Lecture 2

• Parts of blood pressure

  systolic; diastolic (S1, S2)
• What influences blood pressure?

  age, gender, ethnocultural background, diurnal rthythm, weight, exercise, emotions, stress
• Physiological factors of blood pressure

  Cardiac output, peripheral vascular resistance, volume of circulating blood, viscosity, elasticity of vessel walls
• Cardiac output

  how easy or hard it is to spread blood around the body
• Viscosity

  thickness of blood
• Elasticity of vessel walls

  how much energy is needed to push blood around. How do they work (or do not work) with pressure of blood
• What is blood pressure

  the force pushing against the vessel wall that your heart is causing to pump blood around the body
• Systolic pressure


  pressure against the arteries during contraction (when it beats)
• diastolic pressure

  electric recoil during relaxation (between heart beats)
• Blood pressure cuff size

  SIZE IS EXTREMELY IMPORTANT; width of rubber bladder should = 40% of patient's arm; length of rubber gladder should = 80% of patient's arm
• Positioning

  either lying down or sitting up with feet flat on floor, arm lying chest level
• Anxious before blood pressure?

  let them sit for a few minutes so they can relax and give a more accurate reading. Test three times, discard first test, average last two
• Common errors with measuring

  patient positioning, cuff size, cuff inflation, observer error, orthostatic errors
• Step one of blood pressure

  Steps:

  1. palpate brachial pulse, medial to biceps tendon
  2. place deflated cuff one inch above brachial artery
  3. hold/palpate brachial artery or radial/medial pulse
  4. inflate cuff while holding pulse and watch number where you cannot feel pulse anymore

  *number of where you stopped feeling is your marker (add 30mmHg to number)
• Step two of blood pressure

  steps:

  1. place bell of stethoscope over brachial artery (seal with some pressure)
  2. inflate to maximal inflation (number + 30 mmHg)
  3. DEFLATE SLOWLY
  4. note when you first start hearing noise (systolic number)
  5. note when you stop hearing noise (diastolic number)
• Korotkoff's sounds

  swooshing noises
• What influences blood pressure

  gender, ethnocultural background, diurnal rhythm, exercise, emotions
• Oxygen saturation measurement


  pulse oximetry (how much oxygen is in the blood)

  sensor compares ratio of light emitted to light absorbed by hemoglobim and converts into percentage of Spo2

  normal range is 97-98%
• What is a healthy patient for O2 saturations?

  no lung disease, no anemia, 97-99%, warm skin, normal hemoglobin
• Hand hygiene

  alcohol based hand-wipe (when hands are not visibly soiled)

  Soap and running water (when hands are visibly dirty, or following visible exposure to body fluids)
• Apex of heart

  found in 5th intercostal space, midclavicular line (left side of chest wall)
• Base of heart

  located in 2nd intercostal space, right and left sternal border
• Blood flow?

  comes into heart by vena cavas into right atrium, moves into right ventricle after, travels up to pulmonary arteries into lungs, comes back to heart via pulmonary veins from lungs into left atrium, left ventrical after, up into aorta to sent out into body
• AV valves?

  atrioventricular. valves between atrium and ventricle. Tricupsid is RA to RV and mitral is LA to LV
• Movement of blood through heart?

  cardiac cycle
• S1 and S2

  S1 = systole, where mitral and tricuspid are closed; S2 = diastole, where aortic and pulmonary are closed
• Development in infants and kids

  foramen ovale, ductus arteriousus, position of heart in chest
• development in pregnant peeps

  increase in blood volume, increase in stroke volume and cardiac output
• development in older adults

  influence of lifestyle, increase systolic BP, decrease ability of heart to augment CO with exercise, increase in supraventricular and ventricular arrhythmias, decreased tolerance for tacharrhythimias, changes in conductions system on ECG
• Socioeconomic factors influencing

  high BP, smoking, serum cholesterol, obesity, diabetes
• neck vessles

  carotid artery, internal and external jugular arteries
• assessment: Subjective data

  chest pain, dyspnea, orthopnea, cough, fatigue, cyanosis or pallor, edema, nocturia, past cardiac history, family cardiac history, personal habits
• dyspnes

  uneven, uncontrolled breathing
• orthopnes


  how do they sleep?
• personal habits (cardiac risk factors)

  stress, exercise, smoking, medicaitons, nutrition
• aging

  mild increase in SBP in healthy adults, no change in DBP and resting HR, decreased ability to compensate for exercise
• Infants


  maternal health, feeding without tiring, growth, activity and milestones
• children

  growth, activity peers, joint pain and fever, headache and nosebleed, respiratory disease, family history
• pregnant women

  Hypertension, hypotension, weight gain, acknowledge vascular flow
• older adults

  disease, medication, environment, stairs