VITAL SIGNS / CARDINAL SIGNS
- baseline information
- determined to monitor changes in body functions
WHEN TO ASSESS
1. Upon or on admission
2. As ordered
3. Before and after pre-op meds (invasive procedure/surgery)
4. Before and after administration of blood (to monitor change)
•stop infusion!!! – chilling, allergic reaction
5. Before and after any nursing intervention
6. When (+) for chest pain or any ABN sensation occurs
7. Before and after administration of medication that affects the Cardiovascular or
Respiratory systems
4 RULES IN TAKING VITAL SIGNS
1. Place patient in a comfortable position
2. Inform the patient about the procedure
2 important protocols in institutions
- check dr.’s orders
- verify your patient
3. Report any ABN reading to your baseline data
4. Frequency depends on the Dr.’s order and the institution
BODY TEMPERATURE
Body Temperature - reflects the balance between the heat produced and the heat
lost from the body, and is measured in heat units called degrees
2 kind of BT
1. Core Temperature – is the temperature of the deep tissues of the body,
Such as the cranium, thorax, abdominal and the pelvic cavity.
- remains relatively constant at 37°C
2. Surface Temperature - skin, subcutaneous tissues, fats
- 20°C to 40°C or 68°F to 104°F
Hypothalamus - center for thermoregulation
a. Anterior H – controls heat loss and vasodilation
b. Posterior H – controls heat production and vasoconstriction
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Alterations / ABN
Fever / Pyrexia / Hyperthermia - BT ↑ normal – 36.5 to 37.5°C
- > 37.8°C (oral)
- > 38°C (rectal)
Hyperpyrexia – BT ↑ 41°C
- convulsions, seizures
- possible brain damage
Hypothermia - ↓ normal = < 35.5°C in adults
* normal BT in infants = 35.5°C to 36.5°C = underdeveloped hypothalamus, small body surface
Mechanisms of Heat Loss
1. Evaporation/Vaporization – continuous evaporation of moisture from the respiratory
tract and from the mucosa of the mouth and from the skin
a. insensible heat loss – continuous and unnoticed heat loss
- accounts for 10% of basal heat loss
b. insensible water loss – continuous and unnoticed water loss
2. Conduction – transfer of heat from one molecule to a molecule of lower temperature,
e.g. TSB and ice pack
3. Radiation – Transfer of heat from the surface of one object to the surface of another
without contact between the 2 objects, e.g. infrared rays
4. Convection – dispersion of heat by air currents
FACTORS THAT AFFECT HEAT PRODUCTION
1. BMR – rate of energy utilization in the body required to maintain essential activities such
as breathing
2. Muscle Activity – increases metabolic rate
3. Thyroxine output – increased thyroxine output increases the cellular metabolism –
chemical thermogenesis-the stimulation of heat production in the body through
increased cellular metabolism
4. Epinephrine, norepinephrine and sympathetic stress response
5. Fever
Clinical signs of fever (Healthcare Lecture)
1. ↑ PR
2. ↑ RR
3. Shivering
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4. Cold skin
5. Body malaise
6. Cyanotic nail beds
7. Herpetic lips
8. prone to severe dehydration
9. cessation of sweating
NURSING INTERVENTION / MANAGEMENT /CARE OF Px WITH FEVER
