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.
