1. 1 Pulse

2. 2 Is a blood wave created by contraction of the left ventricle of the heart It represents the stroke volume output. Compliance : Ability of the arteries to contract and expand. Cardiac output: the volume of the blood pumped in the arteries = SV X HR.

3. 3 Pulse PERIPHERAL PULSE APICAL PULSE

4. 4 Factors affecting the pulse Age: ↓ with age Gender: after puberty male slightly < than female. Exercise: ↑ with exercise Fever: ↑ with fever Medications: e.g ↑ with epinephrine and ↓ with digitalis. Hypovolemia: ↑ with blood loss Stress: ↑ with stress Position changes: sitting or standing → pooling of blood in dependent vessels → ↓BP & ↑ HR. Pathology

5. 5 Pulse sites Radial Readily accessible Temporal When radial pulse is not accessible Carotid During cardiac arrest/shock in adults Determine circulation to the brain Apical Infants and children up to 3 years of age Discrepancies with radial pulse Monitor some medications

6. 6 Pulse sites BrachialBlood pressure Cardiac arrest in infants FemoralCardiac arrest/shock Circulation to a leg; PoplitealCirculation to lower leg Posterior tibialCirculation to the foot Dorsalis pedisCirculation to the foot

7. 7 Figure 29-12 Nine sites for assessing pulse.

8. 8 Assessing pulse Palpation (60 sec.) Middle three fingers Using stethoscope Doppler ultrasound Moderate pressure Aware of (medications, activity, position)

9. 9 Assessing pulse Rate : tachycardia (>100B/m), bradycardia (< 60B/m) Rhythm : Equality of beats and intervals between beats. dysrhythmia, arrhythmia (ECG) Volume (strength or amplitude) : full or bounding, weak, feeble, thready (Normal: felt with moderate pressure). Elasticity: should be straight, smooth, soft, pliable Pulse deficit : any discrepancy b/w apical-radial pulses.

10. Assessing Apical pulse Explain procedure Privacy Supine, or sitting position Point of maximal impulse (PMI) 5 th. Intercostal space MCL. Clean ear piece and diaphragm by antiseptic gel Warm diaphragm before use Assess for “lub-dub”

11. Assessing Peripheral pulses

14. 14 Nursing Diagnosis Ineffective Cerebral Tissue Perfusion related to cerebral ischemia