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Pulse

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Pulse

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.

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Pulse

PERIPHERAL PULSE

APICAL PULSE

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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

Pulse sites

Radial Readily accessible

Temporal When radial pulse is not accessible

Carotid During cardiac arrest/shock in adultsDetermine circulation to the brain

Apical Infants and children up to 3 years of ageDiscrepancies with radial pulseMonitor some medications

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Pulse sites

Brachial Blood pressureCardiac arrest in infants

Femoral Cardiac arrest/shockCirculation to a leg;

Popliteal Circulation to lower legPosterior tibial Circulation to the footDorsalis pedis Circulation to the foot

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Figure 29-12 Nine sites for assessing pulse.

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Assessing pulse

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

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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.

Assessing Apical pulse

Explain procedure Privacy Supine, or sitting position Point of maximal impulse (PMI) 5th. Intercostal space MCL. Clean ear piece and diaphragm by antiseptic gel

Warm diaphragm before use Assess for “lub-dub”

Assessing Peripheral pulsesAssessing Peripheral pulses

Assessing Peripheral pulsesAssessing Peripheral pulses

Assessing Peripheral pulsesAssessing Peripheral pulses

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Nursing Diagnosis

Ineffective Cerebral Tissue Perfusion related to cerebral ischemia