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 FSM 2002

Blood pressure is the hydrostatic pressure or
circulatory force exerted by the blood on the walls
of a blood vessel. The pressure is generated by the
contraction of ventricles of heart to maintain
perfusion in all parts of the body. Highest BP in
the aorta & large systemic arteries.

In young resting adults BP rises to 140 to 120mm Hg
during systole (contraction) & drops to about 80mm
of Hg during diastole (relaxation).
                Blood Pressure
High BP - Hypertension
• Systolic >160 & Diastolic >90 mm of Hg in young adult
Low BP - Hypotension
If systolic <100 mm of Hg in a young adult.

Good clinical practice to check BP lying, sitting, & standing.
Patient is at ease & relaxed.

Normally from lying to standing there is increase in
diastolic & decrease in systolic of 5 to 9 mm Hg. If it is >10
to 15 mm of Hg patient might feel dizzy & fall. This is
known as orthostatic (postural) hypotension. This occurs
due to DM, anti-hypertensive drug, old age, hypovolaemia,
autonomic neuropathy

If low blood volume - the BP taken with pt. lying flat
may fall upon sitting upright or on standing

Normally Systolic BP varies up to 10mm of Hg
between right and left brachial arteries

Average BP tends to increase with age.

Age < 65 years if diastolic BP constantly > 90mmHg
Age > 65 years if diastolic BP constantly >100 or
systolic BP >180mmHg
          Basic Measurements
Mean arterial blood pressure (MABP)
•Average pressure calculated
•Diastolic BP +1/3 (systolic BP- diastolic BP
•Normally is 93mm of Hg

Blood Pressure
BP = Cardiac output(CO) X Peripheral resistance

Pulse pressure
•Difference of systolic and diastolic pressures
•Normal is 40mm of Hg.
•It is high in AR/MR/aortic sclerosis (old)
•It is low in mitral stenosis
Greek word ‘Sphygmos’ means pulse
Greek word ‘Manometer’ means to measure - measuring scale with
mercury column.
Is used to measure BP/measuring the force and frequency of pulse and
pulse pressure
Instrument should be placed upright with even surface (avoid bed with soft

Position cuff correctly on pt.’s arm so that antecubital fossa is accessible.
Place the cuff inch or 2.5 cm above the bend of elbow or antecubital crease

It is important that the cuff should be firmly applied with the centre of the
inflatable part over the brachial artery.

Apply cuff bladder with tube directed above or below laterally so that
brachial artery is easily found for ausclatation

Cuff should be totally deflated, valve closed and not applied too tightly.
Should be able to admit one finger
All clothes should be removed from the hand

Inflation should be above 20-30mmHg after which the radial
pulse cannot be felt to avoid auscaltatory gap
Korotkoff sounds are heard as pressure is reduced 2-3 mmHg
per second
First sound heard (1st phase for peak systolic pressure)
indicates systolic pressure - ventricular systole
The sound will slowly become faint which is the fourth phase.
During the 5th phase, the sound disappears.
Note: Auscultatory gap is a silent interval that may be preset
between the systolic or diastolic pressure. An unrecognized
auscultatory gap may lead to serious underestimation of
systolic pressure or overestimation of diastolic pressure.
Always record auscultatory gap in your findings.
Aeronoid Sphygmomanometer
Mercury Sphygmomanometer
      Taking Blood Pressure Will Standing

Arm support in standing position
Proper way of measuring Blood Pressure
      Important Points to Remember
5 –10 minutes rest period should be given before measurement
Subject is seated & BP is measured on right arm using standard mercury
Check the accuracy of the sphyg. prior to the checkup - position & readiness. The
mercury should be clean and at zero mark.
Position pt's arm correctly; flexed at the elbow & comfortably on the table.

Palpate Brachial & radial pulse..

Cuff size should cover 2/3 of the length of the upper arm with a length width ratio
of 2:1. Large cuffs with bladder size 33 by 15.5cm should be available for subject
with mid arm circumference >33 cm.
Cuff size
1. Infant: 25X4.5cm
2. Child 1-3 yrs 33X5 cm
3. Child 4-6 yrs 38X7 cm
4. Boy 45X10.5 cm
5. Adult 50X14 cm
6. Obese 62X17 cm
(Livingstone International Pty Ltd.)
      Important Points to Remember
Check cuff is emptied of air.

Cuff must be free of leaks. During cuff inflation, the mercury should rise
smoothly and stop immediately as inflation stops.

Pressure is normally recorded to the nearest 2mm Hg from the top of
mercury meniscus.

Systolic pressure is recorded at the 1st appearance of the sounds. The
systolic pressure is the point at which at least 2 repetitive 'clear' taps are

Continue reducing the pressure slowly and a distinct muffling of tapping
sounds occur (phase IV) continue the pressure reduction & the diastolic
pressure the point at which repetitive 'taps' disappear (phase V).
    Important Points to Remember

Occasionally tapping persists until the
sphygmomanometer has recorded 0. In such a case
utilize phase 4 muffling. Always record which phase
was used for the diastolic recording.

After measurement the cuff is deflated for 30s &
measurement is then repeated.
    Important Points to Remember
2nd and 3rd sounds are due to turbulent flow of
blood through a partially occluded vessel. 4th phase
is 7 to 10mm of Hg above the diastolic pressure.
BP is affected by anxiety, excitement, posture and
physical activities
Difference between systolic and diastolic pressure -
normal is 30 to 60 mm of Hg.
For children - leave a gap of 1cm below the axilla and
above antecubital fossa for cuff
For thigh BP, patient is prone and 18 cm cuff applied
to above knee and auscultated over popliteal artery.
                 Checklist for Taking Blood Pressure
Greet & introduce

Explain the procedure, show consideration & explain that this procedure is not going to hurt
Position the patient’s arm correctly & comfortably on table at level of heart
Palpate brachial & radial pulse
Check sphygmomanometer - position and readiness - even surface, steady, straight & unlock.
Check cuff is empty of air
Apply cuff correctly to patient’s upper right arm about an inch or 2.5 cm above the antecubital crease.
Closely apply cuff bladder over anterior aspect of arm whether tube directed above or below so that the
brachial artery is easily accessible
Ensure valve on pump is closed
Pump pressure up steadily with appropriate speed and force for patient's comfort
Feel radial pulse while pumping
Pump up to 20 - 30 mmHg above from the point where the radial pulse is obliterated to avoid
auscaltatory gap.
Place stethoscope on brachial artery quickly so that pressure is not maintained for too long

Lower pressure steadily at 2 mmHg per second.
Obtain reading at first attempt or, if repeats, empty cuff of air for 20 to 30 seconds and start again. Avoid
pumping pressure up & down
Obtain accurate reading of blood pressure
Show consideration to the patient through out.
Unlock the valve, deflate the cuff by removing from the patient
State your findings

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