Vital Signs

Pulse

What is the Pulse?

A blood wave created by contraction of the left ventricle

Compliance : Ability of the arteries to contract and expand.

Cardiac output: the volume of the blood pumped in the arteries = SV X HR.

Factors affecting the pulse

Age

Gender

Exercise

Fever

Medications

Hypovolemia

Stress

Position changes

Pathology

PERIPHERAL PULSE

APICAL PULSE

-infants and children up to 3 years of age

-used once there is discrepancies with radial pulse

-in conjunction w some medications such as Digoxin.

Pulse sitesTemporal-when radial not accessibleCarotid-cardiac arrest, circulation to the brainApicalBrachial-Bp, cardiac arrest in infantsRadial- most common and accessibleFemoral-cardiac arrest, infant and children, POVDPopliteal, POVD, Posterior tibial, Foot circulationPedal (dorsalis pedis), foot circulation

Arteries in the arm – Brachial– Ulnar– Radial

Arteries in the leg– Femoral– Popliteal– Posterior tibial

– Dorsalis Pedis

Arteries in the arm – Brachial– Ulnar– Radial

Arteries in the leg– Femoral– Popliteal– Posterior tibial

– Dorsalis Pedis

Peripheral blood vesselsPeripheral blood vessels

Assessing pulse

Palpation (60 sec.)

Middle three fingers

Using stethoscope

Doppler ultrasound

Moderate pressure

Aware of (medications, activity, position)

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 pulse

Rate : tachycardia (100B/m), bradycardia (60B/m)

Rhythm : dysrhythmia, arrhythmia (ECG)

Volume : full bounding, weak, feeble, thready

elasticity : straight, smooth, soft, pliable

Pulse deficit : any discrepancy b/w apical-radial pulses.

Assessing Peripheral temperatureAssessing Peripheral temperature

Assessing Peripheral pulsesAssessing Peripheral pulses

Assessing Peripheral pulsesAssessing Peripheral pulses

Assessing Peripheral pulsesAssessing Peripheral pulses

Assessing Peripheral pulsesAssessing Peripheral pulses

Assessing Peripheral pulsesAssessing Peripheral pulses

Nursing Dx.

Ineffective peripheral tissue perfusion r/to…..