British Journal of Healthcare Assistants BLOOD PRESSURE Independent Practice Nurse Facilitator Suzie...

British Journal of

Healthcare Assistants

BLOOD PRESSUREBLOOD PRESSURE

Independent Practice Nurse FacilitatorIndependent Practice Nurse Facilitator

Suzie Lovett-ClementsSuzie Lovett-Clements

British Journal of


AIM AIM OF THE SESSIONOF THE SESSION

To accurately record a patient’s blood pressure, recording and reporting results.

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ObjectivesObjectives 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

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Learning OutcomesLearning 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

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Blood pressureBlood 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

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DefinitionDefinition

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

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Factors affecting blood Factors affecting blood pressurepressure

Disease Age Heredity Blood Volume Weight Diet Hormones Salt Caffeine

Environmental factors

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

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Blood PressureBlood 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

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Normal ValuesNormal Values

Normal Adult range

Can fluctuate within a wide range and still be normal

Systolic/diastolic 100/60 - 140/80

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You have undertaken 4 new pt checks this You have undertaken 4 new pt checks this morning and all the patients have raised Bp morning and all the patients have raised Bp

levels. What could be the causes?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

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TimTim

AgeOverweight – poor diet therefore

increased risk of CHD , hypertension, diabetes

SmokerExcessive alcoholPhysical activity-physically

strenuous job

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SamanthaSamantha

Physically fit – has she been exercising this morning?

? Use of substances? Existing medical condition?family history?contraceptive pill

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PriyaPriya

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

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CliveClive

AgeJob ? Physical fitness levelsOverweight ? dietary habits ?

Caffeine intake Family history of hypertension? Existing medical condition? Alcohol intake

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HypotensionHypotension

Defined in adults as a systolic pressure below 100mm Hg

Rarely treated in this country

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HypertensionHypertension 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

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PreventionPrevention

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

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Weight ReductionWeight ReductionWhy 10% weight reduction? >20% total mort alit y

>30% diabetes-related deat hs >40% obesity related cancer deat hs

10 mmHg systolic BP 20 mmHg diastolic BP

50% in fasting blood glucose

10% tot al cholesterol 15% LDL cholesterol 30% t r iglycerides 8% HDL cholester ol

Ref : Obesit y i n Scotland I nt egrat ing prevent ion with weight management (Scot ti sh I nt er coll egiate Guidelines N etwork - SI GN 1996)

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British Hypertension SocietyBritish Hypertension Society

DVD on Blood Pressure Measurement demonstrated to group

Tel 07716 467973 to order DVD £ 5.99 inc pp

Email [email protected] www. bhsoc.og Suggest purchasing ! Valuable to all

members of the Practice

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Blood Pressure Blood Pressure MeasurementMeasurement 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

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Blood Pressure Blood Pressure MeasurementMeasurement

Ask the patient not to talk whilst BP is being taken Estimate the systolic beforehand:a) Palpate the brachial arteryb) Inflate cuff until pulsation disappearsc) Deflate cuffd) 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.

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Korotkoff’s SoundsKorotkoff’s 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

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Surgery procedure and when Surgery procedure and when to referto refer

Does the surgery have Guidelines? Priority to have clear & agreed Practice

Guidelines to support the HCA’s 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

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REFERENCESREFERENCES

British Hypertension Society www.bhsoc.org

Blood Pressure Associationwww.bpassoc.org.uk

National Institute of Clinical Effectiveness (NICE) (2006).

Hypertension: Management of hypertension in adults in primary care

http://www.nice.org.uk

British Journal of Healthcare Assistants BLOOD PRESSURE Independent Practice Nurse Facilitator Suzie...

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