Manipulations for the “ZChO” exam, section “ Elderly age»
Manipulations:
1. Collection of information about the patient for the purpose of drawing up a medical and social registration card for elderly and old age.
2. Demonstration of the technique of determining the pulse and its characteristics with an assistant. Evaluation of research results.
3. Demonstration of the technique of measuring blood pressure with an assistant. Evaluation of research results.
4. Determination of body weight and measurement of height by an assistant. BMI calculation. Evaluation of research results.
5. Training the assistant to determine BMI and evaluate the result.
6. Training the assistant to determine the relationship between OT and OB and evaluate the result.
7. Drawing up a plan for examining the patient’s home to assess fire safety.
8. Drawing up a plan for examining the patient’s apartment in order to assess the safety of the home and prevent domestic injuries.
Manipulation response standard
1. Standard manipulation response No. 1: Collecting information about the patient for the purpose of drawing up a medical and social registration card for elderly and senile people.
To obtain a medical and social registration card for elderly and senile people, you must:
· collect medical and social history:
1. Patient’s passport details
2. Marital status
4. Patient's financial status
6. Assessment of patient independence:
State of consciousness and mood of the patient
Function of analyzers (vision and hearing)
Ability to independent movement and use public transport
Self-care ability (independent performance of daily household activities, personal hygiene skills, satisfaction of basic needs)
Self-administration of medications
Financial independence
Provision of clothing, shoes, household appliances
Security technical means rehabilitation (cane, crutches, walkers, stroller)
7. The nature of the diet of a geriatric patient (presence of basic nutrients and their food sources)
8. Patient communication and leisure
9. Circle of people who can provide assistance
10. Patient complaints at the time of information collection
11. Availability chronic diseases
12. Drug treatment
13. Allergy history
14. Bad habits
15. Determination of physical health indicators:
Anthropometry of the patient, determination of the patient’s BMI, examination of the skin.
Blood pressure measurement, pulse examination
· Identify all the patient’s real and potential problems and highlight priorities.
· Formulate the goals and content of the nurse’s activities to solve priority problems
Standard manipulation response No. 2: Demonstration of the technique for determining the pulse and its characteristics with an assistant. Evaluation of research results.
Purpose: Determine the basic properties of the pulse: symmetry, rhythm, frequency, filling and tension and write them down on the patient’s temperature sheet or nursing observation chart.
Indications: As prescribed by a doctor, during a pre-medical examination
Contraindications: No
Equipment: Watch with second hand or stopwatch, temperature sheet, pen, soap and towel
Sequencing nurse with security environment:
§ Inform the patient about the upcoming procedure and its progress
§ Obtain patient consent
§ Wash your hands with soap
§ Sit or lay the patient down, asking him to relax his arms
§ Remember that the hand and forearm should not be suspended
§ Using the 2nd, 3rd and 4th fingers of your hand, press the radial arteries on the patient’s hands (the 1st finger of your hand is located on the back of the patient’s hand)
§ Determine pulse symmetry
§ Carry out further examination of the pulse on one arm if the pulse is symmetrical
§ Conduct a study on each arm if the pulse is not symmetrical
§ Determine the rhythm of the pulse based on the equal duration of the intervals between pulse impulses
§ Take a watch or stopwatch and examine the number of pulse beats within 30 seconds if the pulse is rhythmic (in the case of an arrhythmic pulse, determine the frequency within 60 seconds)
§ When determining your heart rate for 30 seconds, multiply the result by 2
§ Determine the filling of the pulse, which is normally assessed as good or satisfactory filling
§ Determine the pulse voltage. To do this, use your 3rd and 4th fingers to press radial artery To radius, and with the 2nd finger located at the base thumb determine the presence of a pulse in the patient. Normally, the pulsation should disappear, that is, the pulse is not tense. If the pulsation persists, then the pulse is tense. This is typical for increasing blood pressure and sclerotic changes vascular wall
§ Tell the patient the result of the study
§ Record the result on the temperature sheet
§ Wash your hands.
Standard manipulation response No. 3Measurement of blood pressure (BP).
Purpose: to determine blood pressure as an indicator of a person’s health status and record the result of blood pressure measurement.