1. Tepid Sponge Bath – running, lukewarm water w/o alcohol (dry skin, skin darkening, can
be an irritant) – never rub (friction)
2. √ Vital signs
3. √ Skin Color – (+) cyanosis
4. Remove excessive clothing / blanket – for heat loss
5. Provide adequate nutrition – monitor Intake-output
6. IVF as ordered by physician
7. Promote good hygiene – good nursing care
Good oral hygiene – enhances appetite
- prevents spread of infection
- promotes salivation
8. Promote Rest
9. Provide full circulation of air through electric fan (convection)
10.Administer anti-pyretic drugs as ordered
2 TYPES OF NURSING INTERVENTION
1. Independent nursing intervention
2. Dependent nursing intervention – with Dr.’s orders
Clinical signs of fever (Kozier)
Onset (Cold or chill phase) -Increased heart rate
-Increased respiratory rate and depth
-Shivering
-Pallid, cold skin
-Complaints of feeling cold
-Cyanotic nail beds
-“Gooseflesh” appearance of the skin
-Cessation of sweating
Course (Plateau Phase) -Absence of chills
-Skin that feels warm
-Photosensitivity
-Glassy-eyed appearance
-Increased pulse and respiratory rates
-Increased thirst
-Mild to severe dehydration
-Drowsiness, restlessness, delirium or
convulsions
-Herpetic lesions of the mouth
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-Loss of appetite (if the fever is prolonged)
-Malaise, weakness and aching mucsles
Defervescence (Fever
abatement/Flush Stage
-Skin that appears flushed and feels warm
-Sweating
-Decreased shivering
-Possible dehydration
CLINICAL MANIFESTATIONS OF HYPOTHERMIA
1. Decreased body temperature, pulse and respirations
2. Severe chilling (initially)
3. Feelings of cold and chills
4. Pale, cold, waxy skin
5. Frostbite (nose, fingers, toes)
6. Hypotension
7. Decreased urinary output
8. Lack of muscle coordination
9. Disorientation
10.Drowsiness progressing to coma
FACTORS AFFECTING BODY TEMPERATURE
AGE Infant – greatly influenced by temp of the environment
-low BT
-underdeveloped Hypothalamus
Children – more variable than adults before puberty
Older people – at risk for hypothermia due to
-inadequate diet,
-loss of subcutaneous fat,
-lack of activity and
-reduced thermoregulatory efficiency
-they are also sensitive to extremes in the environmental temp.
DIURNAL VARIATIONS ↑ 1600 to 1800 hours
↓ 0400 to 0600 hours
(by as much as 1° C or 1.8° F
EXERCISE Can increase BT up to 38.3°C to 40°C (101°F to 104°F) - rectal
HORMONES Women > hormone fluctuations than men. Progesterone secretion at
the time of ovulation raises the BT by about 0.3°C to 0.6°C (0.5 to
1°F)
STRESS May increase production of epi-, norepi,
ENVIRONMENT Extremes in environmental temp may affect a person’s BT
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FEVER
FEBRILE - ↑ 37.6°C
AFEBRILE – 36.5 to 37.5°C
Common types of Fever
1. Intermittent – the BT alternates at regular intervals between periods of fever and periods
of normal or subnormal temp.
2. Remittent – wide range of temp. fluctuations more than 2°C (3.6°F) occurs over a 24-
hour period, all above normal
3. Relapsing – short, febrile periods of a few days are interspersed with periods of 1 or 2
days of normal temp.
