Vital Signs Lesson 3: Pulse and Respirations 35 Vital Signs Lesson 3: Pulse and Respirations

Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. State the normal values of temperature, pulse, respiratory rates, and blood pressure. List and describe the nine pulse sites. Describe the respiratory rate range for the various age groups.

The Pulse The amount of times the heart beats per minute (bpm) Wave of blood created each time the left ventricle of the heart contracts Each pulse beat is one cardiac cycle or one heartbeat Normal heartbeat is about 70 times per minute Increased oxygen results in a faster pulse rate Tachycardia = pulse rate above 100 bpm Bradycardia = pulse rate below 60 bpm 3

Factors that Influence Pulse Rate Exercise Age Gender Size Physical condition Disease states Medications Depression Fear, anxiety, anger 4

Average Pulse Rates by Age Less than 1 year: 120-160 bpm 2-6 years: 80-120 bpm 6-10 years: 80-100 bpm 11-16 years: 70-90 bpm Adult: 60-80 bpm Older adult: 50-65 bpm 5

Characteristics of Pulse Rate Volume Rhythm Compliance of the arterial wall 6

Rate and Volume of Pulse Rate – describes the number of pulse beats per minute Volume – refers to the strength of the pulse Volume is noted as: Full or bounding pulse, indicating an increase in blood volume A strong or normal amount of force or blood volume A weak or thready pulse (barely perceptible) force or blood volume

Rate and Volume of Pulse Volume is influenced by the forcefulness of the heartbeat, the condition of the arterial walls, and dehydration A variance in intensity of the pulse may indicate heart disease

Rhythm Refers to the regularity, or equal spacing, of all the beats of the pulse Various aspects of rhythm are as follows: Normally, the intervals between each heartbeat are of the same duration A pulse with an irregular rhythm is known as a dysrhythmia or arrhythmia The irregular rhythm may be random irregular beats or a predictable pattern of irregular beats It is not considered abnormal if the heart occasionally skips a beat – This is referred to as an intermittent pulse

Common Pulse Sites Radial Brachial Carotid Temporal Femoral Popliteal Posterior tibial Dorsalis pedis Apical 10

Brachial

Radial

Carotid

Femoral

Popliteal

Posterior Tibial

Pedal (Dorsalis Pedis)

Steps in Measuring a Radial Pulse Rate Step 1: Perform hand hygiene. Identify the patient. Step 2: Explain procedure to the patient and ask the patient about any recent physical activity or smoking. Step 3: Ask patient to sit down and place arm in a comfortable, supported position. Step 4: Place finger tips on radial artery on thumb side of wrist. Step 5: Check quality of pulse. 18

Steps in Measuring a Radial Pulse Rate Step 9: Perform hand hygiene and record the pulse beats per minute in the patient’s record. Step 8: Immediately write the pulse beats per minute on a piece of paper. Step 7: Count the pulse for 1 full minute. Step 6: Start counting pulse beats when second had on watch is at 3, 6, 9, or 12. 19

Steps for Taking an Apical-Radial Pulse Identify the patient Explain the procedure Uncover the left side of patients chest – Provide privacy with a drape, if necessary The first person places the ear pieces of the stethoscope in the ears with opening in tips forward

Steps for Taking an Apical-Radial Pulse Locate the apex of patients heart by palpating to the left fifth intercostal space (between fifth and sixth ribs) at the midclavicular line – This is found just below the nipple Warm the chest piece by holding it in the palm of hand before placing onto patient’s chest

Steps for Taking an Apical-Radial Pulse The second person locates the radial pulse in the thumb side of wrist 1 inch below base of thumb The first person places the chest piece of the stethoscope at the apex of the heart – When the heart beat is heard, a nod is made to the second person and counting begins – Ideally, the count should begin when the second hand is at the 3,6, 9 or 12

Steps for Taking an Apical-Radial Pulse Count for 1 full minute – Note: the systole and diastole (or lubb/dubb) count as 1 beat Remove stethoscope and ear pieces Record the rate and quality of heartbeats Include both apical and radial rates using the designation “AP” – Calculate the pulse deficit by subtracting the radial pulse rate from the apical pulse rate Assist the patient with replacement of clothing, if necessary

Steps for Taking an Apical-Radial Pulse Assist the patient from the examining table Wipe the earpieces and chest piece of the stethoscope with alcohol wipes or cotton balls with alcohol Perform hand hygiene

Respiration The act of breathing The exchange of oxygen and carbon dioxide Consists of one expiration and one inspiration Each rise and fall of a patient’s chest equals one respiration Taken typically at the same time as a pulse 25

Characteristics of Respiration Rate Rhythm Depth Quality Breath sounds 26

Respiratory Rate Ranges by Age Group Newborn: 30-50 1 year old: 20-40 2-10 years: 20-30 11-18 years: 18-24 Adult: 14-20 27

Situations that Alter Respirations Allergic reactions Medications Disease Exercise Emotions Fever Hemorrhage High altitudes Obstruction of air passage Pain and shock 28

Terms for Describing Breath Sounds Stridor Stertorous sounds Crackles or rales Rhonchi Wheezes Cheyne-Stokes Bubbling 29

Steps to Measuring Respirations Step 1: Perform hand hygiene. Step 2: Identify the patient. Assist the patient into a comfortable position. Step 3: Place hand on the patient’s wrist in position to take the pulse. Step 4: Observe and count each breathing cycle. Step 5: Count for 1 full minute. Step 6: Record respiratory rate in the patient’s chart. 30

Questions? 31