General Medicine

 The pressure of the blood felt against the wall of an artery as the heart beats Felt most easily in arteries, especially those that can be gently pressed against a bone  The pulse lets us know how the cardiovascular system is meeting the body’s needs

 Radial pulse is most commonly used and is found in the inner aspect of the wrist  You must note 3 things when checking a pulse Rate or speed Rhythm (regular or irregular) Volume (strong, weak, thready, bounding)  You must record date and time pulse was taken in addition to the above findings

 Pulse rate is measured as the number of beats per minute  Counted for one full minute and recorded as a number  Followed by the abbreviation bpm (beats per minute)  Varies by individual age, sex, body size and illness

 Normal Ranges Adult  Children 7+  Children 1-7  Infants   You must report Tachycardia (over 100 beats per minute) Bradycardia (below 60 beats per minute) Irregularities in rhythm or volume

 May be affected by many things illness Emotions Age Exercise Elevated temperature Drugs position

Measured by counting the heart contractions  Left side of chest  Between 5/6 ribs  Just below left nipple  Under left breast in a female Listen for lub dub…  The sound you hear are the heart valves opening and closing

 Always count for one full minute  Who needs an apical pulse checked? Whenever pulse deficits exists or is suspected Before meds that change heart rate or rhythm On any child 12 months or younger  Can be hard to feel/count a faster pulse Whenever radial pulse if irregular or if you are uncertain of the accuracy of the radial pulse On any child in which it is difficult to get a radial pulse

 This occurs when the heart is too weak and does not pump enough blood to produce a pulse or when the heart beats too fast, not allowing the heart to fill with blood between beats.  The apical rate would be greater than the radial rate.  How do you check a pulse deficit? One person checks apical rate while another checks radial rate. If the rates are different, a pulse deficit exists.

 Measures the force of blood against the artery walls Blood pressure is measured in mmHg (millimeters of mercury)  Systole (systolic reading)-the force of blood against the artery walls during ventricular contraction-working pressure  Diastole (diastolic reading)-the constant pressure in the walls of the arteries-resting pressure

 What elevates the BP? Exercise Eating Stimulants Stress, fear, anxiety Arteriosclerosis, high cholesterol, diabetes Pain Obesity

 What lowers BP? Rest Depressants Weight loss Shock Grief Dehydrations Diuretics

 What does the equipment look like? Electronic sphygmomanometers Aneroid sphygmomanometer Mercury sphygmomanometers Stethoscope

 Cuff is placed directly over the brachial artery (1 inch above the antecubital space)  Systolic pressure is the first regular sound you hear  Diastolic pressure will be the change or last sound you hear  Pulse pressure will give you information on the condition of the arteries in the body The difference between the systolic and diastolic pressure

 Normal Ranges-recorded as a fraction Average resting pressure  120/80 Normal Systolic Pressure Range  Normal Diastolic Pressure Range  Hypertension-pressure above 140/90 Hypotension-pressure below 100/60 The systolic and diastolic values should be looked at separately to determine normal

 Can you use any arm to check BP?  No. When would you not use an arm? If it has an IV line or other device inserted Is being treated for burn, fracture, etc Has dialysis access device Is on the same side as a recent mastectomy or other surgical procedure If the arm is paralyzed, injured or has edema If the arm has a pulse oximeter on it

 Inaccurate or erroneous blood pressure readings are due to: Wrong size cuff Improperly wrapped cuff Incorrect positioning of the arm Not using the same arm each time Not having the gauge at eye level Deflating the cuff too slowly Mistaking an auscultatory gap for the diastolic pressure

 Make sure the gauge is at eye level  It should not be tilted  The gauge Each small line represents 2mm Hg Each large line represents 10mm Hg

 What do I report? If you were unable to get the reading If it is higher than a previous reading If it is lower that a previous reading If the site where the BP was taken was other than the brachial artery The position of the patient (sitting, standing, lying down)

 Orthostatic, or postural, hypotension occurs when there is a sudden drop in both systolic and diastolic pressures when an individual moves from a lying to a sitting or standing position  Your blood vessels can’t compensate quickly enough to the change in position  Dizziness, lightheadedness and blurred vision may happen  Patients may need orthostatic blood pressures taken to see if this condition is occurring We do them lying, sitting then standing to determine if there is a drop

 Electronic blood pressure monitors are not for everyone  Do not use on those with: Extreme hypertension or hypotension Very rapid heart rates Excessive body movements or tremors Irregular heart rhythms or dysrhythmias

 Why is it important? It supplies the cells in our bodies with oxygen and rids them of excess carbon dioxide  One respiration consists of one inspiration and one expiration  Respiration is the process of taking in oxygen and getting rid of carbon dioxide

 Adults   Children   Infants   Patients may experience cyanosis (bluish discoloration of skin, nail beds due to lack of oxygen to tissues) if they are not breathing adequately

 How can I describe respiration? Normal Tachypnea-shallow, rapid breathing Dyspnea-difficult or labored breathing Apnea-a period of no respirations Cheyne-Stokes-period of dyspnea followed by periods of apnea Rales-moist respirations (bubbling) Wheezing-whistling or sighing sound

 The patient must not be aware that you are checking their respirations. Why?  You must note 5 things when checking respirations Rate or speed Rhythm (regular or irregular) Symmetry-equal expansion of chest Character-depth or quality of breaths  labored or unlabored, deep or shallow, difficult, stertorous (snoring like sounds), moist

A person notices that sleep is more comfortable with several pillows under his head, or A more severe one in which he can breathe deeply and comfortably only when sitting or standing. May occur along with swelling of the feet or ankles. Orthopnea is a sign of heart failure. It is caused by congestion in the lungs

 Bradypnea < 10 breaths/minute  Tachypnea > 25 breaths/minute  Normal Ranges breaths/minute  What can affect the respiratory rate? Illness Emotions Elevated temp Age Exercise Position drugs

 Practice measuring pulse and blood pressure following your check off sheets