Vital Signs Flashcards
Blood Pressure (BP)
• Measurement of force the heart exerts while pumping
• Directly depends on cardiac output (CO) and peripheral vascular resistance (PVR), hence BP = CO x PVR
- Measured in mmHg
Systolic vs. Diastolic BP
• Systolic blood pressure (SBP)
- Pressure during contraction of heart
• Diastolic blood pressure (DBP)
- Pressure during relaxation of heart
• BP is reported as: systolic/diastolic (120/80)
Necessary Instruments
- Sphygmomanometer: often attached to an inflatable air-bladder cuff for measuring BP in an artery
- Stethoscope: auscultation to convey sounds in the chest or other parts of the body to the ear of the examiner
Types of Sphygmomanometers
- Aneroid: widely used; accurate if calibrated; requires maintenance q6 months
- Mercury: (most accurate but impractical for home use)
- Digital: preferred for patient self-measurement
- Finger monitors: inaccurate, not recommended
- Ambulatory BP monitoring: worn 24h, measures q15-30 min, allows measurement of night readings or if inconsistent readings seen at clinic vs. at home
Step 1: Before Taking BP
- Seat patient quietly x5 minutes
- Both feet flat on the floor and back supported
- Upper arm bare and supported at heart level
- Ask if had caffeine or smoked within 30 minutes
- Ensure patient has emptied bladder
- Neither you nor patient should talk during rest period or actual measurement
Step 2: Set Up
- Place yourself in convenient proximity to patient
- Select cuff with bladder length ≥80% of arm circumference
- Locate and align midline of cuff with brachial artery
- Wrap cuff smoothly/snugly around the arm, centering bladder 2 finger widths above elbow bend or at sternum midpoint
- Place stethoscope diaphragm over brachial artery
Cuff Sizes
- Small adult cuff: 22-26cm
- Regular adult cuff: 27-34 cm
- Large adult cuff: 35-44 cm
- Thigh cuff: >= 45 cm
Step 3: Determining a Starting Point
• While palpating radial artery: Inflate cuff until you can no longer feel the pulse (AKA systolic pressure or pulse obliteration) - note this level on the manometer • Add 20-30 mmHg to pulse obliteration • Deflate cuff • Wait 30-60 seconds, then do BP reading
Step 4: Take BP
• Insert stethoscope earpieces forward
• Apply bell/diaphragm lightly but completely over brachial artery
• Inflate cuff rapidly to 20-30 mmHg above pulse obliteration
• Release air from cuff at 2 mmHg/second by turning knob
• SBP is the first 2 consecutive sounds (aka “Korotkoff
sounds”); note on manometer
• DBP is the last sound heard; note on manometer
• Continue listening 10-20 mmHg below last sound
• Record BP in even numbers and which arm used
• Wait 1-2 minutes; confirm in opposite arm and average
• If the first 2 readings differ >5 mmHg, take 3rd measurement and average all three
Classification of BP
- Normal: <120 (s), <80 (d)
- Elevated: 120-129 (s) AND <80 (d)
- Stage 1: 130-139 (s) OR 80-89 (d)
- Stage 2: =>140 (s) OR => 90 (d)
- HTN crisis: >180 (s) AND/OR >120
Factors that Alter BP
- Smoking w/in 30 min
- Caffeine w/in 30 min
- Full bladder
- Incorrect cuff size or placement
- Cuff over clothing
- Talking during measurement
- Back not supported
- Feet not supported
- Legs crossed
- Arm not at heart level
Medications that Increase BP
- Corticosteroids (prednisone, testosterone)
- Pseudoephedrine, ephedrine
- NSAIDs (ibuprofen, naproxen, etc)
- Albuterol
- Amitriptyline
- Venlafaxine
Medications that Decrease BP
- Antihypertensives
- Alprazolam
- Diazepam
- SGLT2 inhibitors (empaglifozin, canaglifozin)
Signs/Symptoms of HTN
- Signs: High BP
- Symptoms: asymptomatic, weakness/fatigue, blurred vision, headache
Lifestyle Modifications to Manage HTN
- Weight reduction
- DASH eating plan
- Dietary sodium reduction
- Physical activity
