BP and JVP

Question 1

do BP either first or last depending on the situation

Answer 1

outline the steps of BP

Question 2

identify the characteristics that differentiate the JVP from the carotid pulse

Answer 2

1. it’s biphasic waveform
2. non palpable
3. occludable
4. changes with respiration
5. changes with hepatojugular reflex
6. changes with position

Question 3

first step of jbp exam

Answer 3

positioning; should be 30-45 degrees, turn the patients head slightly left.

• patients who are very dehydrated might need a lower bd to see the jvp
• people with congestive heart failure might need the bed raised.

Question 4

after positioning what is next

Answer 4

2. inspection; look between the heads of the SCM. It is lateral to the sternal notch.
   - the shadows of the pulsation can b visualized by shining a light tangentially across the patients neck.
   - comment on how it can be differentiated by the carotid (biphasic, occludabple, non palpable, changes with respiration, hepatojugular reflex, and positioning)

Question 5

after examining the JVP what do you do

Answer 5

measure the JVP from the angle of Louis to the tip of the JVP. should be 3 cm ASA.

Question 6

after measuring JVP what is next?

Answer 6

hepatjugular relfex. ask the patient to breath normal with their mouth to prevent valsalva. press down on the liver and the JVP should increase then go back to normal within 10 seconds.
- before palpating the patient, ask if they have any abdominal tenderness.

Question 7

outline the waves and slopes of the JVP

Answer 7

a= atrial contraction
x= atrial relaxation
c= tricuspid closure
v= atrial filling (from the vena cava)
y= tricuspid opening.

Question 8

afteter hepatojugular reflex, what is the last step of JVP exam?

Answer 8

kussmauls sign– during respiration ,the JVP should lower. if the jvp raises during inspiration, this wouldd indicate poor compliance of the pericardium or myocardium– kussmaul’s sign is the paradoxical rise of JPV with inspration.