Vital Signs : BP

The pupil’s ability to change size (constrict and dilate) in response to changes in focusing on near objects

accommodation

Patient lying on their back with the head of the bed elevated about 15–30°

Low Fowler’s position

Patient lying on their back with the head of the bed elevated about 30–45°

Semi-Fowler’s position

Patient lying on their back with the head of the bed elevated about 60–90°

High Fowler’s position

PERRLA

Pupils Equal, Round, Reactive to Light and Accommodation.

[Think: Light = flashlight. Accommodation = near object.]

Functions that support adequate cardiac output and transport oxygenated blood blood to the body tissues.

Perfusion

6 Rights of Medication Administration

Right client,

Right Medication,

Right dose,

right route,

right time

right documentation

EMR

Electronic Medical Record

Measurements that reflect the body's physiological functions, including pulse, temperature, blood pressure, respiratory rate, oxygen saturation, and sometimes pain level

Vital signs

To cough up or spit out phlegm, mucus, or sputum from the throat and lungs

Expectorate

A measurement of the amount of pressure exerted by the blood within the circulatory system, expressed in $mm\,Hg$

Blood pressure

The maximum amount of pressure exerted when the heart contracts and forces blood into the aorta during systole (represented by the top number in a blood pressure measurement)

Systolic blood pressure

The minimum amount of pressure exerted when the heart is relaxed during diastole (represented by the bottom number in a blood pressure measurement)

Diastolic blood pressure

Cardiac output, blood volume, blood viscosity, vascular elasticity, and peripheral vascular resistance

Five direct physiological determinants of blood pressure

The amount of blood pumped into the circulatory system by the heart within $1\,min$

Cardiac output

calculated as $CO = SV \times HR$
where SV is stroke volume and HR is heart rate.

The amount of blood ejected by a ventricle during one heart contraction

Stroke volume

Identify the Right Coronary Artery

Identify the Aorta

identify the Left Main Coronary Artery

Identify the Circumflex Coronary Artery

Identify the

Identify the Left Descending Coronary Artery

Blood viscosity

The resistance of a liquid to flow.

Vascular elasticity

The ability of blood vessels to stretch and compress, then return to their original shape.

Peripheral vascular resistance

The total resistance to flow of blood in the vascular bed.
the resistance to blood flow,

Think of it like a faucet:

• 🚰 Vessels constrict (narrow) → resistance increases → BP increases

• 🚰 Vessels dilate (widen) → resistance decreases → BP decreases

Contractility

The heart's ability to contract efficiently, measured by the ejection fraction.

*do not confuse with heart beating*

Ejection fraction

The percentage of blood ejected from the ventricles with each contraction, generally measured in the left ventricle via an echocardiogram.

Ejection fraction = (Stroke Volume ÷ End-Diastolic Volume) × 100

Preload

The amount of blood inside the ventricles immediately before they contract. (fill)

Afterload

The amount of resistance or constriction that the heart must overcome to eject blood into systemic circulation.

When the ventricle contracts, it tries to push that blood into the aorta.

Afterload = the resistance/pressure the ventricle has to push against
→ Mainly the pressure in the arteries (especially the aorta)

Effect of decreased vessel elasticity on blood pressure

Increases the rigidity of the vessel wall, which in turn increases blood pressure.

Less elasticity → stiffer blood vessels → higher blood pressure.

Effect of increased afterload on cardiac muscle

Leads to cardiac hypertrophy, which ultimately decreases contractility.

atherosclerosis

hardening of the arteries

consists of a cuff with an inflatable bladder. The cuff is connected to a manometer that indicates the amount of pressure in the cuff.

Sphygmomanometer

How to document palpated blood pressure?

120/p
p=palp

Palpated blood pressure only gives you a systolic reading

This is the palpable estimated systolic blood pressure.

[Blood Pressure Assessment] Routine measurement age criteria in health care settings

Clients older than $3\,\text{years}$ of age, or younger clients with a preexisting medical condition.

[Blood Pressure Assessment] Clinical importance of accurate measurement

Many treatment decisions are directly based on a client's blood pressure.

[Blood Pressure - Patient Preparation] Requirement regarding client clothing at the cuff site

Bulky or layered clothing over the measurement site must be removed prior to applying the cuff.

[Blood Pressure - Patient Preparation] Proper leg and foot placement for a seated client

Legs uncrossed with feet flat on the floor.

[Blood Pressure - Patient Preparation] Proper positioning and height of the client's arm

Supported at the level of the heart with the palm facing upward.

