2. Chapter 1 Vital Signs Copyright © The McGraw-Hill Companies, Inc.

3. Chapter 9 2 Signs 2 Temperature Pulse Respiration Blood Pressure

4. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 3 Pulse A wave of blood flow created by a contraction of the heart. Name these pulses. Click HERE to check answers.HERE A. B. D. E. F. C.G. H.

5. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 4 Pulse Sites (Answers) A. Temporal B. Femoral C. Popliteal D. Posterior tibial E. Carotid F. Brachial G. Radial H. Dorsalis pedis Back

6. Copyright © The McGraw-Hill Companies, Inc. Factors affecting pulse: Age; as age increases, the pulse rate gradually decreases. Gender, male’s pulse rate is slightly lower than the female’s. Exercise; the pulse rate normally increase with activity Fever; the pulse rate increases in response to the lowered blood pressure that results from peripheral vasodilatation associated with elevated temperature and because of the increased metabolic rate. Medications; some medications decrease the pulse rate, and others increase it such as digitalis decrease the heart rate.

7. Copyright © The McGraw-Hill Companies, Inc. Pathology; certain diseases such as some heart conditions or those with impair oxygenation can alter the resting pulse rate. Chapter 9 6

8. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 7 Pulse (cont.) Pulse sites most commonly used: – Radial pulse – located inside the wrist, near the thumb. – Brachial pulse – found in the antecubital space of the arm (the bend of the elbow) in adults.

9. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 8 Pulse (cont.) Pulse Sites (cont.) – Apical pulse – auscultated with a stethoscope on the chest wall. The pulse is found at the apex of the heart.

10. Copyright © The McGraw-Hill Companies, Inc. Pulse Sites

11. Copyright © The McGraw-Hill Companies, Inc. Pulse Sites – Temporal; passes over the temporal bone of the head. The site is superior and lateral to the eye. – Carotid; at the side of the neck between the trachea and the sternocleiodomastoid muscle. – Apical; at the apex of the hearty. About 8cm to the left of the sternum and at the fourth and sixth intercostals space. – Brachial; at the inner aspect of the biceps muscle of the arm

12. Copyright © The McGraw-Hill Companies, Inc. – Radial; on the thumb side of the inner aspect of the wrist – Femoral; alongside the inguinal ligaments – Popliteal; where the popliteal arteries passedbehind the knee – Posterior tibial; on the medial surface of the ankle, to check the distal circulation in the lower extremities – Pedal “dorsalis pedis”; over the bones of the feet to check the distal circulation in the lower extremities

13. Copyright © The McGraw-Hill Companies, Inc.

14. Assessing the Pulse A pulse is normally palpated by applying moderate pressure with the three middle fingers of the hand. A pulse is commonly assessed by palpation “feeling’ or auscultation “hearing”. Apical pulse; if the peripheral pulse is difficult to assess accurately because it is irregular. The apical pulse located at 5-6 intercostals rib.

15. Copyright © The McGraw-Hill Companies, Inc. A Doppler ultrasound stethoscope (DUS) is used for pulses that are difficult to assess. The nurse should aware of the following: Any medications that could affect the heart rate. Whether the client has been physically active. Whether the client should assume a particular position.

16. Copyright © The McGraw-Hill Companies, Inc.

17. When assessing the pulse the nurse collect the following data: 1. Rate, an excessively fast heart rate over 100 BPM in an adult is called Tachycardia. A heart rate in an adult of less than 60BPM is called Bradycardia. 2. Rhythm is the pattern of the beats and the intervals between the beats. A pulse with an irregular rhythm is referred to as a dysrhythmia or arrhythmia. 3. Volume is called pulse strength or amplitude, refers to the force of blood with each beat. It can range from absent to bounding. 4. Elasticity of the arterial wall reflects its expansibility or its deformities. A healthy, normal artery feels straight, smooth, soft, and pliable. Elders often have inelastic arteries that feel twisted and irregular upon palpation.

18. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 17 Pulse (cont.) Characteristics of the Pulse – Pulse Rate(60-100)beats Assessed as beats per minute, or BPM. Counted for 15, 20, 30, or 60 seconds. Tachycardia – a pulse rate faster than normal.more than 100 Bradycardia – a pulse rate slower than normal.less than 60

19. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 18 Pulse (cont.) Characteristics of the Pulse (cont.) – Pulse Rhythm – the pattern of the heartbeats. A client with an irregular heartbeat (arrhythmia or dysrhythmia) must be measured a full minute to determine the average rate. When documenting pulse rhythm, record as regular or irregular. Click Pictures for Sounds RhythmRegular Irregular

20. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 19 Pulse (cont.) Characteristics of the Pulse (cont.) – Pulse volume, or strength of the pulse, can be measured with the following scale: 0 – absent, unable to detect. 1 – thready or weak, difficult to palpate, and easily obliterated by light pressure from fingertips.

21. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 20 Pulse (cont.) Characteristics of the Pulse – Pulse Volume (cont.) 2 – strong or normal, easily found and obliterated by strong pressure from fingertips. 3 – bounding or full, difficult to obliterate with fingertips. A thready or weak pulse may indicate decreased circulation. A bounding pulse may indicate high blood pressure.

22. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 21 Pulse (cont.) Characteristics of the Pulse (cont.) – Bilateral Presence – pulses should be found within the same areas on both sides of the body and have the same rate, rhythm, and volume.

23. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 22 Section 9-1 Apply Your Knowledge Where would one measure tympanic temperature? Answer: Tympanic temperature is measured in the ear canal.

24. Copyright © The McGraw-Hill Companies, Inc. Chapter 9 23 Order of Performance Perform the least invasive vital sign first. Use this order if possible: – Respiratory rate. – Pulse. – Temperature. – Blood pressure.