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Factors affecting pulse
- Age- ↓ with age
- Sex- male lower than female after puberty
- Exercise-↑ with activity
- Fever- ↑
- Medications-
- hypovolemia-↑ with loss of blood
- stress-↑
- position- blood pools ↑ PR,↓ BP
- pathology-certain diseases heart condition that impair oxygenation can alter resting pulse
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pulse sites
- temporal
- Carotid
- Apical
- Brachial
- radial
- femoral
- popliteal
- posterior tibial
- pedal
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reasons for pulse site
radial
readily accessible
-
reasons for pulse site
temporal
used when radial not accessible
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reasons for pulse site
Carotid
- used during cardiac arrest/shock in adults
- used to determine circulation to the brain
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reasons for pulse site
Apical
- routinely used for infants and children up to 3
- used to determine discrepancies with radial pulse
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reasons for pulse site
Brachial
- used to measure bloodpressure
- used during cardiac arrest for infants
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reasons for pulse site
Femoral
- used in cases of cardiac arrest or shock
- used to determine leg circulation
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reasons for pulse site
popliteal
used to determine circulation in the lower leg
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reasons for pulse site
posterior tibial
used to determine circulation in foot
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reasons for pulse site
dorsalis pedis
used to determine circulation in foot
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S1 occurs when
the atrioventricular valves close after the ventricles have been sufficiently filled.
-
S2 occurs when
the semilunar valves close after the ventricles empty
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normal pulse average range
newborn
130 (80-180)
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pulse average range
1 year old
120 (80-140)
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pulse average range
5-8 year olds
100 (75-120)
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pulse average range
10 year olds
70 (50-90)
-
pulse average range
Teen
75 (50-90)
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pulse average range
adult
80 (60-100)
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pulse average ranges
older adult
70 (60-100)
-
pulse volume or amplitude
1+
- weak or thready
- lacks fullness obliterates easily
-
pulse volume or amplitude
2+
- normal
- easily palpable
- obliterated with strong pressure
-
pulse volume or amplitude
3+
- full
- volume higher than normal
-
pulse volume or amplitude
4+
- Bounding
- higher than normal
- visible pulsation
- very strong on palpation
-
what facter effect temp
- age
- diural variations/circadian rhythms
- exercise
- hormones
- stress
- environment
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what are risks of cardiovascular disease?
Non-modifiable
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What are risks for cardiovascular disease?
Modifiable
- Sedentary Lifestyle
- Obesity
- Diabetes
- Smoking
- HTN
- elevated Lipids/Triglycerides
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how do you calculate CO?
stroke volume X heart rate = cardiac output
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stroke volume
- the amount of blood ejected from the ventricles into circulation in one beat
- average 70ml
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what is cardiac output
the amount of blood pumped by the ventricle in one minute
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when is apical/radial pulse used
- when peripheral pulse is irregular or unavailable
- clients with cardiovascular, renal, pulmonary disease
- before giving meds that raise or lower HR
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where do you place the stethoscope for apical pulse
- midclavicular
- 5th intercostal space
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advantages and disadvantages for temp sites
Accessible and convenient
- thermometers can break if bitten
- inaccurate if ate, drank or smoked
- could injure mouth following oral surgery
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advantages and disadvantages temp sites
rectal
reliable measurement
- inconvenient/unpleasant
- could injure rectum
- presence of stool may interfere with placement
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advantages and disadvantages of axillary temp site
safe and noninvasive
thermometer may need to be left in place a long time to get accurate measurement
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tympanic membrane
advantages and disadvantages
temp site
readily accessible, reflects core temp, very fast
- can be uncomfortable, risk of injury to ear canal
- wax will alter reading
- left and right can be different
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temporal artery temp site
advantage and disadvantages
safe and noninvasive, very fast
requires electronic equipment that may be expensive or unavailable
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average resp rate
- newborn 35 (30-60)
- 1 year old 30 (20-40)
- 5-8 yrs 20 (15-20)
- 10 yrs 19(15-25)
- teen 18(15-20)
- adult 16(12-20)
- older adult 16(15-20)
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what to assess when assessing breathing
- depth- deep or shallow
- client position- affects amount of air that can be inhaled
- rhythm-regularity should be evenly spaced
- quality/character- amount of effort needed
- sound- normal is silent
-
altered breathing sounds
- stridor
- stertor-snoring
- wheeze
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factors associated with HTN
- thickened arterial walls
- inelastic arteries
- smoking
- heavy alcohol consumption
- high cholesterol
- stress
- lack of physical activity
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what indicates orthostatic Hypotension
- rise in pulse 15-30 BPM
- drop in BP 20mmHg systolic or 10mmHg diastolic
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what effect does HTN have on the kidney
- it damages to blood vessels that supply the kidneys with blood, O2 and nutrients
- as blood flow is reduced the kidney is no longer able to filter the blood for waste products and excess fluid
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how quickly should the air be released from the BP cuff while auscultating for Korotkoffs sounds
2 to 3 mmHg per second
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what is the Mean Arterial Pressure?
MAP
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what is normal pulse oximetry reading
- 95-100% is considered normal
- under 70% is life threatening
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what can affect O2 saturation measurement
- hemoglobin levels can give false normal
- impaired circulation
- activity, shivering or excessive movement
- CO2 poisioning
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what is normal O2 sat and Pulse rate for neonatal
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when are rectal thermometers contraindicated?
- MI
- Rectal Surgery
- Diarrhea
- Diseases of rectum
- clotting disorders
- hemorrhoids
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when is axillary preferred or indicated for use
- newborns
- children (monitor but not to detect)
- adults with wired jaws, oral inflammation, cannot breathe through nose, irrational clients
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how to position the ear for tympanic temp
- up and back for adult
- down and back for child
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when is tympanic temp method not used
- if client has ear infection or a lot of ear cerumen
- pt has tubes
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temperature normal for 3 month to 3 yrs old
- slightly higher than adults
- 99.4 / 37.2
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how many pulse sites are there
- 9
- temporal, carotid, apical, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis
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factors that affect heart rate
- activity level ↑
- Medications ↓ or ↑
- disease processes Cardiac & Resp ↑
- Age ↑ age = ↓ rate
- gender -males tend to be slower
- Fever - ↑
- Hypovolemia- ↑
- stress - ↑
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apical pulse will be higher than radial, when should doc be notified
- ↑ 10
- especially if BP changes or pt has SOB, chest Pain or any other changes
-
what is pulse pressure
difference between systolic and diastolic
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