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indirect, noninvasive measurement of the force exerted against the arterial walls during ventricular systole (systolic blood
    pressure [SBPJ) and during ventricular diastole (diastolic blood
    pressure). BP is affected by peripheral vascular resistance (blood
    volume and elasticity of arterial walls) and CO. Table 1-7 lists
    normal BP ranges. Occasionally, BP measurements can only be
    performed on certain limbs secondary ro the presence of conditions Stich as a percutaneous inserted central catheter, arteria-Table 1-7. Normal Blood Pressure Ranges
    Systolic
    Diastolic
    Age 8 yrs
    85-1 14 111m Hg
    52-85 mOl Hg
    Agel2 yrs
    95-'135 mm Hg
    58-88 mm Hg
    Adulr
    100- 140 mm Hg
    60-90 mm Hg
    Borderline
    140-150 mm Hg
    90-100 mm Hg
    hypertension
    Hypertension
    >150 mm Hg
    > 100 mm Hg
    Normal exer
    Increases during rime and wirh
    ,,) O mm Hg
    cise
    increased load or intensity
    Sources: Data from SL Woods, ES Sivarajian Froelicher, S Underhill-Moner (cds). Cardiac Nursing (4th cd). Philadelphia: Lippincott, 2000; :md LS Bickley. Bate's Guide to Physical Examination and Hisrory Taking (7th cd). Philadelphia: Lippincon, 1999.

    20
    ActITE CARE HANDBOOK FOR PHYSICAL TIIERAPlm
    venous fistula for hemodialysis, blood clots, scarring from brachial
    artery cutdowns, or lymphedema (i.e., status-post mastectomy).
    BP of the upper extremity should be measured ill the following
    manner:
    1 . Check for posted signs, if any, at the bedside that indicate
    which arm should be used ill taking BP. BP variations of 5- J 0 mm Hg
    between the right and lefr upper extremity are considered normal.
    Patients with arterial compression or obstruction may have differences of more than 10-15 mm Hg.12
    2.
    Use a properly fitting cuff. The inflatable bladder should have
    a width of approximately 40%, and length of approximately 80% of
    the upper arm circumference. 13
    3 .
    Position the cuff 2.5 em above the antecubital crease.
    4.
    Rest the arm at the level of the heart.
    5.
    To determine how high to inflate the cuff, palpate the radial
    pulse, inllate until no longer palpable, and nOte this cuff inflation
    value. Deflate the cuff.
    Note: With a patient who is in circulatory shock, auscultation may
    be too difficult. In these cases, this method can be used to measure the
    SBP and is recorded as systolic BPfP (i.e., "BP is 90 over palp").13
    6.
    Place the bell of the stethoscope gently over the brachial arrery.
    7.
    Re-inflare rhe cuff to 30-40 mm Hg greater rhan the value in
    srep 5. Then slowly deflare rhe cuff. Cuff deflation should occur at
    approximately 2-3 mm Hg per second.13
    8.
    Listen for the onset of tapping sounds, which represents blood
    flow returning to the brachial arrery. This is the systolic pressure.
    9.
    As the pressure approaches diastolic pressure, the sounds will
    become muffled and in 5-10 mm Hg will be completely absent. These
    sounds are referred to as Korotkoff's sounds (Table 1_8). 12.13
    Clinical Tip
    •
    Recording pre-, para-, and posrexerrion SP is important
    in identifying BP responses [0 activity. During recovery
    from exercise, blood vessels dilate to allow for greater
    blood flow to muscles. In cardiac-compromised or very

    CARDIAC SYSTEM
    2 1
    Table 1-8. Kororkoff's Sounds
    Phase
    Sound
    Indicates
    First sound heard,
    Systolic pressure (blood stans to flow
    faint tapping
    through compressed artery).
    sound with
    increasing intensity
    2
    Start swishing sound
    Because of the compressed artery, blood
    flow continues to be heard while the
    sounds change due to the changing
    compression on the anery.
    3
    Sounds increase in
    inrensity with a
    distinct tapping
    4
    Sounds become muf
    Diasrolic pressure in children <13 yrs old
    ned
    and in adults who are exercising, pregnanr, or hyperrhyroid (see phase 5).
    5
    Disappearance
    Diastolic pressure in adults-occurs 5-10
    mm Hg below phase 4 in normal
    adults. In states of increased rate of
    blood flow, it may be greater than 10
    mm Hg below phase 4. In these cases,
    the phase 4 sound should be