Week 2: Vital Signs - Blood Pressure

Question 1

What are 5 factors affecting blood pressure?

Answer 1

1. cardiac output
2. Vascular resistance
3. Volume
4. Viscosity
5. Elasticity of Arterial walls (inverse)
   1-4 are proportional

Question 2

What are 3 ways to measure blood pressure?

Answer 2

• manual BP unit
• Automated Electronic BP Unit (includes pulse)
• Full VS, O2Sat Unit

Question 3

When should you take a blood pressure? (4)

Answer 3

• routine vital signs (every shift)
• Once a day
• Every hour
• when the client demonstrates a sign their condition may be changing (chest pain, dizziness, low urine output, high or low HR, difficulty breathing)

Question 4

When do you find the baseline BP

Answer 4

comprehensive exam and/or admission to hospital

Question 5

How should you take a blood pressure?

Answer 5

• 5 min rest, 3 measures 2 minutes apart
• discard first and average the second and third
• seated, feet flat, arm supported BP used to diagnose hypertension

Question 6

You measure the blood pressure in both arms and notice the readings are a few mmHg difference. What should you do? (2)

Answer 6

1. if 5-10 mmHg diff. take the higher reading
2. If arms differ by >20 mmHg, you may need to continue to do both

Question 7

List the steps in which you will hear during a manual blood pressure reading. (6)

Answer 7

1. Korotkoff I - first sound, tapping = systolic pressure
   - may be an auscultatory gap which is abnormal but more common w/ hypertension
2. Korotkoff II - Swooshing
3. Korotkoff III - knocking
4. Korotkoff IV - Abrupt muffling
5. Korotkoff V - Silence aka Diastolic

Question 8

What are some common errors in BP measurement? (9)

Answer 8

• related to patient status (pain, stress, etc)
• Positioning
• cuff size (loose = low, etc)
• Failure to wait 1-2 min between measures with cuff fully deflated
• halting during deflation
• re-inflating cuff during measure
• overinflating (pain)
• deflating too quickly
• Pushing stethoscope too hard

Question 9

what are some characteristics in an automated electronic BP monitor? (4)

Answer 9

• common in hospital and home
• vibrations detected by electronic sensors
• can set to measure at intervals, ex. 5 minutes or 15 minutes
• memory for readings

Question 10

What should you know about automatic BP monitors and irregular HR? (3)

Answer 10

• Inaccurate with very irregular heart rate, SBP < 90 mmHg, shivering, tremors
• always correlate with how the patient looks
• Verify with manual if needed

Question 11

How accurate are electronic and manual blood pressure readings?

Answer 11

Electronic:
- 1 mmHg
- 131/43

manual:
- 2 mmHg
- 132/42

Question 12

What are some influences on blood pressure? (8)

Answer 12

1. Age - gradually rises through childhood
2. Gender - post menopause F>M
3. Ethnocultural background - African>european
4. Diurnal rhythm - late afternoon > early morning
5. Weight - Increases w/ obesity
6. Exercise - increase w/ activity (post 5 min to drop)
7. Emotions, stress - SNS stimulation =fear, anger, pain
8. Caution - false measure - want rest, relax, pain free

Question 13

What is hypotension? What values are associated w/ hypotension? (3)

Answer 13

• low bp
• typically less than 95/60 with ++variation
• see how fast and how much it changed

Question 14

What is symptomatic hypotension?

Answer 14

low perfusion

Question 15

What is hypertension? What values are associated with this? (4)

Answer 15

• high bp
• greaher than 140/90 mmHg
• multiple measures, standard position
• how fast and how much did it change?