[Blood Pressure - Cuff Placement] Correct placement location relative to the antecubital fossa

Applied snugly approximately $1\,\text{inch}$ above the antecubital fossa with the artery indicator aligned over the brachial artery.

[Blood Pressure - Auscultation] Stethoscope placement location on the upper arm

The bell or diaphragm is placed directly over the brachial artery.

[Blood Pressure - Palpation Method] Clinical indications for use

Used when Korotkoff sounds are difficult to hear during auscultation or when a digital monitor fails to detect blood pressure.

[Blood Pressure - Palpation Method] Indicator of estimated systolic blood pressure during cuff deflation

The pressure reading on the manometer when a pulsatile thrill is first felt.

[Blood Pressure - Auscultation Method] Target cuff inflation level above expected systolic pressure

$\approx 30\,\text{mm\,Hg}$ above the expected systolic pressure value.

[Blood Pressure - Auscultation Method] Recommended cuff deflation rate

Approximately $2\,\text{mm\,Hg}$ per second.

[Blood Pressure - Auscultation Method] Manometer indicator of systolic blood pressure

The point at which the first Korotkoff sound is heard.

[Blood Pressure - Auscultation Method] Manometer indicator of diastolic blood pressure

The point at which Korotkoff sounds are no longer audible.

A series sounds created by movement of blood through a partially compressed vessel during a manual blood pressure assessment.

Korotkoff sounds

An IV catheter placed in a large vein to give medications, fluids, nutrition, or blood.

Central intravenous line

A connection between an artery and vein that provides access for hemodialysis.

Arteriovenous (AV) shunt

Alternative blood pressure measurement methods for clients with an arm circumference greater than $50\,\text{cm}$

Using a forearm cuff, thigh cuff, or conical-shaped cuff.

Extrinsic factors affecting blood pressure

External and modifiable factors that a client can control to some extent, such as weight, caffeine or nicotine intake, medications, sodium intake, stress, activity level, anxiety, pain, and fever.

Intrinsic factors affecting blood pressure

Non-modifiable internal factors including age, ethnicity, genetics, and natural hormonal variations.

Effect of heart failure on blood pressure

Causes a decrease in blood pressure.

Structural arterial change in adults that frequently causes hypertension

Thickening of arterial vessel walls and a decrease in vessel elasticity, which increases peripheral vascular resistance.

Measurement requirement for a diagnosis of hypertension

At least two elevated readings taken on two or more separate occasions.

Blood pressure criteria for Normal classification in adults

Systolic $< 120\,\text{mm\,Hg}$ and diastolic $< 80\,\text{mm\,Hg}$

Blood pressure criteria for Elevated classification in adults

Systolic $120$ to $129\,\text{mm\,Hg}$ and diastolic $< 80\,\text{mm\,Hg}$

Blood pressure criteria for Stage 1 Hypertension in adults

Systolic $130$ to $139\,\text{mm\,Hg}$ or diastolic $80$ to $89\,\text{mm\,Hg}$

Blood pressure criteria for Stage 2 Hypertension in adults

Systolic $\ge 140\,\text{mm\,Hg}$ or diastolic $\ge 90\,\text{mm\,Hg}$

Blood pressure criteria for Hypertensive crisis

Systolic $\ge 180\,\text{mm\,Hg}$ and/or diastolic $\ge 120\,\text{mm\,Hg}$

Sensory receptors in blood vessels that respond to pressure and stretching

Baroreceptors

Three hormones released or triggered via baroreceptor response to regulate blood pressure

Antidiuretic hormone (ADH), renin, and aldosterone

Physiological mechanism by which antidiuretic hormone (ADH) elevates blood pressure

Secreted by the hypothalamus, ADH increases water reabsorption in the kidneys (raising plasma volume) and causes mild vasoconstriction at higher levels.

Three triggers for juxtaglomerular cells in the kidneys to release renin

1. Decreased blood pressure

2. Increased sympathetic nervous system activity

3. Decreased sodium levels in the distal convoluted tubules

Substrate converted by renin in the renin-angiotensin-aldosterone system

Angiotensinogen (produced by the liver), which renin converts into angiotensin I.

Enzyme that converts angiotensin I to angiotensin II and the resulting effects

Angiotensin-converting enzyme (ACE) converts angiotensin I into —> angiotensin II, which increases blood pressure through vasoconstriction and improved reabsorption of water and sodium.

The adrenal gland; aldosterone enhances the activity of the sodium-potassium pump, increasing sodium reabsorption and potassium excretion.

Gland that releases aldosterone and its mechanism for raising blood pressure

An idiopathic form of high blood pressure, commonly linked to genetics and salt sensitivity.

