Week 2 Blood Pressure Lab Physiology Kelompok C2 PDF

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LAPORAN LABORATORIUM PHYSIOLOGY “Blood Pressure” Group C2

Oleh Annisa Nur Zamzam (01071170115) Anderson Cenweikiawan (01071170145) Anthony Hasim (01071170178) Anastasia Johanna (01071170061) Angeline Tancherla (01071170034) Ammar Galih W (01071170148) Amanda Salsabila (01071170219) Anthony Yusuf (01071170067) Anissa Tanadi (01071170189) Annette Patricia (01071170119)

FAKULTAS KEDOKTERAN UNIVERSITAS PELITA HARAPAN 2017/2018

Experiment 1 Objective : To know the effect of position on blood pressure

Equipments : •

Sphygmomanometer

•

Small pillow

•

Stethoscope

Procedure : 1. With the subject in the recumbent position, determine the palpatory systolic blood pressure. To confirm that the middle of the cuff on the upper arm is at the level of the right atrium, the back and the arm are supported using a small pillow. 2. The radial artery is palpated at the wrist. The cuff pressure is then increased until the radial pulse disappears. The pressure is then allowed to fall at the rate of 2-3 mm per second. (Note the pressure at which the radial pulse returns as the palpatory systolic pressure. 3. Then, determine the arterial pulse, and auscultatory systolic and diastolic pressure using a stethoscope. The pressure of the cuff is raised to about 30 mmHg above the systolic pressure, which is obtained by palpatory method. Repeat these observations five minutes after the initials measurements. Record the results. 4. With the subject in the sitting position, repeat these observations. Repeat these observations at 3 minute intervals with the subject standing stiffly at attention. 5. Draw a chart of systolic and diastolic blood pressure values, plotting blood pressure against time.

Results :

Measurement

Blood Pressure (mmHg)

Heart Rate (beat/min)

1

110/60

70

2

110/65

75

(Recumbent Position)

Table 1 : Blood Pressure and Heart Rate in Recumbent Position

Measurement Blood Pressure (mmHg)

Heart Rate (beat/min)

1

120/70

80

2

125/70

78

(Sitting Position)

Table 2 : Blood Pressure and Heart Rate in Sitting Position

Measurement

Blood Pressure (mmHg)

Heart Rate (beat/min)

1

130/80

100

2

125/70

92

(Standing Position)

Table 3 : Blood Pressure and Heart Rate in Standing Stiff Position

135#

Blood%Pressure%(mmHg)%

130# 125# 120# Systolic#of#Recumbent# 115#

Systolic#of#Sitting# Systolic#of#Standing#

110# 105# 100# 1st#Measurement#

2nd#Measurement# Time%

Figure 1 : Systolic Chart of Recumbent, Sitting and Standing Position

90# 80#

Blood%Pressure%(mmHg)%

70# 60# 50# Diastolic#of#Recumbent# 40#

Diastolic#of#Sitting#

30#

Diastolic#of#Standing#

20# 10# 0# 1st#Measurement#

2nd#Measurement# Time%

Figure 2 : Diastolic Chart of Recumbent, Sitting and Standing Position

Analysis From the experiment, the data suggests there are differences of blood pressure and heart rate measured from different body positions. There are relations between body positions and heart rates, also relation between body positions and blood pressure respectively. Generally, heart rate and blood pressure were higher when measured sitting and standing position than recumbent position. From the tables and figures above, we can see that blood pressure in recumbent position is 110/60 mmHg and 110/65 mmHg. Meanwhile, in sitting position, the blood pressure increased to 120/70 mmHg and 125/70 mmHg. And the highest is 130/80 mmHg when standing. The heart rate also increased from 70 and 75 during recumbent, into 80 and 78 during sitting, followed by 100 and 92 during standing. Or we can also easily observe from the chart that systolic and diastolic blood pressure of standing and sitting position are higher than recumbent position. The difference between standing, sitting and recumbent position can be explained as body physiological adaptation to body part distribution of gravity. In recumbent position, all body parts share equal gravitional forces which result in equally distributed blood through the arteries and veins. The result is blood pressure is distributed equally consequently. But, in sitting and standing position, gravitional forces affects inequally in all body parts with

