Blood Pressure

Question 1

Define Blood Pressure

Answer 1

The force exerted by the blood on arterial walls

Skills for midwifery practice 2016

Question 2

What is mmHg?

Answer 2

millimetres of mercury

Question 3

Define systolic blood pressure

Answer 3

The pressure exerted on the arterial walls following ventricular systole. This is when the arteries contain the most blood and it is the time of maximal pressure
(Skills for midwifery practice 2016)

Question 4

What is systolic pressure determined by?

Answer 4

Stroke volume (amount of blood ejected into arteries)
Force of the contraction

An increase in these raises the systolic pressure

Question 5

Define diastolic pressure

Answer 5

The pressure exerted on the arterial walls following ventricular diastole. This is when the arteries contain the least amount of blood, resulting in the least amount of pressure being exerted
(Skills for midwifery practice 2016)

Question 6

What is diastolic pressure influenced by?

Answer 6

Degree of peripheral resistance
Systolic pressure
Cardiac output

It is lower when these are reduced
When heart rate is slower there is less blood remaining in the arteries

Question 7

Define Hypertension

Answer 7

High blood pressure

WHO 2003 define it as a systolic blood pressure of 140mmHg or above and a diastolic pressure of 90mmHg or above

Question 8

Define Hypotension

Answer 8

Low blood pressure

When the systolic pressure is lower than 90mmHg

Question 9

Why do we carry out Blood Pressure?

Answer 9

Provides a baseline

Allows us to monitor any deviations from the norm

Question 10

What equipment do we need when measuring blood pressure?

Answer 10

Sphygomomanometer

Stethoscope

Question 11

What can affect the accuracy of blood pressure?

Answer 11

Position of the cuff (must be at heart level)
Position of woman
Inappropriate cuff size
Poorly maintained equipment 
Rapid deflation of cuff

Question 12

What can having a high blood pressure indicate?

Answer 12

Pain
Pre-eclampsia
Stress
Medical conditions 
Change in posture
Recent exercise 
Ethnicity 
Smoking 
Alcohol

Question 13

When would we take a woman’s blood pressure?

Answer 13

At the initial booking appointment as a baseline (NICE 2008)
At each antenatal visit (NICE 2008)
During labour, initially and then 4 hourly (NICS 2014)
When MEOWS triggers further investigation
Hypertension of any cause

Question 14

Explain the procedure when taking a woman’s blood pressure

Answer 14

1. The NMC code states that informed consent must be obtained and the procedure is explained to woman
2. Encourage woman to empty bladder
3. Ensure she is in a relaxed and suitable position (skills for midwifery practice advise to uncross the woman’s legs and take off restrictive clothing)
4. Don PPE and wash hands in front of woman
5. Ensure the correct cuff size is used to avoid inaccurate result
6. Identify and palpate brachial artery
7. Apply the cuff 2-3 cm above the brachial artery
8. Skills for midwifery practice states that the bladder of the cuff must be placed centrally above artery to ensure even distribution of pressure
9. Ensure valve is closed
10. Palpate brachial artery and inflate the cuff
11. When you feel the pulse disappear, pump 30mmHg above this then slowly deflate the cuff by opening the valve slightly, taking note of when the pulse reappears. This gives an approx reading for systolic pressure
12. Quickly deflate by opening valve fully
13. Place stethoscope over brachial artery
14. Inflate the cuff to 30mmHg higher than the palpated systolic pressure
15. Slowly deflate the cuff at 2-3mmHg per second, listening for the first clear thudding sound
16. Record this thudding sound as the systolic pressure
17. Continue to deflate the cuff slowly until the sounds are absent
18. When thudding sound disappears, this is recorded as the diastolic pressure
19. Deflate cuff rapidly and remove
20. Doff PPE and wash hands
21. Discuss findings with the woman
22. Record and document appropriately (if results are concerning, the NMC code states a timely referral must be made)