Assessing Heart Rate & Blood Pressure

Your pulse represents arterial palpation of the heartbeat using your fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone: at the neck (carotid artery), on the inside of the elbow (brachial artery), at the wrist (radial artery), at the groin (femoral artery), behind the knee (popliteal artery), near the ankle(posterior tibial artery), on the foot (dorsalis pedis artery). Pulse is equivalent to measuring the heart rate. The heart rate can also be measured by listening to the heart beat directly (auscultation), traditionally using a stethoscope and counting it for a minute.

Normal Pulse Rates at Rest newborn (0–3 months old) infants (3 – 6 months) infants (6 – 12 months) children (1 – 10 years) children over 10 years & adults, including seniors well-trained adult athletes – –13060–10040–60 The pulse rate can be used to check overall heart health and fitness level. Generally lower is better, but bradycardia can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting.

Characterizing the Pulse The strength of the pulse can be reported: 0 = Absent 1 = Barely palpable 2 = Easily palpable 3 = Full 4 = Aneurysmal or Bounding Pulse

Terms used to characterize the pulse regular, irregular, thready, bounding, absent [peripherally and/or centrally])

Pulse Points Practice taking a patient’s pulse Using the following points: Temporal artery Carotid artery Brachial artery Radial artery Popliteal artery Posterior tibial artery Characterize the pulse at each point.

Apical Pulse

Heart Sounds

LUB = Systole –a force that drives blood out of the heart by the contraction of the Left Ventricle DUB = end of Systole/beginning of Diastole –the period of time when the heart refills with blood after systole

Sinus Rythym sinus rhythm is the normal beating of the heart, as measured by an electrocardiogram There are typically six distinct waves (identified by the letters P, Q, R, S, T, and U) in a single beat of the heart in sinus rhythm, representing the electrical activity in a beating heart

Blood Pressure sometimes referred to as arterial blood pressure, is –the pressure exerted by circulating blood upon the walls of blood vessels as a result of muscular contractions of the heart

During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure Blood pressure varies in healthy people, but its variation is under control by the nervous and endocrine systems. Blood pressure that is unusually low is called hypotension, and that which is abnormally high is hypertension.

Classification of blood pressure for adults[4][5] Categorysystolicsystolic, mmHgmmHgdiastolicdiastolic, mmHg Hypotension< 90< 60 Desired90–11960–79 Prehypertension120–13980–89 Stage 1 HypertensionHypertension140–15990–99 Stage 2 Hypertension160–179100–109 Hypertensive Emergency≥ 180≥ 110 Reference ranges for blood pressure in children[19] StageApproximate ageSystolicDiastolic Infants1 to 12 months75–10050–70 Toddlers and preschoolers 1 to 5 years80–11050–80 School age6 to 12 years85–12050–80 Adolescents13 to 18 years95–14060–90

Physiological Factors affecting BP Blood Volume – the amount of blood present in the body –The more blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac output Resistance – blood vessels present some resistance to the flow of blood –Smaller, longer blood vessels offer more resistance than larger, shorter vessels

Viscosity – the thickness of blood –Thicker blood will result in higher blood pressures as the heart must work harder to force the thicker, heavier fluid through arteries, arterioles and capillaries

Stroke Volume The amount of blood expelled from the left ventricle of the heart during a single systolic contraction

Pulse Pressure Determined by the interaction of the stroke volume of the heart, flexibility of the aortic walls and resistance to blood flow in the arteries. –By expanding under pressure, the aorta absorbs some of the force of the blood surge from the heart. In this way, the pulse pressure is reduced from what it would be if the aorta wasn't flexible. –Pulse pressure is simply the difference between systolic and diastolic pressures