4. Constant/Sustained – the BT fluctuates minimally but always remains above normal.
5. Fever spike – temp that rises to fever level rapidly following a normal temp and then
returns to normal within a few hours
Heat stroke – generally have been exercising under hot weather
- have warm, flushed skin
- do not sweat
Heat exhaustion - result of excessive heat and dehydration
-signs include paleness, dizziness, nausea, vomiting, fainting, and a moderately increased
temp. (101°F to 102°F)
Types of thermometers
1. Mercury in glass – used for oral and axillla
2. Blue colored / Red colored – rectal
3. Disposable – single use
4. Electronic – 2 to 60 secs
5. Temperature sensitive tape– surface temp. only; forehead and abdomen
6. Infrared – sense body heat in the form of infrared energy given by a heat source, w/c is in
the ear canal
7. Temporal artery thermometers – uses a scanning infrared thermometer that compares
the arterial temp in the temporal artery of the forehead to the temp in the room and
alculates the heat balance to approximate the core temp of the blood in the pulmonary
artery
* 2 types of oral thermometer that can be glass or elctronic
1. Basal thermometer – calibrated with 0.1 F intervals and is for fertility purposes
2. Hypothermia thermometers – have a greater low range 81 to 108 F
CONVERSION
Celsius = (F -32) 5/9
Fahrenheit = (1.8 C) +32
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As Per RLE Lecture
Factors Affecting BT
-Condition of client
-Envronment
-Circadian Rhythm
-Food
-Gender – Female higher BT than males after puberty; ovulation raises BT by 1 C
-Hormones
1. Hypothyroid – low T4 and T3 – low BT – endomorphic
2. Hyperthyroid – high T4 and T3 – high BT - ectomorphic
•Cleaning Thermometer – cleanest to dirtiest
•For Rectal, use water based lubricant (KY Jelly) – oil based may irritate mucous
membranes
Equipment:
1. Thermometer
2. Thermometer sheath or cover
3. Water soluble lubricant for rectal temperature
4. Disposable gloves
5. Antiseptic wipes
6. Towel for axillary temperature
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ASSESING A PERIPHERAL PULSE
CLINICAL SIGNS OF CARDIOVASCULAR ALTERATIONS
1. Dyspnea – difficulty in breathing
2. Fatigue
3. Pallor
4. Cyanosis – bluish discoloration of skin and mucous membranes
5. Palpitations
6. Syncope (fainting)
7. Impaired peripheral tissue perfusion (as evidenced by skin discoloration and cool temp.)
FACTORS THAT MIGHT ALTER THE PULSE
-emotional status
-activity level
-medications that affect heart rate such as digoxin, beta blockers, or calcium channel
blockers
FACTORS AFFECTING THE PULSE
AGE Age Increase ↑ – Pulse rate decrease↓
GENDER After puberty, average male’s PR is < females PR
EXERCISE PR ↑ *rate of increase in athletes is lesser than average person
because of greater cardiac size, strength and efficiency
FEVER PR ↑ 1. in response to the lower BP that results from peripheral
vasodilation associated with elevated BT
2. due to increased metabolic rate
MEDICATIONS PR/HR ↑ - Epinephrine, Thyroxine
PR/HR ↓ - Cardiotonics (e.g. digitalis preparations)
↓ - Narcotics
↓ - Cardiac Glycoside or Digitalis Glycoside - digoxin (Lanoxin)
- decrease heart rate by prolonging cardiac conduction,
especially at the AV node
↓ - Beta blocker (e.g. propranolol)
↓ - Calcium channel blockers (verapamil)
ELECTROLYTE IMBALANCE
PR/HR ↑ - Blood Potassium ↓ (Hypokalemia)
PR/HR ↓ - Blood Potassium ↑ (Hyperkalemia) and irregular pulse
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PR/HR ↑ - Blood Calcium ↑ (Hypercalcemia)
PR/HR ↓ - Blood Calcium ↓ (Hypocalcemia)
HYPOVOLEMIA PR/HR ↑
•in adults, loss of blood results in an adjustment of the heart rate to
increase blood pressure as the body compensates for the blood
loss
•adults may lose 10% of their normal circulating volume without
adverse effects
STRESS PR/HR ↑
•sympathetic nervous stimulation increases overall activity of the
heart (epinephrine, norepinephrine)