Indications: As prescribed by a doctor, to conduct a pre-medical examination of the patient
Contraindications: no
Equipment: tonometer, phonendoscope, pen, temperature sheet, soap and towel
The sequence of actions of the nurse to ensure the safety of the environment:
1. Inform the patient about the upcoming procedure and the progress of its implementation
2. Obtain patient consent
3. Sit or lay the patient down
4. Place the patient's arm in an extended position, palm up
5. Ask the patient to place the clenched fist of his free hand under the elbow of his extended arm.
6. Place a cuff on the patient’s shoulder above the elbow 2–3 cm.
7. Fasten the cuff so tightly that only one finger fits between it and your shoulder.
8. Connect the cuff to the tonometer
9. Check the position of the tonometer needle relative to the zero mark of the scale
10. Feel the pulse in the area of the ulnar fossa and place a phonendoscope in this place
11. Close the valve on the bulb
12. Pump up right hand air into the cuff with a bulb
13. Raise the pressure on the pressure gauge 20 - 30 mm above the level at which arterial pulsation disappears
14. Release the air from the cuff by slowly turning the screw on the bulb
15. Listen at this moment with a phonendoscope for the appearance of pulsation (tones)
16. Record digital data on the tonometer when the first regular sounds appear - systolic pressure
17. Continue deflating the cuff
18. Record the digital data on the tonometer when the pulsation disappears - diastolic pressure
19. Measure the pressure three times on each arm with an interval of 3 - 5 minutes.
20. Take the smallest numbers as readings
21. Communicate the findings to the patient
22. Remember that you need to measure blood pressure in the morning: before getting out of bed, then after taking vertical position, during the daytime and in the evening
23. Wash your hands
24. Write down the temperature sheet as a fraction (the numerator is systolic pressure, the denominator is diastolic pressure, for example: 120/80)
Target: obtain objective data about the patient's condition. Determine blood pressure indicators and evaluate the results of the study.
Indications: as prescribed by a doctor.
Equipment: tonometer, phonendoscope, pen with blue paste, temperature sheet, antiseptic, cotton balls.
Preparation for the procedure:
1. Establish a trusting relationship with the patient.
2. Explain the essence and course of upcoming actions.
4. Warn the patient about the upcoming procedure 15 minutes before it begins.
5. Prepare the necessary equipment.
6. Wash and dry your hands.
Performing the procedure:
7. Check the serviceability of the tonometer and phonendoscope.
8. Check with the patient about his working pressure and his state of health at this moment.
9. Give the patient a comfortable position, sitting or lying down.
10. Place the patient’s hand on the table or on the edge of the bed at chest level, in an extended position with the palm up (you can place the free hand clenched into a fist under the elbow).
11. Free the patient’s shoulder from clothing and sit on a chair.
12. Place the tonometer cuff on the patient’s bare shoulder 2-3 cm above the elbow bend so that one finger fits between them.
Note − Clothing should not compress the shoulder above the cuff; lymphostasis that occurs when air is pumped into the cuff and compression of blood vessels is excluded.
13. The cuff tubes face down.
14. Connect the pressure gauge to the cuff, securing it to the cuff.
15. Check the position of the pressure gauge needle relative to the zero scale mark.
16. Determine the pulsation in the ulnar fossa with your fingers and apply a phonendoscope to this place.
17. Close the bulb valve, pump air into the cuff until the pulsation in the ulnar artery disappears +20-30 mmHg. (i.e. slightly higher than expected blood pressure).
18. Open the valve, slowly release air, listening to Korotkoff sounds, and monitor the pressure gauge readings.
19. Note the number of appearance of the first beat of the pulse wave, corresponding to systolic blood pressure.
20. Slowly release air from the cuff.
21. Note the disappearance of sounds, which corresponds to diastolic blood pressure.
Note − The sounds may weaken, which also corresponds to diastolic blood pressure.
22. Release all the air from the cuff.
Completing the procedure:
23. Remove the cuff.
24. Place the pressure gauge in the case.
25. Disinfect the phonendoscope head by wiping it twice with an antiseptic.
26. Evaluate the result.
27. Tell the patient the measurement result.
28. Register the result in the form of a fraction (in the numerator - systolic pressure, in the denominator - diastolic) in the necessary documentation.