- Moderate alcohol consumption
Heart Rate (HR)
• HR = # of times heart contracts/min
• Recorded as beats per minute (bpm)
• Detected via pulse
-Pulse = the wave or beat of blood coursing through artery after heart contracts
• Inaccurate with certain arrhythmias
- Pulse will feel irregular
With patient’s elbow and forearm resting comfortably on a table and the palm turned upward…find the radial pulse
Measuring Radial Pulse / Carotid Pulse
• With the pads of your index and middle finger, compress radial/carotid artery until maximal pulsation detected
• Count rate for 15 seconds and multiple by 4
• If unusually fast or slow, count for 60 seconds
- Do NOT use thumb
- Note if regular rhythm
Normal HR (bpm)
- Brady = slow, thus bradycardia is pulse < 60 (adult)
- Tachy = fast, thus tachycardia is pulse > 100
Medications that Increase HR
- Sympathomimetics: pseudoephedrine, ephedrine
- Steroids: prednisone, testosterone
- Bronchodilator: albuterol
- Hormone replacement: levothyroxine
- Antidepressants: venlafaxine, amitriptyline
Medications that Decrease HR
• Blood pressure medications
- Beta blockers
- Calcium channel blockers
• Opioids
- Codeine
- Hydrocodone
Respiratory Rate (RR)
- Rate of breathing
- Best to measure at rest (patient unaware)
- Count rate for 30 seconds and multiply by 2
- Watch the chest rise
Observe/Listen for:
- Audible breathing, effort
- Regularity
- Abnormal sounds (usually need stethoscope): crackles, rales, wheezing, rhonchi
What Affects RR?
• Medications - Opioids ↓ - Sedative/hypnotics ↓ • Stress ↑(emotion/fever/injury) • Alcohol ↓ • Caffeine ↑
How many BP readings are recommended each time you measure BP?
At least 2.
Which of the following is true?
- You should never measure BP at the thigh.
- At subsequent visits, it is sufficient to take one BP reading.
- If you take 2 BP readings and the systolic pressure are 134 and 141, the average should be recorded as SP.
- At the first visit, BP measurements should be made in both arms.
At the first visit, BP measurements should be made in both arms.
Which of the following patient postures can cause an error of a higher BP reading?
Patient seated on exam table.
A physician using a mercury column instrument observes a systolic pressure reading of 133. Which is the correct reading to make in the patient’s chart?
134.
According to evidence-based guidelines, what is the recommended cuff deflation rate for patients who are not bradycardic?
2-3 mmHg per second.
What is the recommended frequency for retraining health care professionals on BP measurement techniques?
Every 6 months.
When selecting the correct cuff size, the bladder should be wide enough to encircle what percent of the upper arm?
40%
What is the correct time to wait in between two consecutive BP readings on the same individual?
At least 1 minute.
Which of the following is false?
- The patient should not talk during measurement.
- The patient should relax seated for 5 minutes before the first measurement.
- In the absence of a hard surface to rest their arm, the patient can hold up their arm during BP measurement.
- Urinary bladder distension can cause a significant error in BP measurement.
In the absence of a hard surface to rest their arm, the patient can hold up their arm during BP measurement.
Blood pressure measurement guidelines recommend which of the following?
- Use the bell of the stethoscope.
- The upper arm should be bare, without constrictive clothing.
- Inflate the BP cuff to at least 30mmHg above the point where the radial pulse disappears.
- All of the above.
All of the above.
What bladder length of arm circumference should be used? Where should you center bladder?
- Select cuff with bladder length ≥80% of arm circumference
- Center bladder 2 finger widths above elbow bend
