Readings taken from a patient
Blood Pressure
 Respiratory Rate
 Arterial Pulse
 Body temperature


Results from the alternating expansion and recoil
of an artery

Occurs with each beat of the Left ventricle creating a
pressure wave
Pulse rate normally equals the heart rate
 Average of about 70 – 76 BPM


Felt in an artery that is close to the surface

Pressure points- used to stop blood flow into distal tissues

Compress the artery – do not apply too much
pressure

Radial arterial pulse


Located distal forearm at wrist on radial side
Routinely used to take a pulse

Superficial temporal pulse – head

Facial Artery – by the TMJ

Common carotid artery – neck

Brachial artery - at the antebrachial fossa

Femoral Artery – groin

Popliteal Artery – behind the knee (popliteal
region)

Posterior Tibial Artery – at the medial malleolus

Dorsalis Pedis
Superficial temporal artery
Facial artery
Common carotid artery
Brachial artery
Radial artery
Femoral artery
Popliteal artery
Posterior tibial
artery
Dorsalis pedis
artery
Use your first 2 or 3 fingers
 Do not use the thumb (has own pulse)
 Press firmly then ease compression
 Feel for the pulse


If no pulse, then you are pressing too hard or
you are not in the right location

The pressure the blood exerts on the walls of blood
vessels


allows for circulation
Created from an increase in arterial pressure from a
ventricle that is contracting



Pressure is highest closer to the heart and in larger arteries
(aorta, brachial)
Pressure is greater on the left (closer to the heart)
Pressure drops continuously until virtually zero in the Vena
Cava


Most distal, before return to the heart
Venous return to the heart does not rely solely on
blood pressure


Veins – valves to prevent backflow
Compression of the skeletal muscle

Differences in flow



A cut vein – see even flow of blood
Arterial – pulsating blood flow
Arteries provide elasticity - compression of arteries
will aid the blood flow
−10
Venae cavae
Veins
Venules
Capillaries
Arterioles
Arteries
60
Aorta
Pressure (mm Hg)
120
Systolic pressure
100
80
Diastolic
pressure
40
20
0

Measure 2 pressures


Systolic pressure – arterial pressure is high due to ventricular
contraction
Diastolic pressure – results from the relaxation of ventricles


Units of measurement (mmHg)



120/80 Systolic/ Diastolic
Pressure is greater on the left (closer to the heart)
Pressure drops continuously until virtually zero in the Vena
Cava


Pressure is low pressure
Most distal, before return to the heart
Venous return to the heart does not rely solely on
blood pressure


Veins – valves to prevent backflow
Compression of the skeletal muscle
Blood pressure
120 systolic
70 diastolic
(to be measured)
Brachial
artery
(a) The course of the
brachial artery of
the arm. Assume a
blood pressure of
120/70 in a young,
healthy person.
Pressure
in cuff
above 120;
no sounds
audible
120 mm Hg
Rubber cuff
inflated with
air
Brachial
artery
closed
(b) The blood pressure
cuff is wrapped
snugly around the
arm just above the
elbow and inflated
until the cuff
pressure exceeds the
systolic blood
pressure. At this
point, blood flow into
the arm is stopped,
and a brachial pulse
cannot be felt or
heard.
Pressure
in cuff
below 120,
but above 70
120 mm Hg
70 mm Hg
Sounds
audible in
stethoscope
(c) The pressure in the cuff
is gradually reduced
while the examiner
listens (auscultates) for
sounds in the brachial
artery with a
stethoscope. The
pressure read as the
first soft tapping
sounds are heard (the
first point at which a
small amount of blood
is spurting through the
constricted artery) is
recorded as the systolic
pressure.
Pressure
in cuff
below 70;
no sounds
audible
70 mm Hg
(d) As the pressure is
reduced still further,
the sounds become
louder and more
distinct; when the
artery is no longer
constricted and blood
flows freely, the
sounds can no longer
be heard. The
pressure at which the
sounds disappear is
recorded as the
diastolic pressure.
Blood pressure
120 systolic
70 diastolic
(to be measured)
Rubber cuff
inflated with
air
Brachial
artery
(a) The course of the
brachial artery of
the arm. Assume a
blood pressure of
120/70 in a young,
healthy person.
Pressure
in cuff
above 120;
no sounds
audible
Pressure
in cuff
below 120,
but above 70
120 mm Hg
120 mm Hg
70 mm Hg
Brachial
artery
closed
Pressure
in cuff
below 70;
no sounds
audible
70 mm Hg
Sounds
audible in
stethoscope
(c) The pressure in the
(b) The blood pressure
cuff is gradually
cuff is wrapped
reduced while the
snugly around the
examiner listens
arm just above the
(auscultates) for
elbow and inflated
sounds in the
until the cuff
brachial artery with
pressure exceeds
a stethoscope. The
the systolic blood
pressure read as the
pressure. At this
first soft tapping
point, blood flow into
sounds are heard
the arm is stopped,
(the first point at
and a brachial pulse
which a small
cannot be felt or
amount of blood is
heard.
spurting through the
constricted artery) is
recorded as the
systolic pressure.
(d) As the pressure is
reduced still further,
the sounds become
louder and more
distinct; when the
artery is no longer
constricted and
blood flows freely,
the sounds can no
longer be heard. The
pressure at which the
sounds disappear is
recorded as the
diastolic pressure.

