)
4) Wrap cuff smoothly and snuggly around arm (~2.5cm above antecubital fossa (crease of the elbow)
5) Position the manometer in direct line of eye site

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21
Q

What size of cuff for arm circumference of 18-26 cm?

A

9 x 18 cm (child)

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22
Q

What size of cuff for arm circumference of 26-33 cm?

A

12 x 23 (standard adult model)

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23
Q

What size of cuff for arm circumference of 33-41 cm?

A

15 x 33 (large)

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24
Q

What size of cuff for arm circumference of >41 cm?

A

18 x 36 cm (extra large, obese)

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25
Q

Bladder width = ?

A

40% of arm circumference

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26
Q

Bladder length = ?

A

80% of arm circumference

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27
Q

The Manometer should be positioned at ?

A

eye level

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28
Q

Describe Take One of Inflating the Cuff

A

1) While palpating the radial pulse, inflate cuff to point at which the radial pulse can longer be felt (Add 30 mmHg to this reading)
2) Rapidly deflate cuff, wait 30 seconds before re-inflating

29
Q

Why do you estimate the systolic pressure?

A
  • To determine how high to raise the cuff pressure
  • To prevent discomfort from unnecessarily high cuff pressures for subsequent inflations
  • To prevent error caused by an auscultatory gap
30
Q

Earpiece on a stethoscope should be angled ?

A

forward

31
Q

How do you “turn on” your stethoscope?

A
  • You may need to twist the bell

- Tap the diaphragm to check that you can hear

32
Q

Describe Take Two of Inflating the Cuff

A

1) Place the bell of the stethoscope lightly, but with an air tight seal, over the palpable brachial artery
2) Rapidly inflate the cuff to the maximum inflation level (determined previously)
3) Slowly deflate the cuff at a steady rate of 2-3 mmHg/sex

***Taking a blood pressure reading

33
Q

Korotkoff Sounds:

The pressure at which the first of two consecutive beats are heard (Korotkoff Phase 1) is the _______ BP

A

systolic

34
Q

Korotkoff Sounds:

The pressure at which the last beat is heard (Korotkoff Phase V) is the _______ BP

A

diastolic

35
Q

Korotkoff: Phase Cuff correctly inflated

Description & Rationale

A

Description: No sound

Rationale: Cuff inflation compresses brachial artery

36
Q

Korotkoff: Phase 1

Description & Rationale

A

Description: Soft, clear tapping, increasing intensity

Rationale: The SYSTOLIC pressure

37
Q

Korotkoff: Phase 2

Description & Rationale

A

Description: Swooshing

Rationale: Turbulent blood flow through still partially occluded artery

38
Q

Korotkoff: Phase 3

Description & Rationale

A

Description: Knocking

Rationale: Artery closes just briefly during late diastole

39
Q

Korotkoff: Phase 4

Description & Rationale

A

Description: Muffling

Rationale: Artery no longer closes in any part of cardiac cycle. Change in quality, not intensity

40
Q

Korotkoff: Phase 5

Description & Rationale

A

Description: No sound

Rationale: The last audible sound (marking the disappearance of sounds) is the DIASTOLIC pressure

41
Q

Continue listening until ____ mmHg below the diastolic blood pressure, then rapidly and completely deflate the cuff

A

20

42
Q

Record the systolic and diastolic BP levels to the nearest __ mmHg, along with the patient’s _______.

A

2

position (sitting, standing, lying)

43
Q

Wait __ minutes, then repeat.

A

2

44
Q

Take __ readings on the same arm and average the last 2 readings.

A

3

45
Q

Common mistakes:

Cuff too small = falsely _____ readings.

A

high

46
Q

Common mistakes:

Cuff too big = falsely ____ readings.

A

low

47
Q

Common mistakes:

Arm below heart level = falsely _____ readings

A

high

48
Q

Common mistakes:

Arm above heart level = falsely _____ readings

A

low

49
Q

Common mistakes:

Patient not rested or comfortable = falsely ______ readings

A

high

50
Q

Common mistakes:

Stopping during deflation or re-inflating the cuff too soon causes forearm venous congestion - leads to what?

A

falsely low SBP or high DBP reading

51
Q

Common mistakes:

Deflating too quickly does not allow enough time to hear the possible faint tapping of SBP - leads to what?

A

falsely low SBP and/or high DBP

52
Q

What is an auscultatory gap?

A

A silent interval that may be present between the systolic and diastolic pressures.

53
Q

What is an auscultatory gap associated with?

A

arterial stiffness and atherosclerotic disease

54
Q

What may an auscultatory gap lead to?

A

may lead to a serious underestimation of the SBP or overestimation of DBP

55
Q

If you can’t hear anything there may be a technical issue such as?

A
  • placement of stethoscope
  • making full skin contact with bell
  • avoid repeated inflations
  • consider also the possibility of shock
56
Q

What can you do to intensify weak Korotkoff sounds?

A
  • Raise patient’s arm before and while you inflate the cuff. Then lower the arm and determine the BP.
  • Inflate cuff. Ask the patient to make a fist several times, and then determine the BP.
57
Q

What BP is an emergency?

A

SBP > 180

DBP > 120

58
Q

What BP is an urgent referral ?

A

SBP > 180

DBP = 120 - 129

59
Q

What BP is a referral to physical for BP follow up?

A

SBP > 140

DBP > 90

60
Q

What BP is an annual follow up?

A

SBP < 140

DBP < 90

61
Q

What are examples of hypertensive urgencies or emergencies? (3)

A
  • hypertensive encephalopathy
  • acute kidney injury
  • eclampsia of pregnancy
62
Q

What are examples of target organ damage?

A
  • cerebrovascular disease
  • stroke
  • vascular dementia
63
Q

BP goal for a diabetic

***different from clinical

A

SBP < 130

DBP < 80

64
Q

BP goal for all others

A

SBP < 140

DBP < 90

65
Q

BP goal for > 80 yrs old

A

SBP < 150

*in clinical it is 150/80

66
Q

How do you measure orthostatic hypotension?

A

1) Measure BP while patient is in supine (lying face upward) position at rest for 3-10 minutes
2) Measure BP again within 3 minutes after the patient stands up

67
Q

What BP levels would diagnose orthostatic hypotension?

A
  • Drop in SBP of > 20 mmHg

- Drop in DBP of > 10 mmHg

68
Q

What can cause orthostatic hypotension?

A
  • drugs
  • moderate to severe blood loss
  • prolonged bed rest
  • disease of the autonomic nervous system
69
Q

What may orthostatic hypotension be exacerbated by?

A
  • advanced age
  • dehydration
  • deconditioning
  • ambient temperature

Physical Assessment (6 decks)

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