•stress increases the rate as well as the force of the heartbeat
•Fear, anxiety as well as severe pain stimulate the sympathetic
system
POSITION
CHANGES
* when a person is sitting or standing, blood usually pools in dependent
vessels of the venous system → pooling results to transient decrease in
venous blood return to the heart → reduction in BP results → increased
HR
PATHOLOGY Certain diseases such as some heart conditions or those that impair
oxygenation can alter the pulse rate
PR/HR ↓ - Acute MI
PR/HR ↑ - Hyperglycemia
PR/HR ↓ - Congestive Heart Failure
PR/HR ↓ - Hypertensive Heart Disease
SITE MOST APPROPRIATE FOR ASSESSMENT
RADIAL - Readily accessible
TEMPORAL - Used when radial pulse is not accessible
CAROTID -Used during cardiac arrest/shock in adults
-Used to determine circulation to the brain
APICAL -Routinely used for infants and children up to 3 years of age
-Used to determine discrepancies with radial pulse
-Used in conjunction with certain medications
-Used to monitor clients with cardiac, pulmonary or renal disease
BRACHIAL -Used to measure blood pressure
-Used during cardiac arrest for infants
FEMORAL -Used in cardiac arrest/shock
-Used to determine circulation to the leg
POPLITEAL - Used to determine circulation to the lower left leg
POSTERIOR
TIBIAL
- Used to determine circulation to the foot
DORSALIS
PEDIS
- Used to determine circulation to the foot
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****PURPOSE OF ASSESSING A PERIPHERAL PULSE
-establish a baseline data for subsequent evaluation
-identify whether the pulse rate is within the normal range
-determine whether the pulse rhythm is regular and the pulse volume appropriate
-determine the equality of corresponding peripheral pulses on each side of the body
-monitor and assess changes in the client’s health status
-monitor clients at risk for pulse alterations
-evaluate blood perfusion to the extremeties
PROCEDURE:
1.) - Identify yourself
- verify client’s identity
- explain procedure – what, why, and how the client can cooperate
2.) Aseptic techniques
3.) Privacy
4.) Select the pulse point
5.) Position client in a comfortable resting position.
6.) Palpate and count the pulse
7.) Assess the pulse rhythm and volume
8.) Document the pulse rate, rhythm and volume
PULSE VOLUME LEVEL (0-4)
0 = No pulse/absent
1 = thready
2 = weak
3 = normal
4 = bounding
NORMAL VALUES – ADULTS 60 -100 ppm
PULSE RHYTHM – Regular or Irregular
Equipment:
1. Watch
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KOZIER NOTES
PULSE – a wave of blood created by the contraction of the left ventricle of the heart
PULSE WAVE – represents the stroke volume output or the amount of blood that enters the
arteries with each ventricular contraction
COMPLIANCE OF THE ARTERIES – ability of the arteries to contract and expand
CARDIAC OUTPUT – volume of blood pumped into the arteries by the heart equals the result of
the stroke volume (SV) times the heart rate (HR) per minute
•In a healthy person the pulse reflects the heartbeat
PERIPHERAL PULSE – pulse located away from the heart
APICAL PULSE – central pulse; located at the apex of the heart; also referred to as the Point of
Maximal Impulse (PMI)
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ASSESSING AN APICAL PULSE
CLINICAL SIGNS OF CARDIOVASCULAR ALTERATIONS
1. Dyspnea – difficulty in breathing
2. Fatigue
3. Pallor
4. Cyanosis – bluish discoloration of skin and mucous membranes
5. Palpitations
6. Syncope (fainting)
7. Impaired peripheral tissue perfusion (as evidenced by skin discoloration and cool temp.)
FACTORS THAT MIGHT ALTER THE PULSE
-emotional status
-activity level
-medications that affect heart rate such as digoxin, beta blockers, or calcium channel
blockers
Equipment:
1. Watch with a second hand
2. Stethoscope
3. Antiseptic wipes
Procedure:
1.) - Identify yourself
- verify client’s identity
- explain procedure – what, why, and how the client can cooperate
2.) Aseptic techniques