29. Wash and dry your hands.
2 You can repeat the measurement after one or two minutes.
3 Do not press the head of the phonendoscope on the area of the artery.
Arterial pulse- these are rhythmic oscillations of the artery caused by the release of blood into the arterial system during one heartbeat. The arterial pulse can be central (on the aorta, carotid arteries) or peripheral (on the radial, dorsal artery of the foot and some other arteries).
The nature of the pulse depends both on the size and speed of blood ejection from the heart, and on the condition of the artery wall, primarily on its elasticity. It should be noted that when palpating an artery, it is not the filling of the vessel with blood that is felt, but the vibration of its wall, which is transmitted from the aorta to its final branches much faster than blood.
More often, the pulse is examined in adults on the radial artery, which is located superficially between the styloid process of the radius and the tendon of the internal radial muscle.
Exploring arterial pulse, it is important to determine its rhythm, frequency, tension, content, and magnitude.
Rhythm pulse is determined by the intervals between pulse waves. If pulse oscillations of the wall occur at regular intervals, therefore, the pulse rhythmic. In case of rhythm disturbances, irregular alternation of pulse waves is observed − spasmodic pulse ( arrhythmic). In a healthy person, the contraction of the heart and the pulse wave follow each other at regular intervals. If there is a difference between the number of heart contractions and pulse waves, then this condition is called pulse deficiency(at atrial fibrillation).
Frequency– this is the number of pulse waves in 1 minute. The normal heart rate (beats per minute) for an adult is 60-80.
An increase in heart rate of more than 85-90 beats per minute is called tachycardia. A heart rate rate of less than 60 beats per minute is called bradycardia. The absence of a pulse is called asystole. When body temperature rises by 1°C, the pulse increases in adults by 8-10 beats per minute.
Voltage pulse depends on blood pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with moderate force, so the pulse is normal moderate(satisfactory) voltage. At high blood pressure the artery is compressed by strong pressure - this is called a pulse tense, or hard. When low pressure the artery contracts easily - pulse soft, relaxed. It is important not to make a mistake, because... the artery itself may be sclerotic. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.
Filling pulse is determined by the height of the pulse wave and depends on the systolic volume of the heart. If the height is normal or increased, then it can be felt normal pulse – full, if not, then pulse empty.
Magnitude pulse depends on filling and tension. A pulse of good filling and tension is called big, weak - small Sometimes the magnitude of pulse waves can be so small that they are difficult to detect. This pulse is called thread-like.
Before examining the pulse, you need to make sure that the person is calm, not worried, not tense, and that his position is comfortable. If the patient performed any physical activity (fast walking, housework), suffered painful procedure, received bad news, pulse examination should be postponed because these factors may increase the rate and change other properties of the pulse.
It is better to determine the pulse rate at the moment when the second hand is at the number 12 (in this case, you will not forget at what moment the countdown began).
! You cannot examine the pulse with your thumb, because it has a pronounced pulsation and you can count your own pulse instead of the patient's pulse.
! The places where the pulse is examined are the points where the arteries are pressed during arterial bleeding.
COUNTING THE ARTERIAL PULSE ON THE RADIAL ARTERY
AND DETERMINATION OF ITS PROPERTIES
Target: determine the basic properties of the pulse - frequency, rhythm, filling, tension.
Indications: grade functional state body
Equipment: clock or stopwatch, temperature sheet, pen with red rod.
Preparation for the procedure:
1. Establish a trusting relationship with the patient.
2. Explain the essence of the procedure.
3. Obtain the patient's consent to the procedure.
4. Prepare the necessary equipment
5. Wash and dry your hands.
Performing the procedure:
6. Give the patient a comfortable position, sitting or lying down.
7. At the same time, grasp the patient’s hands with your fingers above the wrist joint so that the 2nd, 3rd, 4th fingers are above the radial artery, the 2nd finger is at the base of the thumb). Compare the vibrations of the artery walls in the right and left arms.
8. Press the artery against the radius - you will feel jerky vibrations of the artery walls under your fingers.
9. Count the pulse waves in the artery where they are best expressed for 60 seconds, using a watch.
10. Assess the intervals between pulse waves.
11. Assess pulse filling.
12. Compress the radial artery until the pulse disappears and evaluate the pulse tension.
Completing the procedure:
13. Register the properties of the pulse in the temperature sheet graphically, and in the observation sheet digitally.
14. Inform the patient about the results of the study.
15. Wash and dry your hands.
Note − To identify a pulse deficit using a phonendoscope, count the heart rate for 60 seconds and compare it with the pulse rate (used for atrial fibrillation; the greater the difference, the more severe the patient’s condition).