Arterial Blood Pressure (BP) is directly
related to:

Cardiac Output (CO)


The amount of blood pumped out of the left
ventricle / min.
Peripheral Resistance (PR)

The amount of friction the blood encounters as it
flows through the arteries

The amount of friction the blood
encounters as it flows through the
arteries

Arterial constriction- narrowing of the blood
vessels due to a Sympathetic N.S. response or
atherosclerosis
Increased blood volume
 Increased blood viscosity – thickness
 Other factors


Age, weight, time of day, exercise, body
position, emotions, drugs
I. Neural Factors
1. Autonomic Nervous System
a. 2 divisions – Sympathetic and Parasympathetic
1. Sympathetic – to stimulate
2. Parasympathetic – calm down (has no effect)
b. Sympathetic stimulation
1. causes vasoconstriction (narrowing of the BV)
2. center located in the Medulla of the brain (Involuntary)
3. if active, causes vasoconstriction
c. Activated by:
1. Standing suddenly after lying down
2. This causes blood pooling in legs and feet
3. Activates special receptors (Baroreceptors) in large arteries
of the neck and chest
4. This in turn will signal a reflexive vasoconstriction and an
increase in blood pressure back to normal (homeostatic)
levels
2. Hemorrhage – results in a decreased blood volume
a. B.P. drops
b. Increased heart rate trying to compensate
c. decreased blood results in decreased venous return
d. sympathetic system turns on and results in
vasocontriction
3. Vigorous exercise or being frightened
a. this results in the “Fight or Flight” response
b. results in generalized vasoconstriction except in the
skeletal muscles
1. dilate to increase the blood flow to working muscles
c. Sympathetic system will never cause vasoconstriction of
the Blood Vessels of the heart and Brain
II. Renal Factors - Kidneys
1. help to regulate B.P. by Regulating water
a. when the BP and or blood volume inc., the kidneys
will allow more water to leave the body in the urine
b. this will decrease the blood volume and will in turn
decrease the BP
c. If dec. arterial BP, the kidneys will retain water to
try to inc. BP.
2. Renin – an enzyme released by the kidney cells when
Arterial BP is low.
a. Renin stimulates a series of reaction to form
Angiotensin II
1. a potent vasoconstrictor
2. stimulates the Adrenal cortex to release
Aldosterone
3. this will inc. Na+ ion re-absorption by kidneys, then inc.
water re-absorption and then blood volume
III. Temperature
1. cold results in vasoconstriction
a. Reduces blood flow and swelling
2. Heat causes vasodilating effect
a. used to speed circulation into inflamed areas
IV. Chemicals - drugs
a. Epinephrine – inc. both heart rate and BP
b. Nicotine – Inc. BP by causing Vasoconstriction
c. Alcohol and Histamines – cause vasodilation and decreased BP.
“Drunken face”
V. Diet
1. diet low in slat, saturated fats and Cholesterol help to prevent
Normal Adult Range
a. Systolic between 110-140 mmHg
b. Diastolic between 70-80
c. Varies during the day, usually peak in the A.M.
d. varies by weight, age, race, mood, exertion and posture
1. Hypotension (low blood pressure)
a. Systolic below 1090 mmHg
b. usually the result of physical conditioning
c. associated with long life and an old age free of illness
2. Orthostatic Hypotension
a. Seen in the elderly
b. a temporary low BP and dizziness when they rise suddenly