3.) Privacy
4.) Position client in a comfortable supine or sitting position. Expose the area of the chest over
the apex of the heart
5.) Locate the apical pulse
- Manubrium → Angle of Louis → slide to the left of the sternum (palpate the 2nd
intercostals space → place your middle or next finger in the 3rd ICS until you locate the 5th ICS→
move finger toward the MCL
6.) Auscultate and count heart beats
- clean earpiece and diaphragm
- warm diaphragm
- insert earpiece of the stethoscope
- tap finger on diaphragm
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- place stethoscope on site of apical pulse
- if you have difficulty auscultating the apical pulse, ask the client to roll ontonhis/her
left side or the sitting client to lean slightly forward
7.) Assess Rhythm (regular/irregular) and strength (strong or weak) of heartbeat
ASSESSING AN APICAL RADIAL PULSE
CLINICAL SIGNS OF HYPOVOLEMIC SHOCK
1. Hypotension
2. Pallor
3. Cyanosis
4. Cold, clammy skin
5. Thirst
6. Alterations of mental status
7. Suppression of kidney function
Equipment
1. Watch with a second hand
2. Stethoscope
3. Antiseptic wipes
Procedure:
1.) - Identify yourself
- verify client’s identity
- explain procedure – what, why, and how the client can cooperate
2.) Aseptic techniques
3.) Privacy
4.) Position the client appropriately
5.) Locate the apical and radial pulse sites
6.) count the apical and radial pulse rates
Two-nurse technique
One nurse technique
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ASSESING RESPIRATIONS
***PURPOSE
-acquire baseline data
-monitor abnormal respirations and respiratory patterns and identify changes
-monitor respirations before or following the administration of a general anesthetic or any
medications that influence RR
-monitor clients at risk for respiratory alterations
1. fever
2. pain
3. acute anxiety
4. COPD
5. asthma
6. respiratory infection
7. pulmonary edema or emboli
8. chest trauma or constriction
9. brain stem injury
PREPARATION
Assess
1. Skin and mucous membrane color – cyanosis or pallor
2. Position assumed for breathing – e.g. use of orthopneic position
3. Signs of cerebral anoxia – irritability, restlessness, drowsiness, loss of consciousness
4. Chest movements – retractions between the ribs or above or below the sternum
5. Activity Tolerance
6. Chest pain
7. Dyspnea
8. Medications affecting respiratory rate
a. Narcotics - ↓ RR (e.g. morphine, large doses of barbiturates such as secobarbital
sodium depress the respiratory centers in the brain, thereby depressing the RR
and the depth.)
Factors that affect Respirations
INCREASE DECREASE
Exercise
Stress Certain medications (narcotics)
Increased Environmental Temp. Decreased environmental Temp.
Lowered Oxygen concentration at high
altitudes
Increased intercranial pressure
Body Position
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Supine - ↓ Respiration
1. Increase in the volume of the blood inside the thoracic cavity
2. compression of the chest
Equipment:
1. Watch with second hand
Procedure:
1.) - Identify yourself
- verify client’s identity
- explain procedure – what, why, and how the client can cooperate
2.) Aseptic techniques
3.) Privacy
4.) Observe or palpate RR
5.) Observe depth – watch movement of chest
rhythm - regular or irregular
character – sound they produce and the effort they require
6.) document the respiratory rate, depth, rhythm and character
1 cycle of respiration = 1 inhalation and 1 exhalation
Respiratory Rate
Normal values = 16 – 20 cpm
Respiratory Depth:
-Normal (500 ml of air) - Tidal volume
-Deep
-Shallow
Respiratory Rhythm:
-Regular
-Irregular
Respiratory quality or character
-amount of effort a client exerts in breathing (e.g. labored breathing)
-sound of breathing (e.g. wheeze)
14
Pulse Oximeter – indirectly measures the amount of hemoglobin in the arterial blood that is
saturated with oxygen; provides a digital readout of both the client’s pulse rate and oxygen
saturation.
