Blood Pressure

Measurement
Sphygmomanometer Stethoscope
 Mercury  Diaphragm
(aneroid) gauge (bell)
 Cuff (bladder)  Tubing
 Hand bulb  Ear pieces
 Tubing
 Release valve
Stethoscope
Blood Pressure
 Measurement of the pressure that the
blood exerts on the walls of the arteries as
the heart contracts or relaxes
 Measured in millimeters of mercury on an
instrument called a sphygmomanometer
 Measurement is read at 2 points:
 Systolic is the top number (numerator)
 Diastolic is the bottom number (denominator)
Systolic Pressure
 Pressure that occurs in the walls of the
arteries when the heart is contracting and
pushing blood into arteries
 Normal systolic reading is 120 mm of Hg
 Normal range is 100 – 140 mm of Hg
 Noted as the reading on the
sphygmomanometer gauge when the first
sound is heard
Diastolic Pressure
 Constant pressure that is in the walls of
the arteries when the heart is at rest or
between contractions
 Blood has moved into the capillaries and
veins, so the volume of blood in the
arteries has decreased
 Normal diastolic reading is 80 mm of Hg
 Normal range is 60 – 90 mm of Hg
Diastolic Pressure
 Adults: Noted as the reading on the
sphygmomanometer gauge when the
sound stops or becomes very faint
 Children: Noted as the reading on the
sphygmomanometer gauge when the
sound changes and becomes soft or
muffled (quiet)
Pulse Pressure
 Difference between the systolic and
diastolic pressure
 Important indicator of the health and tone
of arterial walls
 Normal range for pulse pressure in adults
is 30 to 50 mm Hg
 Ex: If the systolic pressure is 120 mm Hg
and the diastolic pressure is 80 mm Hg,
the pulse pressure is 40 mm Hg
Hypertension
 High blood pressure
 Indicated when pressures are greater than
140 mm Hg systolic and 90 mm Hg
diastolic
 Common caused include stress, anxiety,
obesity, high salt intake, aging, kidney
disease, thyroid deficiency and vascular
conditions such as arteriosclerosis
Hypotension
 Low blood pressure
 Indicated when pressures are less than
100 mm Hg systolic and 60 mm Hg
diastolic
 Occurs with heart failure, dehydration,
depressions, severe burns, hemorrhage
and shock
Factors Influencing Blood Pressure
Readings
 Force of heartbeat
 Resistance of the arterial system
 Elasticity of the arteries
 Volume of blood in the arteries
Factors That May Increase
Blood Pressure
 Excitement, anxiety, nervous tension
 Stimulant drugs
 Exercise and eating
Factors That May Decrease
Blood Pressure
 Rest or sleep
 Depressant drugs
 Shock
 Excessive blood loss
Types of Sphygmomanometers
 Mercury sphygmomanometer
 Contains a long column of mercury
 Each line on gauge represents 2mm of Hg
 Must be placed on a flat, level surface or
mounted on a wall or stand
 Level of Hg should be at zero when viewed at
eye level if manometer is calibrated correctly
Types of Sphygmomanometers
 Aneroid sphygmomanometer
 Does not have a mercury column, just a round
gauge
 Calibrated in mm of Hg
 Each line on gauge represents 2 mm of Hg
 Gauge should be positioned at eye level for
correct readings
Size and Placement of
Sphygmomanometer Cuff
 Cuff contains a rubber bladder
 Bladder fills with air as cuff is inflated
 Applies pressure to arteries to stop blood flow
 Cuffs that are too narrow or too wide
cause inaccurate readings
 Width of cuff should be approximately 20%
wider that diameter of pt’s upper arm
 Small cuff can result in false high reading
 Large cuff can result in false low reading
Size and Placement of
Sphygmomanometer Cuff
 Pt should be seated or lying comfortably
 Forearm should be supported on a flat
surface
 Area of the arm covered by the cuff should be
at heart level
 Arm must be free of any constricting
clothing and cuff should be applied to bare
arm
Placement of Stethoscope
 Place the diaphragm (bell) of stethoscope
directly over the brachial artery at the
antecubital area
 Hold it securely but with as little pressure
as possible
 Record info as:
 9/15/06, 0830, 122/76, Teresa Briggs, RN
 Prosedur
 Persiapan pasien, alat, dan ruangan
 Tempatkan (baringkan) pasien pada posisi supinasi yg nyaman & rileks
 Tempatkan lengan sejajar dgn jantung
 Temukan nadi radial dan brachial
 Bungkus lengan atas dgn manset. Amankan posisi manset.
 Buka pengunci stetoskop dan letakkan diafragma stetoskop pada nadi
brachial
 Tutup pengunci tensimeter.
 Buka pengunci manometer.
 Pompa manset sampai suara nadi tidak terdengar (sekitar 160 mm Hg)
 Buka pengunci pelan-2 dan dengarkan nadi melalui stetoskop
 Dengarkan suara “lupp” yg pertama utk menentukan tekanan sistolik
 Dengarkan suara “dubb” yg terakhir utk menentukan tekanan diastolik
 Buang semua udara di dalam manset dgn membuka pengunci secara
total.
 Lepaskan manset.
 Dokumentasikan hasilnya
 Informasikan hasilnya kpd pasien dan dokter
 USEFUL EXPRESSIONS
 Berbaringlah dgn nyaman dan rileks
 (Lie down in comfortable and relaxed position)
 Gulung lengan baju anda
 (Roll up your sleeve)
 Ulurkan tangan anda
 (Give me your hand)
 Relax Sir/Mam
 (Santai Pak/Bu)
 Tekanan darah anda normal
 (Your BP is normal)
 Tekanan darah anda tdk normal
 (Your BP is abnormal / Your BP is not normal)
 Anda mengidap Hipertensi
 (You have Hypertension)
 Anda mengidap Hipotensi
 (You have Hypotension)
PROCEDURE
 Preparation:
 Prepare the patient
 Prepare the room and equipment
 Greet the pt and give information (ask permission)
 Close the curtain
 Roll up the sleeve
 Place the arm at heart level
 Find and feel the brachial pulse (artery)
 Wrap the upper arm with rubber cuff
 Secure the position of the cuff
 Open the valve of stethoscope. Place the diaphragm
(bell) on brachial pulse
 Lock the valve of sphygmomanometer and pump
(squeeze) the bulb to inflate the cuff
PROCEDURE
 Unlock the valve slowly and listen to the pulse.
 Check (look at) the manometer (scale) to identify
the systolic (first “lupp” sound) and diastolic (last
“dubb” sound) pressure.
 Unlock the valve totally to release the air in the
cuff.
 Remove the cuff.
 Inform the result to the patient
 Document (record) the result on medical record
 Tidy the equipment and patient.
 Inform about the result to the patient and doctor