CONTROL QUESTIONS
1. What is called arterial pressure and how is its value expressed?
2. What pressure is called systolic?
3. What is the difference between systolic and diastolic pressure called?
4. What is high and low blood pressure called?
5. What is arterial pulse?
6. What determines the nature of the pulse?
7. List the main characteristics of the pulse?
8. How is pulse rhythm determined?
9. What does the heart rate depend on?
10. What are the places where the pulse is examined?
CONTROL TASKS
1. When determining the pulse, the doctor presses the radial artery with force so that its pulse fluctuations completely stop. What property of the pulse does it determine and on what does it depend?
2. In a 30-year-old patient, the doctor determined the difference between the heart rate and pulse rate. What does the difference between these indicators indicate?
3. Before performing the manipulations, a 42-year-old patient’s blood pressure was 150/100 mmHg. Are these blood pressure readings normal? Determine pulse pressure.
CONTROL TESTS
1. Normal heart rate (beats per minute):
2. The properties of the pulse include everything except:
a) filling
b) voltage
c) frequencies
3. Based on the filling of the pulse, the following are distinguished:
a) rhythmic, arrhythmic
b) fast, slow
c) full, empty
d) hard, soft
4. The difference between systolic and diastolic pressure is called:
a) maximum blood pressure
b) minimum blood pressure
d) pulse deficit
5. Pulse deficiency occurs when:
a) increased blood pressure
b) decrease in blood pressure
c) bradycardia
d) atrial fibrillation
6. Maximum blood pressure:
a) diastolic
b) systolic
c) arrhythmic
d) pulse
7. A 40-year-old woman has a heart rate of 55 per minute during physical activity. This can be called:
a) arrhythmia
b) bradycardia
c) the norm
d) tachycardia
8. Normal systolic pressure numbers:
a) 160-180 mmHg.
b) 90-110 mm Hg.
c) 150-160 mm Hg.
d) 100-140 mm Hg.
9. The pulse value depends on:
a) tension and filling
b) voltage and frequency
c) filling and frequency
d) frequency and rhythm
10. Normal diastolic blood pressure numbers:
a) 60-80 mm Hg.
6) 90-100 mm Hg.
c) 150-160 mm Hg.
d) 100-140 mm Hg.
LESSON No. 3
"FEVER. THERMOMETRY"
Goal of self-training:
Learn techniques for measuring body temperature. Acquainted with various types fevers and care of febrile patients.
Body temperature depends on many factors, such as heat generation, heat transfer, thermoregulation.
Heat generation– The process is mainly chemical. The source is oxidation processes, i.e. combustion of carbohydrates, fats and partly proteins in all cells and tissues of the body, primarily skeletal muscles and liver.
Heat dissipation– the process is mainly physical. IN calm state About 80% of the heat generated in it is radiated from the surface of the body. Due to the evaporation of water during breathing and sweating - about 20%. With urine and feces about 1.5%.
Thermoregulation– the process by which the formation and release of heat by the body is regulated. Thanks to it, a certain balance is established and maintained between heat generation and heat transfer. This is why body temperature is constant.
Human body temperature is an indication of the body's thermal state and remains relatively constant. Normal human body temperature, measured in armpit And groin areas fluctuates between 36.4-36.8°C. Physiological fluctuations in body temperature are 0.2-0.5°C. Temperature of the mucous membrane oral cavity, vagina, rectum is 0.2-0.4 ° C higher than the skin temperature in the axillary and groin areas. Lethal maximum temperature, i.e. the temperature at which human death occurs is 43.0°C. At this temperature, severe structural changes cells, leading to irreversible metabolic disorders in the body. The lethal minimum human body temperature ranges from 15.0-23.0°C. Maximum temperature bodies are recorded in the afternoon, and the minimum is early in the morning. In summer, body temperature is usually 0.1-0.5°C higher than in winter. The human body temperature depends on the location of measurement, time of day, age, food intake, strong emotional stress, physical activity. Normally, children's body temperature is slightly higher than that of adults, because... In children, oxidative processes necessary for growth are more intense. In the elderly and elderly, body temperature is often slightly reduced, 35.5-36.5°C. Body temperature in women is also subject to physiological fluctuations at a certain phase menstrual cycle, during the period of ovulation, when a mature follicle ruptures and the egg is released, it increases by 0.6-0.8 ° C.
