PULSE

• A wave of blood being pumped into the arterial circulation by the contraction of the left ventricle
• Middle three fingertips are used for palpating all pulse sites except the apex of the heart; a stethoscope is used for assessing
apical pulses & FHT

@ASSESSMENT PARAMETERS / CHARACTERISTICS OF PULSE

AGE GROUP PULSE RANGE
FHT and right after birth 120-160 bpm
Newborn 80-180 bpm
Crying _________bpm
Sleeping _________bpm

Adults 60-100 bpm

Elderly 60-100 bpm

Abnormal Assessment Findings:    = 

A. Bradycardia- **Slow pulse rate less than 60/ minute and must immediately be reported
B.  Tachycardia -   Rapid heart rate over 100/ minute, and must be reported
Normal pulse – can be felt w/ moderate pressure of the fingers & can be obliterated w/ greater pressure
Full or bounding pulse – forceful or full blood volume that is obliterated only with difficulty
Weak, feeble, thready – pulse that is readily obliterated w/ pressure from the fingers

Pulse Deficit – difference between the apical and radial counts taken simultaneously
To measure pulse deficit you will need (2)two people; one to check apical pulse while the other checks another pulse site.

*Pulse is taken one full minute. The rate of the radial pulse is subtracted from the apical.
*The difference is the pulse deficit.
***The pulse deficit is charted/recorded - A84/R68 ;Pulse Deficit = 16

@LOCATION OF PERIPHERAL PULSES

>temporal – superior and lateral to the eye
>carotid - @ side of cheek; lateral side of trachea or ________________
>brachial – inner aspect of the bicep muscle of the arm or medially in the antecubital space
>radial - @ the thumb side of the inner aspect of the wrist
>femoral - @ inguinal ligament
>politeal – behind the knee
>posterior tibial – medial surface of the ankle
>dorsalis pedis/ pedal – over the bones of the foot
>Apical- Located at the apex of the heart, left side of chest just below the nipple line.
- Only one not palpated but listened for using the stethoscope.
- The most accurate way to take a pulse.

@Reasons for Using Specific Pulse Site

Pulse Site Reasons for Use

Radial Readily accessible

Temporal Used when radial pulse is not accessible
Carotid Used in cases of cardiac arrests
Used to determine circulation to the brain

Apical Routinely used for infants 7 children up to 3 yrs.

Used to determine discrepancies with radial pulse
Used in conjunction with some medications

Brachial Used to measure blood pressure

Used during cardiac arrest for infants
Femoral Used in cases of cardiac arrest
Used for infants and children
Used to determine circulation to the leg

Popliteal Used to determine circulation to the lower leg

Posterior tibial , Pedal Used to determine circulation to the foot

@Factors Affecting Pulse Rate

1. Age – inc age, dec PR
2. Sex/gender – after puberty male’s pulse is slightly lower than femlae’s
3. Exercise – inc exercise, inc PR
4. Emotions/stress – SNS stimulation (fear, anxiety, perception of pain)
5. Prolonged heat application – inc metabolic rate, inc PR
6. Body positions- when sitting or standing, blood usually pools in dependent vessels of venous system  transient dec in
venous return to the heart  inc HR to compensate
7. Pain – d/t SNS stimulation
8. Decreased BP – inc HR as compensatory mechanism
9. Increased temperature – inc metabolic rate
10. Any conditions resulting to poor oxygenation of blood ex. CHF – inc HR to compensate

@ASSESSING RR
@Respiration – act of breathing
 Pulmonary ventilation –(breathing) movement of air in and out of the lungs
 Inspiration –(inhalation) act or breathing in
 Expiration –(exhalation) act of breathing out
 External respiration – exchange of O2 and CO2 between alveoli and blood
 Internal respiration – exchange of O2 and CO2 between blood and tissue cells

Respirations

regulated by the Medulla oblongata – the respiratory center

and the PONS the apneustic and Pneumotaxic center
number of breaths per minute
***represented by
1 Inspiration + 2secs Expiration

@III. ASSESSMENT PARAMETERS / CHARACTERISTICS OF RESPIRATION

1. Rate – number of breaths per minute

AGE GROUP RESPIRATORY RANGE
Newborn 30 – 60 bpm
Adults 12-20 bpm

@2 TYPES OF BREATHING
1. Costal/thoracic breathing – involves external intercostal muscles and other accessory muscles; Observed thru upward and
outward movement of the chest
2. diaphragmatic (abdominal) breathing – involves contraction & relaxation of the diaphragm

