BP and comprehensive versus focused exam Flashcards
What is the most critical part of the exam?
general appearance and vital signs
What is true BP?
average BP measured over days and weeks
Hypertension BP
140/90 or higher
Pre-hypertension BP
135/90
There is no consensus on what in terms of measuring BP and classifying patients?
Setting, timing and total number of measurement
Two types of hypertension
White coat hypertension and masked hypertension
White coat hypertension
In the office, BP is high but ambulatory is normal–> cardiovascular risk is low
Masked hypertension
Office BP is normal but ambulatory is high–> high risk for cardiovascular disease
Why don’t we roll up a patient sleeve when measuring BP?
Compresses brachial artery and causes a higher read
Where is the arm positioned when doing a BP?
Brachial artery, at the antecubital crease, needs to be at heart level, which is the 4th interspace at the junction with the sternum
Width of the inflatable bladder should be what % of the arm circumference
40%
Length of the inflatable bladder should be what % of the arm circumference
80%
What happens if the cuff is too small?
BP will be high
What happens if the cuff is too big?
BP will be low
Where should the lower border of the cuff be?
2.5cm above the antecubital crease
How do you find a reference BP?
Feel the radial pulse with fingers of one hand, rapidly inflate the cuff until the radial pulse disappears. Read the pressure on the meter and add 30mmHg to it.
Why do we need a reference BP?
To prevent discomfort from unnecessarily high cuff pressures and to avoid errors due to auscultatory gap
What is the auscultatory gap?
Silent interval that may be present between the systolic and diastolic pressures
What sounds are heard over the brachial artery?
Korotkoff sounds
How do you hear systolic pressure?
Hear 2 consecutive beats
How do you hear true diastolic pressure?
Last distinct sound before muffled/disappeared sound
HR is with what and pulse is with what?
HR- stethoscope
Pulse- radial artery
What do you compress radial artery with?
Pads of index and middle fingers
What is the normal range for HR/pulse?
50-90beats/min
What is the 5th vital sign?
pain
What is a comprehensive exam?
Patients you are seeing for the first time; includes all teh elements of health history and the complete physical examination
What is a focused (problem-oriented) assessment?
Patients you know well who are returning for routine care or patients with specific urgent care concerns