gravitional force has stronger effect on caudal part on the body, causing the blood to accumulate in lower part. The accumulation of blood in the lower part of body will cause higher venous pooling which will result in decreased venous return to heart and higher blood pressure also blood volume in the lower part of the body. Decreased venous return will result in lower stroke volume, and lower blood pressure in the heart consequtively. Gravity will affect circulation in the arteries above heart negatively due to decreased venous return of venous pooling in lower part of the body and opossing gravitional force. This will result in hypotension of higher part of the body due to low pressure. Lower pressure of higher body will have inadequate oxygen delivery as the consequence yet oxygen is needed in vast amount in order for brain to function properly. The compensation of lower blood pressure is done by baroreceptors that can be found in carotid sinus and aortic arch. Due to venous pooling in lower part of the body and lower venous return, baroreceptors will send signal to brain and activates sympathetic signaling in the body. Sympathetic signaling will activate cardioaccelatory and vasomotor control of the body resulting in higher heart rate, vasoconstriction in arteries and vein, and decreased venous compliance due to venomotor tone. Contractility of heart also is increased and result in higher stroke volume. These actions will result in lower amount of blood pooled in the lower part of body and increased venous return to the heart, hence causing the blood pressure to be normal again. The maintainance of relatively constant blood pressure (Mean Arterial Pressure) done by baroreceptor reflex are important in order to ensure that all body parts will receive adequate oxygenation especially in the one above the heart. Postural hypotension or can be called as orthostatic hypotension can be explained as failure or delay of baroreceptor reflex to maintain Mean Arterial Pressure in sudden changes of body posture (from sitting or lying down to standing). This results in lower blood pressure due to uncompensated venous pooling. Notably, systolic blood pressure will drop about 20 mmHg and 10 mmHg in diastolic blood pressure due to postural hypotension. This will affect oxygenation in the brain due to reduced blood flow to the brain and can result in fainting (syncope). Postural hypotension occurs mostly in hypovolemic patient due to dehydration which will result in lower blood volume, stroke volume, cardiac output, and blood pressure consequtively. Disturbance in autonomic nervous system will also affect sympathetic signaling and result in failed compensation reflex done by baroreceptors.

Experiment 2 Objective : To know the effect of sustained intrathoracic pressure (Valsalvamanoeuvre)

Equipments : •

Mercury sphygmomanometer

•

Stethoscope

•

Small Pillow

Procedure : 1. The subject takes a deep breath and then expires against a pressure (Valsava Maneuver) and hold this maneouvre. 2. Throughout the test and for one minute after, count the radial pulse every 10 seconds. Also note the character of the pulse, i.e. whether it is full and strong, or weak and difficult to detect. 3. Determine blood pressure every 20 seconds throughout the test and for one minute thereafter (one minute after breaking point). Note the character of the respirations that follow the breaking point.

Results :

Pre-Treatment (Before Doing Maneouvre) •

Blood Pressure : 110/70 mmHg

•

Radial Pulse Rate : 14x / 10 seconds

During Treatment (During Doing Maneouvre) Time

Blood Pressure

(While doing maneouvre) 20th sec

110/70 mmHg

40th sec

90/60 mmHg

60th sec

80/60 mmHg

Table 3 : Blood Pressure and Radial Pulse Rate During Doing Maneouvre

120#

Blood%Pressure%(mmHg)%

100# 80# 60#

Systolic# Diastolic#

40# 20# 0# 20#

40#

60#

Time%(seconds)%

Figure 3 : Blood Pressure During Doing Maneouvre

Time

Radial Pulse Rate

Character

10th sec

14 x

Strong

20th sec

14 x

Moderate

30th sec

13 x

Weak

40th sec

14 x

Weak

50th sec

13 x

Weak

60th sec

-

Difficult to Palpate

(While doing maneouvre)

Table 4 : Radial Pulse Rate While Doing Maneouvre

Post-Treatment (1 Minute After Breaking Point) Time

Blood Pressure

(1 Min After Breaking Point ) 20th sec

90/60 mmHg

40th sec

100/70 mmHg

60th sec

110/70 mmHg

Table 5 : Blood Pressure 1 Minute After Breaking Point

Time Radial Pulse Rate

Character

10th sec

17 x

Strong

20th sec

17 x

Strong

30th sec

16 x

Strong

40th sec

17 x

Strong

50th sec

17 x

Strong

60th sec

17 x

Strong

(1 Min After Breaking Point)