c. usually results from an aging sympathetic NS responding slowly
to change
3. Chronic Hypotension
a. May result from poor nutrition and inadequate
levels of blood proteins
b. low blood viscosity will result in low blood pressure
c. Acute Hypotension – warning of circulatory shock
1. inadequate circulation
2. Blood loss being the most common cause
4. Hypertension
a. May temporarily rise with exercise, fever, emotion
b. Persistent Hypertension – High Blood Pressure
1. Pathological – when BP is elevated over 140/90
c. Chronic condition
1. usually will progress 10-20 yrs without symptoms
2. strains the heart and damages arteries
3. called the Silent Killer
4. Heart pumps against resistance
a. enlarges the heart (Enlarged Myocardium)
5. the walls of the heart become flabby
6. blood vessels become enlarged, tear the endotheilium
which increases Atherosclerosis
d. associated with long life and an old age free of illness
4. Primary (Essential) Hypertension
a. no specific cause
b. usually due to diet, obesity, heredity, race and stress
1. Women > Men
Black > White
c. child of HTN parent is 2X greater risk
d. Obesity – the length of Blood Vessels increases
1. each pound of fat requires miles of additional blood vessels
2. the heart needs to work harder
1. Results in the narrowing of the arteries
a. causes damming up process of the interior lumen (wall)
b. The vessel walls thicken and protrude into the lumen
c. the vessels can close easily from a roaming clot
d. Usually effects the aorta and coronary vessels
Onset and Stages
According to the Response to injury hypothesis:
1. initial event is damage to the Tunica Intima caused by
a. chemicals Carbon Monoxide (Cigarettes and car exhaust)
b. bacteria or viruses
c. physical factors (trauma or persistent HTN)
2. once the lumen breaks, platelets cling to the site of injury
3. clotting begins to prevent blood loss and the inflammatory
process to repair begins.
a. if a one time injury, then it is over
4. If persistent, the plaque will continue to grow
Onset and Stages (Continued)
According to the Response to injury hypothesis:
5. plaques grow through series of injuries and healing, and
rupture again
6. endothelial cells release Chemotactic agents that increase the
permeability of the endothelium to fats and Cholesterol to
deposit in the tunica inima
7. Monocytes arrive to act as a Macrophage and engorge on the
fat which turns them into lipid filled “foam cells”
a. they now lose the ability to act as a scaenger
8. these cells join with smooth muscle cells from the T.I. and
deposit collagen and fat (more “Foam Cells”)
a. results in the “Fatty Streak stage”
1. thickening of t.i. by greasy gray yellow
lesions called fibrous or atherosclerotic plaques
9. protrusion of these lesions into the lumen is called
atherosclerosis
1. The end stage of Atherosclerosis
a. enlarged plaques hinder nutrient diffusion to deep tissue of
the artery
b. results in the death of smooth muscle cells in the tunica
media, fills with scar tissue and loses elasticity
c. calcium salts deposit to form complicated plaques
d. results in the fraying and ulceration of the arterial wall that
encourages thrombus formation
e. increased rigidity will lead to Hyppertension
f. see an increase risk of stroke, Myocardial infarctions and
aneurysims