Thermometry- This is a measurement of human body temperature. The measurement is carried out using medical maximum thermometer calibrated according to Celsius from 34.0-42.0°C. The volume of mercury filling the reservoir and a small part of the capillary tube of the thermometer increases when heated. Mercury cannot return to the reservoir on its own after heating stops. This is prevented by a pin soldered into the bottom of the tank. You can return mercury to the tank only by shaking it several times.
Body temperature is most often measured in the armpit. In malnourished patients and infants, it can be measured in the rectum or oral cavity. Areas used for temperature measurement should not be inflammatory process, i.e. skin redness, swelling, because it produces a local increase in temperature. The measurement will not reflect the actual body temperature if the patient holds a heating pad or ice pack near the measurement site.
Equipment: tonometer, phonendoscope, pen, paper, temperature sheet (protocol for care plan, outpatient card), a napkin with alcohol.
I. Preparation for the procedure
- Warn the patient about the upcoming study 15 minutes before it begins.
- Clarify the patient’s understanding of the purpose and progress of the study and obtain his consent to conduct it.
- Choose right size cuffs
- Ask the patient to lie down (if previous measurements were taken in the “lying” position) or sit down on the table.
II. Executing the procedure
Rice. 5.13. Blood pressure measurement
- Invite the patient to place his hand correctly: in an extended position with the palm up (if the patient is sitting, ask him to place the clenched fist of his free hand under his elbow). Help move or remove clothes from your hand.
- Place the cuff on the patient's bare shoulder 2-3 cm above the elbow (clothing should not compress the shoulder above the cuff); secure the cuff so that only one finger fits through. The center of the cuff is located over the brachial artery. (It is advisable for the patient to sit quietly with the cuff applied for 5 minutes.)
Attention! You should not measure blood pressure on the arm on the side of the mastectomy or on the weak arm after a stroke; on the paralyzed arm and the arm where the IV needle is located.
- Connect the pressure gauge to the cuff and check the position of the pressure gauge needle relative to the zero scale mark. If the patient is obese and you do not have an appropriate cuff:
- find the pulse of the radial artery;
- quickly inflate the cuff until the pulse disappears;
- look at the scale and remember the pressure gauge readings;
- quickly release all the air from the cuff.
- Find the place of pulsation of the brachial artery in the area of the ulnar fossa and firmly place the phonendoscope membrane on this place.
- With your other hand, close the valve on the bulb, turning it to the right, and with the same hand quickly pump air into the cuff until the pressure in it exceeds 30 mmHg. Art. - the level at which Korotkoff sounds (or radial artery pulsation) disappear.
- Release air from the cuff at a rate of 2-3 mm Hg. Art. in 1 s, turning the valve to the left. At the same time, use a phonendoscope to listen to the sounds on the brachial artery and monitor the indicators of the pressure gauge scale: when the first sounds (Korotkoff sounds) appear, “mark” on the scale and remember the number corresponding to the systolic pressure.
- Continuing to release air from the cuff, note the value of diastolic pressure corresponding to the weakening or complete disappearance of Korotkoff sounds.
- Inform the patient of the measurement result.
- Repeat the procedure after 2-3 minutes.
III. Completing the procedure
- Round the measurement data to 0 or 5, write it down as a fraction (in the numerator - systolic pressure; in the denominator - diastolic).
- Wipe the phonendoscope membrane with a cloth moistened with alcohol.
- Record the research data in the necessary documentation.
Depends on many factors. One of them is the correct measurement of blood pressure (BP). This issue is important for ordinary patients conducting self-monitoring of blood pressure, and for doctors assessing the effectiveness of prescribed treatment, and for scientists developing new drugs against hypertension. Considering special significance correct blood pressure measurement, medical communities different countries We have developed recommendations on this topic and an algorithm for measuring blood pressure. Let's look at them in our article.
How to measure blood pressure
To determine blood pressure levels, two types of devices are used: based on the Korotkoff method and oscillometric.
