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• Age Newborn > Adult• Body build & size Short > Tall• Blood pressure BP rises, P falls

BP falls, P rises• Drugs• Emotions Anxiety raises pulse• Blood loss Pulse fast & weak• Exercise P rises• Fever P rises • Pain P rises

PULSE RATE

Normal rate varies with age:

Infant 120-160 beats/min (bpm)

1 yr old child 110 bpm

5 yr old child 95 bpm

Adult 60-100 bpm

Athlete 45-60 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 <60 or >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 chest5th intercostalspace

Pulse Deficit

Difference between the apical & radial pulse.Checked when the pulse is very irregular.Requires two people:One counts the radial pulseThe other counts the apical pulseThe apical pulse minus the radial pulseEquals 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