Altered Breathing Patterns
Rate:
-Bradypnea – less than or equal to 15 cpm
-Tachypnea – more than or equal to 21 cpm
-Apnea – absence of breathing
Volume:
-Hyperventilation – overexpansion of the lungs characterized by rapid and deep breaths
-Hypoventilation – underexpansion of lungs, characterized by shallow respirations
Rhythm:
- Cheyne-Stokes breathing – from very deep to very shallow breathing and temporary apnea
Ease or effort:
-Dyspnea – difficult and labored breathing
-Orthopnea – ability to breathe in only upright sitting or standing positions
Altered Breath Sounds
Audible without amplification
-Stridor – a shrill, harsh sound heard during inspiration with laryngeal obstruction
-Stertor – snoring or sonorous respiration, usually due to a partial obstruction of the upper
airway
-Wheeze – contninuous, high-pitched musical squeak or whistling sound occurring on
expiration and sometimes on inspiration when air moves through a narrowed or partially
obstructed airway
-Bubbling – gurgling sounds heard as air passes through moist secretions in the
respiratory tract
Chest movements
-Intercostal retraction – indrawing between ribs
-Substernal retraction – indrawing beneath the breastbone
-Suprasternal retraction – indrawing above the clavicles
Secretions and Coughing
-Hemoptysis – the presence of blood in the sputum
-Productive cough – a cough accompanied by expectorated secretions
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-Nonproductive cough – a dry, harsh cough without secretions
KOZIER NOTES
Respiration – act of breathing
Inhalation/Inspiration – intake of air into the lungs
Exhalation/Expiration – breathing out; movement of gases from the lungs to the atmosphere
Costal (thoracic breathing) – involves the external intercostals muscles and other accessory
muscles such as the sternocleidomastoid muscles.
Diaphragmatic (abdominal) breathing – involves the contraction and relaxation of the diaphragm
and it is observed by the movement of the abdomen
Control of Respiration
1. Respiratory centers in the medulla oblongata and pons
2. chemoreceptors located centrally in the medulla and peripherally in the aortic and carotid
bodies (respond to changes in O2, CO2 and H+ concentrations in the blood)
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ASSESSING BLOOD PRESSURE
***PURPOSE
1. obtain baseline data
2. determine client’s hemodynamic status (e.g. cardiac output; stroke volume of the heart
and blood vessel resistance)
3. identify and monitor changes in BP resulting from a disease process or medical therapy
(e.g. presence or history of CV disease, renal disease, circulatory shock, acute pain,
rapid infusion of fluids or blood)
SIGNS AND SYMPTOMS OF HYPERTENSION
1. Headache
2. Ringing in ears
3. Flushing of face
4. Nosebleeds
5. Fatigue
SIGNS OF HYPOTENSION
1. Tachycardia
2. Dizziness
3. Mental confusion
4. Restlessness
5. Cool and clammy skin
6. Pale or cyanotic skin
FACTORS AFFECTING BLOOD PRESSURE
LAB
1. Activity
2. Emotional Stress
3. Pain
4. time client last smoked
5. time client last ingested caffeine
KOZIER
AGE -Newborn – mean systolic pressure of about 75 mm Hg
-BP rises with age reaching peak at the onset of puberty and tends
to decline somewhat
-Elders- elasticity of the arteries is decreased – produces an
elevated systolic pressure. Because the walls do not retract as
flexibly with decreased pressure, the diastolic may also be high
EXERCISE Increase cardiac output ( let client rest for 20 to 30 mins following
17
exercise before taking BP)
STRESS -Stimulation of Sympathetic Nervous System increases Cardiac
Output and vasoconstriction of the arterioles, thus increasing BP
-Severe pain can decrease BP greatly by inhibiting the vasomotor
center and producing vasodilation
RACE African American males over 35 > European American males same age
GENDER -After puberty, females BP < BP of males same age (hormonal)
-After menopause, women have higher BP than before
MEDICATIONS Antihypertensives
1. thiazide diuretic – cause blood vessels to dilate, help kidneys
eliminate salt and water, decrease fluid volume throughout the
body
2. Adrenergic blockers – (alpha-blockers, beta-blockers, alpha-beta-
blockers, peripherally acting adrenergic blockers) block the effects
of the sympathetic division
3. Centrally acting alpha-agonists – by stimulating certain receptors
in the brain stem, these agonists inhibit the effect of the
sympathetic division
4. Angiotensin-converting enzyme (ACE) Inhibitors – dilate arterioles
by preventing the formation of Angiotensin II by blocking the
action of ACE, which converts angiotensin I to angiotensin II
5. Angiotensin II Blockers – directly block angiotensin II, lesser side
effects
6. Calcium channel blockers – dilate arterioles; may be long term or
short term
7. Direct Vasodilators
Hypertension
-use of birth control pills (oral contraceptives)
-Hormonal disorders
a. Cushing’s syndrome – high levels of cortisol
b. Hyperthyroidism – overactive thyroid gland
c. Hyperaldosteronism – overproduction of aldosterone, often
by a tumor in one of the adrenal glands
d. Pheochromocytoma ( a tumor that is located in the adrenal
gland that produces epinephrine and norepinephrine)
-Caffeine- increase PR and BP
-Smoking – constricts blood vessels – tem increase in BP
OBESITY Predisposed to hypertension
DIURNAL
VARIATIONS
BP lowest in early morning where metabolic rate is lowest, rises
throughout the day and peaks in the late afternoon or early evening
DISEASE
PROCESS
Any condition affecting cardiac output, blood volume, blood viscosity,
compliance of the arteries
•Check the client for allergy to latex cuff
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Equipment :
Stethoscope, Blood pressure cuff, Sphygmomanometer
PROCEDURE
1.) - Identify yourself
- verify client’s identity
- explain procedure – what, why, and how the client can cooperate
2.) Aseptic techniques
3.) Privacy
4.) Position client appropriately
5.) wrap the deflated cuff evenly around the upper arm.