Measurement by the Korotkoff method is carried out using a cuff with a pump, a pressure gauge and a phonendoscope. This method is considered the most accurate and is officially recognized as a reference method. However, it is not always convenient. Therefore, electronic tonometers have become widespread.
Electronic blood pressure devices use oscillometric analysis, they measure the changing air pressure in the cuff as the blood pumps through the narrowed vessel. Electronic devices for measuring blood pressure are quite acceptable for self-monitoring, as well as at a doctor’s appointment. They must undergo regular calibration, that is, adjustment and verification of measurement accuracy.
When to measure blood pressure
Blood pressure measurement is most often necessary to confirm hypertension and to assess the effectiveness of its treatment. Depending on the goals, the time and conditions for blood pressure registration may be different.
For self-control healthy person Without complaints, you can measure blood pressure no more than once every six months. Mandatory annual monitoring of blood pressure levels during preventive medical examination, including as part of medical examination.
A patient with hypertension Blood pressure should be measured daily, in the morning and evening at the same time, before taking medications and food, at rest, and after emptying the bladder.
If necessary, additional measurements are taken. However, blood pressure levels in patients with hypertension often fluctuate greatly. Continuous blood pressure measurements that reveal such changes lead to refusal of treatment or excessive use of medications. Therefore, patients are recommended to keep a diary of monitoring only morning and evening blood pressure and show it to their doctor once a month to adjust therapy.
You should not measure your blood pressure after walking or other physical activity. In this case, a physiological (normal) increase in indicators occurs. Only a doctor can assess how adequately the blood pressure has increased.
Blood pressure should be measured no earlier than after a half-hour rest. There is no need to smoke for at least an hour before the examination, but it is better to give up this habit altogether.
How to measure
During measurement, the tonometer cuff should be located on the middle third of the upper arm at the level of the heart. You need to sit in a chair or chair so that your back has support and relax. If the measurement will be carried out in a lying position, you should prepare a small pillow under your shoulder and lie down. After this, you need to rest for 5 minutes.
The patient or assistant then places the cuff on the upper arm. It should be located on the middle third of the shoulder at the level of the heart, lie flat, without folds or twisting, fitting well, but not squeezing the shoulder. The cuff should not be placed over clothing or under a sleeve that is rolled up.
When measuring using the Korotkoff method, the patient or his assistant wears a phonendoscope. It should have an intact membrane and comfortable headphones. It is recommended to place the pressure gauge at eye level or slightly below so that the scale is clearly visible. It can be attached using a clip.
Then, using a rubber bulb, air is pumped into the cuff, monitoring the readings of the pressure gauge. In this case, it is advisable to feel the pulse on the brachial artery with your fingers, that is, on the inner surface of the elbow. Usually it is enough to achieve a pressure 30 mm higher than the one at which the pulse stopped, that is, the artery is completely compressed.
A phonendoscope membrane is placed on the inner surface of the elbow. You don't need to press it too hard against the skin. It is necessary to avoid contact of the phonendoscope head with the cuff or tubes.
Gradually release the air from the cuff. The appearance of the first beats of blood indicates the level of systolic blood pressure. The disappearance of beats is an indicator of diastolic pressure. Air should be released slowly, at a speed of 2 - 3 mmHg. Art. per second. This measurement will be the most accurate.
When using automatic and semi-automatic tonometers, the procedure is simplified: a cuff is put on, air is pumped into it with a device or a bulb, then after pressing a button, the air is released from it. The measurement result is shown on the display.
If repeated measurements are necessary, the cuff should be loosened. You can repeat the process no earlier than after a minute of rest. For greater accuracy, the average value is taken from three measurements taken at intervals of 1 to 5 minutes.
It happens that the blood pressure level is different on the right and left arms. Therefore, during the initial measurement, you should carry out the procedure on both hands and choose the one on which it is higher. Subsequently, it is recommended to monitor blood pressure on the arm with a higher level.
Special patient groups
To measure blood pressure in children, a special small children's cuff is required. When using a conventional cuff, distortions in the indicators are inevitable, often frightening parents. There is no need to measure blood pressure in healthy children. A pediatrician should give such a recommendation if he finds reasons for this.
Blood pressure measurements in older people should be carried out in a sitting position, and then in a standing position after 1 and 3 minutes. This helps to identify orthostatic hypotension, which may be a consequence of an overdose.