Primary (essential) hypertension

High blood pressure resulting from identifiable underlying conditions, such as endocrine disorders, vascular issues, kidney problems, medications, or sleep apnea.

Secondary hypertension

Vascular and cardiac complications associated with prolonged hypertension

Damage to arterial walls, development of atherosclerosis (plaque buildup), stroke, and heart failure.

$$64/41\,\text{mm\,Hg}$$

Expected blood pressure (50th percentile) for a newborn (birth to 4 weeks)

$$85/50\,\text{mm\,Hg}$$

Expected blood pressure (50th percentile) for an infant (1 to 12 months)

Expected blood pressure ranges (50th percentile) for toddlers (1 to 2 years)

• Male: $85$ to $91 / 37$ to $46\,\text{mm\,Hg}$\n- Female: $86$ to $89 / 40$ to $49\,\text{mm\,Hg}$

• Male: Greater than $103$ to $109 / 56$ to $65\,\text{mm\,Hg}$\n- Female: Greater than $104$ to $107 / 58$ to $67\,\text{mm\,Hg}$

Expected blood pressure ranges (95th percentile) for toddlers (1 to 2 years)

• Male: $91$ to $98 / 46$ to $53\,\text{mm\,Hg}$\n- Female: $89$ to $93 / 49$ to $54\,\text{mm\,Hg}$

Expected blood pressure ranges (50th percentile) for preschoolers (3 to 5 years)

• Male: Greater than $109$ to $112 / 65$ to $72\,\text{mm\,Hg}$\n- Female: Greater than $107$ to $110 / 67$ to $72\,\text{mm\,Hg}$

Expected blood pressure ranges (95th percentile) for preschoolers (3 to 5 years)

• Male: $96$ to $106 / 55$ to $62\,\text{mm\,Hg}$\n- Female: $94$ to $105 / 56$ to $62\,\text{mm\,Hg}$

Expected blood pressure ranges (50th percentile) for school-aged children (6 to 12 years)

• Male: Greater than $114$ to $123 / 74$ to $81\,\text{mm\,Hg}$\n- Female: Greater than $111$ to $123 / 74$ to $80\,\text{mm\,Hg}$

Expected blood pressure ranges (95th percentile) for school-aged children (6 to 12 years)

complications of Hypertension

Hypertension increases a client’s risk of heart attack, stroke, blood vessel damage (atherosclerosis) , kidney failure, and vision loss (hypertensive retinopathy).

hypotension in an adult.

a systolic pressure less than 90 mm Hg or a diastolic pressure less than 60 mm Hg

Manifestations of hypotension

dizziness, nausea, blurred vision, increased pulse, and fatigue​​​​​​​.

Standard adult blood pressure threshold for hypotension without baseline data

Systolic $< 90\,\text{mm\,Hg}$ or diastolic $< 60\,\text{mm\,Hg}$

Common causes of low blood pressure (hypotension)

Dehydration, blood loss, shock, and significant illness such as sepsis

Clinical manifestations of hypotension

Dizziness, nausea, blurred vision, increased pulse rate, and fatigue

Two common underlying causes of shock resulting from extreme hypotension

Significant blood loss and heart failure

Clinical manifestations of shock secondary to extreme hypotension

Cold, pale skin, rapid breathing rate, and a weak, rapid pulse

Immediate nursing interventions for a client experiencing shock

Rapid infusion of IV fluids or blood products and administration of medications to increase blood pressure and cardiac contractility

Orthostatic hypotension

A drop in blood pressure that occurs when a client rises to a sitting or standing position.

Common underlying causes of orthostatic hypotension

Dehydration, baseline hypotension, heart failure, or central nervous system disorders.

Primary safety risk associated with orthostatic hypotension

Feelings of faintness or dizziness, which significantly increase the client's risk for falls.

Assessment sequence used to evaluate a client for orthostatic hypotension

Measuring blood pressure sequentially while the client is lying, sitting, and then standing.

Diagnostic blood pressure criteria for orthostatic hypotension

A drop in systolic pressure of at least $20\,\text{mm\,Hg}$ or a drop in diastolic pressure of at least $10\,\text{mm\,Hg}$ within $1\,\text{min}$ of position change

Timeframe to recheck blood pressure for clients reporting symptoms during position changes [Orthostatic hypotension]

$3\,\text{min}$ after moving to a sitting or standing position.

Client education and nursing interventions to minimize orthostatic hypotension

Instruct the client to change positions slowly, slightly elevate the head of the bed while sleeping, avoid prolonged sitting or lying, wear compression stockings as prescribed, stay well hydrated, and avoid temperature extremes.