Professional Documents
Culture Documents
Esther Estrellado Normal heart rate: 60-100 bpm For a healthy individual, you can get it by measuring for 15 seconds, and then multiply by 4. For conditions such as atrial fibirillation, measure in 1 full minute. 7. No talking, (patient and doctor must shut up I guess? Hihi ) TECHNIQUES: 1. Patient must sit properly and upright, feet flat on the floor and legs not crossed. 2. Use right arm if possible. During BP taking, there is a difference of 10mm between the right arm and left arm. (Its still acceptable) 3. Always use the right cuff. Bottom edge must be 2 cm above the antecubital fossa. 4. Use the bell of the stethoscope. 5. Get the average. Feel the radial pulse, and inflate until 160. Deflate slowly, average must be 2-3 mmHg. PHASES: Phase 1 -Korotkoff sound 1st faint sound - Systolic Phase II -murmur, swishing sound Phase III -sound is more intense, crispier Phase IV -abrupt muffling sound Phase V
BP CONSIDERATIONS: 1. Type: Mercurial BP (the best type) 2. Check the calibration, must be at zero. 3. Inflate to 200. 4. Note whether mercury rises and falls smoothly. 5. Length of bladder: 75-80% (circumference) More than 50% of length (width) 6. Conditions wherein you are not supposed to take the BP 1 hour before: Food intake Exercise Coffee (its a stimulant) Smoking ( another stimulant) Must be in a cool environment (54 degrees Fahrenheit)
VITAL SIGNS AND JUGULAR VENOUS PRESSURE Dr. Esther Estrellado -pressure when last sound was heard -heart sound is no longer audible JUGULAR VENOUS PRESSURE Must be measured at the right side of the neck, at the right carotid artery. Normal: 8 cm water It denotes the right hemodynamic state of the right atrium and right ventricle. Height from sternal angle: 3 cm Patient must be at a 45 degree angle. Observe the neck. SIGNIFICANCE: Reflects anything happening at the right atrium of the heart. An elevation denotes CHF. - decreased compliance in the R. ventricle - hypervolemia - obstruction in the tricuspid valve and sup. vena cava Y wave After S1 Decline in atrial pressure when the tricuspid valve opens
A wave Atrial contraction Most prominent when patient inspires Occurs before S1
X descent Atrial relaxation Floor of r. atrium descends toward ventricle at ventricular systole
Diathesis Between Y and A wave Slow flow of blood in the right atrium and ventricle.
Kussmaul sign
VITAL SIGNS AND JUGULAR VENOUS PRESSURE Dr. Esther Estrellado Pradoxical rise in venous pressure Indicates chronic constrictive pericarditis, CHF, tricuspid stenosis
Prominent A wave Right ventricular hypertrophy Tricuspid stenosis (in children) Pulmonary hypertension
ATRIAL PULSE Normal: gradual rise precussion wave rounded wave nicrotic and decrotic wave