Table 6 : Radial Pulse Rate 1 Minute After Breaking Point

•

Characteristics of Breathing 1 Minute After Breaking Point : Rapid and Deep

Analysis :

Valsalva manoeuvre is done by closing our glottis and straining down hard. By doing this, we are unable to breathe. This would also cause the compression of the thoracic organs by the contracting rib cage, and lead to the increase of intrathoracic pressure. The high intrathoracic pressure decreases venous return. Simultaneously, the rise of intrathoracic pressure would increase the aortic pressure during first few seconds. But the pressure would decrease due to reduced cardiac output. In our experiment, we can see that during the first 20th second, the pressure is still the same with the blood pressure before doing maneouvre, which is 110/70. This is because there is an initial pressure rise (phase 1) during the first few seconds, followed by the reduced pressure (phase 2) due to low venous return. The initial

increase and the following decrease in pressure leads to a temporarily stable and normal blood pressure. However, after the 40th second, we can see that the blood pressure dropped to 90/60 mmHg. This is due to the low venous return, which leads to low strokes volume and cardiac output. Baroreceptors will then detect the low blood pressure and triggers normal autonomic response to return the blood pressure to normal level. This causes peripheral vasoconstriction and tachycardia. In our experiment, the pulse rate didn't have significant changes. However, they are getting weaker and weaker during the maneouvre. Despite the compensation of increasing heart rate, the pulse would become weak, due to the reduced blood pressure. And at the end of maneuver, the blood pressure dropped to 80/60 mmHg. The radial pulse was also difficult to palpate. After 1 minute following the breaking point, the blood pressure had increased a little, which is 90/60 mmHg at the first 20 seconds, followed by increase to 110/70 at the 60th second. And the radial pulse had become strong and increased to 17x/min. Meanwhile, the breathing became deep and rapid due to lack of oxygen during the maneouvre. These are the compensatory response of the body after the increase of intrathoracic pressure.

Experiment 3 Objective : To understand the effect of cold pressor test

Equipments : •

Sphygmomanometer

•

Small pillow

•

Stethoscope

•

Bucket with ice water

Procedure : 1. With the subject sitting, measure the blood pressure every minute for 5 minutes. 2. Immerse the subject’s left hand and wrist in a bucket of water at 40°C for 3 minutes. 3. Record blood pressure and pulse rate every minute during the 3 minutes, and at minute intervals afterwards until the measurements come back to normal.

Results :

Pre-Treatment (Before Cold Pressor Test) Time

Blood Pressure (mmHg)

Pulse Rate (bpm)

1st minute

110/60

90

2nd minute

110/60

108

3rd minute

100/60

102

4th minute

100/60

108

5th minute

100/60

102

Table 7 : Blood Pressure and Pulse Rate Before Cold Pressor Test

During Treatment (During Cold Pressor Test) Time

Blood Pressure (mmHg)

Pulse Rate (bpm)

1st minute

110/70

108

2nd minute

110/80

108

3rd minute

110/80

102

Table 8 : Blood Pressure and Pulse Rate During Cold Pressor Test

Post-Treatment (After Cold Pressor Test) Time

Blood Pressure (mmHg)

Pulse Rate (bpm)

1st minute

110/70

90

2nd minute

110/60

108

Table 9 : Blood Pressure and Pulse Rate After Cold Pressor Test

Analysis :