People with an upper arm circumference greater than 32 cm must use a cuff. big size or, as a last resort, use blood pressure monitors that measure blood pressure on the wrist.
It is very important to measure regularly. This will help to diagnose in time severe complication- . This procedure is performed by the doctor at every visit. antenatal clinic. The patient can independently measure blood pressure. This can be done daily or more rarely, preferably in the morning after waking up.
Training video on the topic “How to measure blood pressure?”:
Video on how to measure blood pressure correctly:
To determine the activity of the heart, vascular system and kidneys it is necessary to measure blood pressure. The algorithm for determining it must be followed in order to obtain the most accurate numbers.
From medical practice It is known that timely determination of blood pressure helped a large number of patients not become disabled and saved the lives of many people.
History of the creation of measuring devices
Blood pressure was first measured in animals by Hales in 1728. To do this, he inserted a glass tube directly into the artery of a horse. After this, Poiseuille added a pressure gauge with a mercury scale to the glass tube, and subsequently Ludwig invented a kymograph with a float, which made it possible to continuously record. These devices are equipped with mechanical stress sensors and electronic systems. Direct blood pressure by vascular catheterization is used for scientific purposes in diagnostic laboratories.
How is blood pressure formed?
Rhythmic contractions of the heart include two phases: systole and diastole. The first phase - systole - is the contraction of the heart muscle, during which the heart pushes blood into the aorta and pulmonary artery. Diastole is the period during which the cavities of the heart expand and fill with blood. Then systole occurs again and then diastole. Blood from the largest vessels: the aorta and pulmonary artery passes the way to the smallest - arterioles and capillaries, enriching all organs and tissues with oxygen and collecting carbon dioxide. The capillaries turn into venules, then into small veins and into larger vessels, and finally into the veins that approach the heart.
Pressure in blood vessels and heart
When blood is ejected from the cavities of the heart, the pressure is 140-150 mm Hg. Art. In the aorta it decreases to 130-140 mm Hg. Art. And the further from the heart, the lower the pressure becomes: in the venules it is 10-20 mm Hg. Art., and the blood in large veins is below atmospheric.
When blood pours out of the heart, a pulse wave is recorded, which gradually fades as it passes through all the vessels. The speed of its spread depends on the magnitude of blood pressure and the elasticity or firmness of the vascular walls.
Blood pressure increases with age. In people from 16 to 50 years old it is 110-130 mmHg. Art., and after 60 years - 140 mm Hg. Art. and higher.
Methods for measuring blood pressure
There are direct (invasive) and indirect methods. In the first method, a catheter with a transducer is inserted into the vessel and blood pressure is measured. The algorithm of this research is such that the process of signal monitoring is automated using a computer.
Indirect method
The technique of measuring blood pressure indirectly is possible using several methods: palpation, auscultation and oscillometric. The first method involves gradual compression and relaxation of the limb in the area of the artery and finger determination of its pulse below the place of compression. Rivva-Rocci at the end of the 19th century proposed the use of a 4-5 cm cuff and a mercury manometer scale. However, such a narrow cuff overestimated the true data, so it was proposed to increase it to 12 cm in width. And currently, the technique for measuring blood pressure involves the use of this particular cuff.
The pressure in it is built up to the point where the pulse stops, and then slowly decreases. Systolic pressure is the moment when pulsation appears, diastolic pressure is when the pulse fades or noticeably accelerates.
In 1905 N.S. Korotkov proposed a method for measuring blood pressure through auscultation. A typical device for measuring blood pressure using the Korotkoff method is a tonometer. It consists of a cuff and a mercury scale. Air is pumped into the cuff using a bulb, and then the air is gradually released through a special valve.
This auscultatory method has been the standard for measuring blood pressure for more than 50 years, but according to surveys, doctors rarely follow the recommendations, and the technique of measuring blood pressure is violated.
The oscillometric method is used in automatic and semi-automatic devices in wards intensive care, since the use of these devices does not require constant injection of air into the cuff. Blood pressure is recorded at various stages of air volume reduction. Measuring blood pressure is also possible with auscultatory failures and weak Korotkoff sounds. This method is least dependent on the elasticity of the walls of blood vessels and when they are affected by atherosclerosis. The oscillometric method made it possible to create devices for determining the superior and lower limbs. It allows you to make the process more accurate, reducing the influence of the human factor
Rules for measuring blood pressure
Step 1 - choose the right equipment.
