BLOOD PRESSURE

1
BLOOD PRESSURE

• Independent Practice Nurse Facilitator
• Suzie Lovett-Clements

2
AIM OF THE SESSION

• To accurately record a patients blood pressure,
  recording and reporting results.

3
Objectives

• Demonstrate a basic understanding of anatomy and
  physiology in relation to blood pressure.
• Understand what factors may affect the blood
  pressure.
• Identify normal values for blood pressure.
• Identify the correct equipment for recording
  blood pressure.
• To know when to report any concerns

4
Learning Outcomes

• At the end of this session you will be
• able to
• To have a better understanding
• of what blood pressure is
• Take accurate blood pressure recordings

5
Blood pressure

• High Blood Pressure is a key healthcare issue
• It affects approximately a third of the UK
  population.
• Generally it has no symptoms with the result that
  many people are undiagnosed and left untreated.
• The early identification and treatment of
  Hypertension will help prevent Coronary heart
  disease, Angina, Heart attacks and strokes

6
Definition

• The force exerted by blood against the walls of
  the vessels in which it is contained
• The pressure is determined by the force and the
  amount of blood pumped and the size and
  flexibility of the arteries

7
(No Transcript)
8
Factors affecting blood pressure

• Disease
• Age
• Heredity
• Blood Volume
• Weight
• Diet
• Hormones
• Salt
• Caffeine

• Environmental factors
• Psychological factors
• Stress/Anxiety
• Gravity
• Drugs
• Alcohol
• Time of day
• Ethnic Origin

9
Blood Pressure

• A diagnosis of high blood is not normally made
  unless the Blood Pressure is raised when tested
  of three separate occasions
• A Patients management depends critically on
  accurate estimation and recording of their Blood
  Pressure

10
Normal Values

• Normal Adult range
• Can fluctuate within a wide range and still be
  normal
• Systolic/diastolic
• 100/60 - 140/80

11
You have undertaken 4 new pt checks this morning
and all the patients have raised Bp levels. What
could be the causes?

• Tim - 58yr old builder. Overweight, smoker,
  enjoys alcohol and often exceeds 30 units a week
• Priya - 32 yr old housewife, has three children
  under the age of 7yrs. Arrives in surgery at
  9.10am
• Samantha - 28yr old fitness instructor. BMI 22,
  non smoker
• Clive - 45 yr old company director. Non smoker,
  BMI 29. Mother treated for raised BP

12
Tim

• Age
• Overweight poor diet therefore increased risk
  of CHD , hypertension, diabetes
• Smoker
• Excessive alcohol
• Physical activity-physically strenuous job

13
Samantha

• Physically fit has she been exercising this
  morning?
• ? Use of substances
• ? Existing medical condition
• ?family history
• ?contraceptive pill

14
Priya

• Housewife - 3 young children busy life
• Arrived 9.10 ? Just dropped children of at
  school, rushed to surgery
• ? Raised Bp in pregnancy
• ? Existing medical conditions
• ? Risk factors smoker contraceptive pill poor
  diet
• Ethnic background

15
Clive

• Age
• Job ? Physical fitness levels
• Overweight ? dietary habits ? Caffeine intake
• Family history of hypertension
• ? Existing medical condition
• ? Alcohol intake

16
Hypotension

• Defined in adults as a systolic pressure below
  100mm Hg
• Rarely treated in this country

17
Hypertension

• Defined as an elevation of systolic blood
  pressure
• Persistent hypertension very common
• 30 of people over 50 are hypertensive
• Never diagnosed on one reading
• Indication of cardiovascular disease
• Trauma
• Side effect of medication

18
Prevention

• Reduce the risk of developing High Blood Pressure
  by making lifestyle changes..
• Eat a healthy , well balanced diet
• Reduce salt and fat intake
• Exercise regularly
• Stop smoking
• Reduce alcohol and caffeine consumption to
  recommended levels
• Reduce weight

19
Weight Reduction
20
British Hypertension Society

• DVD on Blood Pressure Measurement demonstrated to
  group
• Tel [phone] to order DVD 5.99 inc pp
• Email bhs_at_le.ac.uk
• www. bhsoc.og
• Suggest purchasing ! Valuable to all members of
  the Practice

21
Blood Pressure Measurement

• Warm, calm environment !
• Provide an explanation of the procedure to the
  patient address any concerns/anxieties
• Allow the patient to rest for 5-10 mins if laying
  or seated
• Empty bladder
• Document any factors that could effect the BP
  level eg smoking , caffeine, exercise
• Sit upright feet flat on ground
• The arm must be supported at the level of the
  heart ensure no tight clothing constricts the arm
  
• The column of the mercury must be vertical and at
  the observers eye level
• Position the hose over the brachial artery
• The cuff should cover ¾ of the upper arm

22
Blood Pressure Measurement

• Ask the patient not to talk whilst BP is being
  taken
• Estimate the systolic beforehand
• Palpate the brachial artery
• Inflate cuff until pulsation disappears
• Deflate cuff
• Estimate systolic pressure
• Then inflate to 30mmHg above the estimated
  systolic level needed to occlude the pulse
• Place the stethoscope over the brachial artery
  and deflate at a rate of 2-3mm/sec until you hear
  regular tapping sounds
• Measure systolic (1st sound) and diastolic
  pressures (sound disappears) to nearest 2mmHg.

23
Korotkoffs Sounds

• Phase 2 A blowing or swishing sound
• Phase 3 A softer thud than sound 1
• Phase 4 A softer blowing sound that
  disappears
• Phase 1 A sharp thud
• Phase 5 Silence

24
Surgery procedure and when to refer

• Does the surgery have Guidelines?
• Priority to have clear agreed Practice
  Guidelines to support the HCAs role for the
  Employer and for the Patients/Public protection
• Record keeping paramount!
• Clearly state when patients should be referred
• Legal responsibility
• NICE clearly stated referral criteria
• Please read www.nice.org.uk

25
REFERENCES

• British Hypertension Society
• www.bhsoc.org
• Blood Pressure Association
• www.bpassoc.org.uk
• National Institute of Clinical Effectiveness
  (NICE) (2006).
• Hypertension Management of hypertension in
  adults in primary care
• http//www.nice.org.uk