When human body gets in contact with cold, it will activate fight or flight response, or it is known as sympathetic nervous system response. Cold would also cause pain to the skin, therefore it stimulates the sympathetic nervous system too. Vasomotor center will be receiving signal from receptors to activate the sympathetic nervous system. This causes the blood vessels to vasoconstrict and the heart rate to increase. Vasoconstriction is also one of the thermoregulations in our body to prevent heat loss. We can compare the results in table 7 and table 8. The blood pressure had increased from 100/60 mmHg to 110/80 mmHg after immersing the hand into the bucket. However, there is no significant change in pulse rate. This may be due to the action of baroreceptor receiving signal from the increased blood pressure and it will cause heart rate to decrease, in order to compensate the increasing blood pressure. An increase of about 10 mmHg in both systolic and diastolic pressure is to be expected. However, if the increase in systolic is more than 20mmHg and increase in diastolic is more than 15 mmHg, it indicates that the person has a hyper-reactive vasomotor system. Our subject had an increase of about 10 mmHg in systole and 20 mmHg in diastole, which indicates that our subject has a slightly hyper-reactive vasomotor system. After removing the hand from cold, the diastolic pressure decreased from 80 mmHg to 60 mmHg. This indicates that the subject's body is slowly recovering into normal state. From this experiment, we can conclude that environmental stressor, such as temperature, is an important factor and can affect the regulation of blood pressure and heart rate.

Experiment 4

Objective : To know the effects of psychological stress on blood pressure

Equipments : •

Sphygmomanometer

•

Small pillow

•

Stethoscope

Procedure : 1. Measure the blood pressure and pulse rate of the sitting subject every minute for 5 minutes. 2. Have the subject count backwards by 7’s from 666 as fast as possible, for 2 minutes. 3. Give 1 mark for each correct answer, and deduct 10 marks for each wrong answer. 4. Record the subject’s blood pressure and pulse rate minute during the test, and each minute afterwards until the measurements come back to normal.

Results : Pre-Treatment Time

Blood Pressure

Pulse Rate

1st min

110/60 mmHg

84 bpm

2nd min

110/60 mmHg

78 bpm

3rd min

110/70 mmHg

77 bpm

4th min

110/70 mmHg

84 bpm

5th min

110/70 mmHg

72 bpm

Table 10 : Blood Pressure and Pulse Rate Before Stress

During Treatment Time

Blood Pressure

Pulse rate

1st min

120/70 mmHg

90 bpm

2nd min

120/70 mmHg

85 bpm

Table 11 : Blood Pressure and Pulse Rate During Stress

Post Treatment Time

Blood Pressure

Pulse rate

1st min

120/70 mmHg

84 bpm

2nd min

110/70 mmHg

85 bpm

Table 12 : Blood Pressure and Pulse Rate After Stress

Analysis Based on the data received from the experiment, stress could affect the blood pressure in the human body. We measured the sitting subject every minute for 5 minutes. The blood pressures and pulse rates have no significant changes. The blood pressure in the first and second minute is 110/60 mmHg. In the third, fourth and fifth minute, the systole and diastole has the same number, which is 110/70 mmHg. Meanwhile, the pulse rate increases and decreases various times, which results to different rates. Afterwards, the subject counted backwards for 2 minutes. The first minute shows the blood pressure is 120/70 mmHg and the pulse rate is 90 bpm. And the second minute shows that the blood pressure is 120/70 mmHg and the pulse rate is 85 bpm. There is an increase of blood pressure and pulse rate. This occurs because stress activates sympathetic nervous system. This would lead to the release of stress hormones, such as adrenaline, cortisol and norepinephrine, wherein blood vessels will vasoconstrict, heart rate will increase and breathing will be rapid. After the subject finished counting, we re-measured the blood pressure and heart rate. During the 1st minute, the blood pressure and pulse rate are still similar to the ones during counting. On the 2nd minute, the blood pressure had dropped to normal state (pre-treatment), which is 110/70 mmHg. This is because the subject had already recovered from the stress condition and the sympathetic nervous system response would be decreased.

Experiment 5 Objective : To know the effects of exercise on blood pressure and heart rate.

Equipments : •

Sphygmomanometer

•

Small pillow

•

Stethoscope

Procedure : 1. Measure the subject’s blood pressure and pulse rate in resting condition while sitting. 2. Take two measurements. 3. Have the subject run stationary with high speed for 2 minutes. 4. Record blood pressure and pulse rate in sitting position every 2 minutes for 6 minutes. 5. Continue until heart rate and blood pressure return to normal. 6. Plot systolic and diastolic blood pressure and heart rate against time, indicating the resting value as a baseline.

Results :

Pre-Tr...