6.) If this is the client’s initial exeamination, perform a preliminary palpatory determination of
systolic pressure
7.) position the stethoscope
- clean the earpieces with antiseptic wipes
- insert ear piece
- ensure that the stethoscope hangs freely from the ears to the diaphragm
- place the bell side over the brachial pulse site
- place stethoscope directly on skin
8.) Auscultate client’s BP
9.) If this is client’s initial examination, repeat procedure in client’s other arm
KOZIER NOTES
Arterial Blood Pressure – is the measure of the pressure exerted by the blood as it flows
through the arteries
Systolic Pressure – pressure of the blood as a result of the contraction of the ventricles, that is,
the pressure of the height of the blood wave
Diastolic Pressure – pressure when the ventricles are at rest; lower pressure, present at all
times in the arteries
Pulse pressure – the difference bet. Systolic and diastolic NV=40
-elevated – exercise = 100
- arteriosclerosis
- low - severe heart failure (25 mm Hg)
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DETERMINANTS OF BP
1. Pumping Action of the Heart
↓Pumping action → ↓blood pumped into arteries → ↓cardiac output → ↓BP
2. Peripheral Vascular Resistance
Factors that create resistance in the arterial system
a. capacity of the arterioles and capillaries
b. compliance of the arteries
c. viscosity of the blood
↓Smaller space within the vessel → ↑resistance → ↑BP
-Vasoconstriction - ↑BP (smoking)
-Vasodilation - ↓BP
3. Blood Volume – directly proportional to BP
4. Blood Viscosity - ↑BP when blood is highly viscous – the proportion of RBC to blood
plasma is high. This proportion is called the hematocrit. Viscosity increases when the
hematocrit is more than 60% to 65%
Classification of Blood Pressure
CATEGORY SYSTOLIC BP mm Hg DIASTOLIC BP mm Hg
Normal < 120 < 80
Prehypertension 120-139 80 – 89
Hypertension Stage 1 140-159 90-99
Hypertension Stage 2 >160 >100
Hypertension – BP that is persistently above normal
- asymptomatic and often a contributing factor to MI
1. Primary hypertension – elevated BP of unknown cause
2. Secondary hypertension – known cause
Factors associated with hypertension
1. thickening of arterial walls
2. inelasticity of arteries
3. cigarette smoking
4. obesity
5. heavy alcohol consumption
6. lack of exercise
7. high blood cholesterol levels
8. continued exposure to stress
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Hypotension – BP that is below normal – a systolic reading consistently between 85 to 110 mm
Hg in an adult whose normal pressure is higher than this
Orthostatic hypotension – BP that falls when a client sits or stands
-caused by peripheral vasodilation in which blood leaves the central body organs,
especially the brain, and moves into the periphery
Hypotension can also be caused by
-analgesics such as Meperidine HCl (Demerol)
-bleeding
-severe burns
-dehydration
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