@FACTORS AFFECTING RESPIRATION

1. Exercise – inc RR
2. Certain medications – eg.
Narcotics
3. Age
4. Emotions – inc RR
5. Cardiac illness
6. Stress – inc RR
7. inc ICP = dec RR
@ASSESSMENT FINDINGS REGARDING RESPIRATION

Eupnea Normal, effortless quite breathing

Tachypnea RR > 20 to 24 bpm
Bradypnea RR < 10 bpm
Apnea Absence of breathing
Hyperpnea Deeper respiration with normal rate
Cheyne stokes Resp. becomes faster and deeper then slower with
alternate periods of apnea(20-60sec)
- periods of deep breaths, followed by very short or
no breaths (apnea), and repeat in cycles (occurs
shortly before death)
Biot’s Faster and deeper than normal with abrupt pauses
in between each breath

@Abnormal RESPIRATION – known as the “______________, sounds”

• Kussmaul’s Faster and deeper respiration without pauses in between panting
- heavy labored breathing with a fruity odor ( DIABETIC clients)
• Apneustic Prolonged grasping followed by extremely short insufficient exhalation
• Dyspnea difficulty of breathing
• Orthopnea - DOB unless sitting
• Wheezing high-pitched sounds, musical sound in expiration, narrowing of airways, causing whistling or
sighing sounds
• Stridor harsh or ______ sounds heard on inspiration
@Rales - sound caused by air passing thru fluid or mucus in the airways usually heard on
inhalation
• Rhonchi sound caused by air passing thru airways narrowed by fluids, edema, muscle spasm usually
heard during exhalation

IV. BLOOD PRESSURE or Arterial blood pressure: pressure exerted on the walls of arteries when the blood is
pumped out of the heart
- Force of the blood against the
arterial walls
- Measured in millimeters of mercury
(mmHg)
Since blood moves in waves, there are 2 BP measures:
1. Systole – the highest pressure; pressure of the blood as a result of contraction of ventricles (Heart at________)
2. Diastole – the lowest pressure; pressure of the blood when ventricles are at rest (heart at ______)
Pulse pressure – difference between the systole and diastole

@AF:
• Hypertension – above 140/90 mmHg
• Hypotension – below 90/60 mmHg
• Orthostatic Hypotension – decrease in Bp when changing position
@Korotkoff’s sound –schematic diagram
@Factors that control Blood Pressure
1.Cardiac Output – amount of blood ejected from the heart per contraction
2. Blood Volume – adult has about 5-6 liters of circulating blood
3. Elasticity of arterial walls – yields upon systole and retracts upon diastole

@Factors affecting Blood pressure

– Age – newborns systolic = 75mmHg; BP rises w/ age
– Emotions/stress – SNS stimulation = inc BP
– Exercise – inc cardiac output = inc BP
– Drugs – dopamine, dobutamine, epinephrine
– Obesity – predispose to hypertension
– Disease process – any dse affecting C.O., blood volume, blood viscosity and compliance of the arteries

Assessment Findings:
1. hypertension – dx made when the ave of 2 or more diastolic readings on 2 visits subsequent to initial
assessment is 90 mmHg or higher or ave of multiple systolic BP readings is higher than 140mmHg
2. hypotension = systolic pressure is consistently between 85-110 mmHg

To ensure accuracy in taking the BP, you must:

Let the patient rest for a minimum of 5 minutes for routine assessment
2. Should not have ingested caffeine or nicotine 30 minutes before
3. Delay assessing if patient is: a. in pain b. emotionally upset, or c. have just exercised.

At age 3 start routine BP taking

Sounds of blood pressure - Korotkoff Sounds
Principles related to Blood Pressure:
1. Patient should be resting for 5 minutes prior to taking the reading

2.   You must document the position the patient was in (sitting/lying)

* Do not take the BP standing unless ordered that way

 3. Use the correct size cuff-

 4. Use the brachial artery -
How to take BP.
A. Find brachial pulse.
B. Apply cuff.
C. Close valve and pump up cuff until brachial pulse can no longer be felt or to 170.
D. Position stethoscope over brachial artery, listen.

Some don'ts when taking BP.

A. Do not take on arm with IV in place.
B. Do not take on arm with cast on.
C. Do not take on side with mastectomy or other breast surgery.

Hypotension - low blood pressure   

**only dangerous with symptoms of shock :
 1. Pale, cold clammy skin
2. rapid weak pulse
3. Sudden drop in blood pressure
 4. Thirst/ nausea

Hypertension - sustained elevated blood pressure

**Can cause a stroke ( Cerebral vascular accident / CVA )    
**High blood pressure also damages the kidneys, heart and retina of the
eyes