1. Vital Signs Lesson 3: Pulse and Respirations35
Vital Signs
Lesson 3:
Pulse and Respirations

2. 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.

3. 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

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

5. Average Pulse Rates by Age
Less than 1 year: bpm
2-6 years: bpm
6-10 years: bpm
11-16 years: bpm
Adult: bpm
Older adult: bpm 5

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

7. 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

8. 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

9. 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

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

11. Brachial

12. Radial

13. Carotid

14. Femoral

15. Popliteal

16. Posterior Tibial

17. Pedal (Dorsalis Pedis)

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Characteristics of Respiration
Rate
Rhythm
Depth
Quality
Breath sounds 26

27. 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

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

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

30. 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

31. Questions? 31