What you will need:
1. Quality stethoscope
2. Correct cuff size.
3. Aneroid barometer or automated sphygmomanometer - a device with manual inflation mode.
Step 2 - Prepare the patient: make sure he is relaxed, give him 5 minutes of rest. To determine blood pressure within half an hour, smoking and drinking alcohol and caffeine-containing drinks are not recommended. The patient should sit upright, release top part hands, position it comfortably for the patient (can be placed on a table or other support), feet should be on the floor. Remove any excess clothing that may interfere with air inflation in the cuff or blood flow to the arm. You and the patient should refrain from talking during the measurement. If the patient is in a supine position, it is necessary to position the upper part of the arm at the level of the heart.
Step 3 - select the correct cuff size depending on the size of your arm: errors often arise due to incorrect selection. Place the cuff on the patient's arm.
Step 4 - Place the stethoscope on the same arm where you placed the cuff, feel the arm at the elbow to find the location of the strongest pulse sounds, and place the stethoscope over the brachial artery in that exact location.
Step 5 - inflate the cuff: start inflating while listening to your pulse. When the pulse waves disappear, you should not hear any sounds through the phonendoscope. If the pulse is not heard, then you need to inflate so that the pressure gauge needle is at the numbers above from 20 to 40 mm Hg. Art. than at the expected pressure. If this value is unknown, inflate the cuff to 160 - 180 mmHg. Art.
Step 6 - slowly deflate the cuff: deflation begins. Cardiologists recommend slowly opening the valve so that the pressure in the cuff decreases by 2 - 3 mmHg. Art. per second, otherwise a faster decrease may lead to inaccurate measurements.
Step 7 - listening to systolic pressure - the first sounds of the pulse. This blood begins to flow through the patient's arteries.
Step 8 - Listen to your pulse. Over time, as the pressure in the cuff decreases, the sounds disappear. This will be the diastolic, or lower pressure.
Checking indicators
It is necessary to check the accuracy of the indicators. To do this, measure the pressure on both arms to average the data. To check your pressure again for accuracy, you should wait about five minutes between measurements. Typically, blood pressure is higher in the morning and lower in the evening. Sometimes blood pressure numbers are unreliable due to the patient's concern about people in white coats. In this case use daily measurement HELL. The algorithm of action in this case is to determine the pressure during the day.
Disadvantages of the method
Currently, blood pressure is measured by auscultation in any hospital or clinic. The action algorithm has disadvantages:
Lower SBP numbers and higher DBP numbers than those obtained with the invasive technique;
Susceptibility to noise in the room, various disturbances during movement;
Necessity correct location stethoscope;
Poor audibility of low intensity tones;
The error of determination is 7-10 units.
This technique for measuring blood pressure is not suitable for monitoring procedures throughout the day. To monitor the patient's condition in intensive care units, it is impossible to constantly inflate the cuff and create noise. This may have a negative impact on general condition the patient and cause him anxiety. Pressure numbers will be unreliable. At unconscious sick and elevated motor activity it is impossible to place his hand at the level of the heart. An intense interference signal can also be created by the patient’s uncontrolled actions, so the computer will malfunction, which will negate the measurement of blood pressure and pulse.
Therefore, in intensive care units, cuffless methods are used, which, although inferior in accuracy, are more reliable, efficient and convenient for constant monitoring of pressure.
How to measure blood pressure in pediatrics?
Measuring blood pressure in children does not differ from the technique for determining it in adults. Just an adult cuff will not fit. In this case, a cuff is required, the width of which should be three quarters of the distance from the elbow to the armpit. Currently, there is a large selection of automatic and semi-automatic devices for measuring blood pressure in children.
Numbers normal pressure depend on age. To calculate systolic pressure numbers, you need to multiply the child’s age in years by 2 and increase by 80, diastolic pressure is 1/2 - 2/3 of the previous figure.
Blood pressure measuring devices
Blood pressure meters are also called tonometers. There are mechanical and digital ones, mercury and aneroid. Digital - automatic and semi-automatic. The most accurate and long-lasting device is a mercury tonometer, or sphygmomanometer. But digital ones are more convenient and easy to use, which allows them to be used at home.
