Measuring Vital Signs PULSE

Pulse Pulse rate reflects the number of times the heart beats per minute. This creates a pressure wave, which is what we palpate (feel) over an artery when we’re taking a pulse or hear (auscultate) with a stethoscope over the heart Stroke volume: amount of blood pumped out of the left ventricle into the aorta with each heart beat.

Cardiac Output=the total quantity of blood pumped per minute Pulse rate multiplied by the stroke volume. The average cardiac output is about 5L/min.

Factors affecting pulse rate AgeNewborn > Adult Body build & sizeShort > Tall Blood pressureBP rises, P falls BP falls, P rises Drugs EmotionsAnxiety raises pulse Blood lossPulse fast & weak ExerciseP rises FeverP rises PainP rises

PULSE RATE Normal rate varies with age: Infant beats/min (bpm) 1 yr old child110 bpm 5 yr old child95 bpm Adult bpm Athlete45-60 bpm

Common pulse points Radial artery in the wrist at the base of the thumb Temporal artery just in front of the ear Carotid artery on the front side of the neck Femoral artery in the groin Apical pulse over the apex of the heart Popliteal pulse just behind the knee Pedal pulse pulse on top of the foot. Also known as Dorsalis Pedis

Brachial Pulse: Used for BP’s Radial Pulse: Most commonly used site.

Pedal Pulse Not counted, but located Compare strength bilaterally & check if = Assessed post procedure if femoral artery was used (such as post cardiac cath) Spot where found usually marked with pen Doppler ultrasound stethescope used if pulse is difficult to palpate.

Assessing the PULSE Count the radial pulse rate for 30 seconds and multiply by 2. Record the result. Note the quality by assessing the pulse volume- Absent-no pulse, Weak or Thready- pulse is barely felt, Normal-Pulse is easily felt, Bounding or Full-Pulse is easily felt with little pressure Note the rhythm (regular or irregular)

Pulse volume: weak or thready Low blood pressure or falling stroke volume

Pulse Strength: Full and bounding

Heart rhythms Normally regular Initiated by an electrical impulse in the SA node Irregular rhythms result from misfiring of the SA node.

Pulse Rate & Rhythm

Abnormal heart rates Tachycardia – pulse rate > 100 bpm Bradycardia – pulse rate < 60 bpm

APICAL PULSE Requires the use of a stethoscope Take an apical pulse if any abnormality noted If the rate is 100 beats per minute The patient is taking cardiac meds (e.g., digoxin) If the radial pulse is weak or irregular Heard best at the apex of the heart Apical pulse is counted for 1 full minute!!!!!! For children under two years of age

Finding the apical pulse Left chest 5 th intercostal space

Pulse Deficit Difference between the apical & radial pulse. Checked when the pulse is very irregular. Requires two people: One counts the radial pulse The other counts the apical pulse The apical pulse minus the radial pulse Equals the pulse deficit.

Pulse Normally palpated or by auscultation Radial, apical, femoral, brachial, pedal Strength determined by force of cardiac contraction and circulating volume Rate affected by fever, pain, hypoxia, anxiety, exercise, cardiac pathology Rate does not normally change with age but arrythmias are common in the elderly