Download Assessing Heart Rate and Blood Pressure

Assessing Heart Rate &
Blood Pressure
Your pulse represents arterial palpation of the heartbeat
using your fingertips. The pulse may be palpated in any
place that allows an artery to be compressed against a
bone:
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•
•
•
•
•
•
at the neck (carotid artery),
on the inside of the elbow (brachial artery),
at the wrist (radial artery),
at the groin (femoral artery),
behind the knee (popliteal artery),
near the ankle(posterior tibial artery),
on the foot (dorsalis pedis artery).
Pulse is equivalent to measuring the heart rate. The heart rate
can also be measured by listening to the heart beat directly
(auscultation), traditionally using a stethoscope and counting it
for a minute.
Normal Pulse Rates at Rest
The pulse rate can be used to check overall heart health and fitness level.
Generally lower is better, but bradycardia can be dangerous. Symptoms of a
dangerously slow heartbeat include weakness, loss of energy and fainting.
newborn
(0–3
months
old)
infants
(3 – 6
months)
infants
(6 – 12
months)
children
(1 – 10
years)
children
over 10
years
& adults,
including
seniors
100-150
90–120
80-120
70–130
60–100
well-trained
adult
athletes
40–60
Characterizing the Pulse
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•
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The strength of the pulse can be reported:
0 = Absent
1 = Barely palpable
2 = Easily palpable
3 = Full
4 = Aneurysmal or Bounding Pulse
Terms used to characterize
the pulse
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•
•
•
•
regular,
irregular,
thready,
bounding,
absent [peripherally and/or centrally])
Pulse Points
Practice taking a patient’s pulse
Using the following points:
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•
•
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•
Temporal artery
Carotid artery
Brachial artery
Radial artery
Popliteal artery
Posterior tibial artery
Characterize the pulse at each
point.
Apical Pulse
Heart Sounds
Heart Sounds
• LUB = Systole
– a force that drives blood out of the heart by
the contraction of the Left Ventricle
• DUB = end of Systole/beginning of
Diastole
– the period of time when the heart refills with
blood after systole
Sinus Rythym
• sinus rhythm is the normal
beating of the heart, as measured
by an electrocardiogram
• There are typically six distinct
waves (identified by the letters P,
Q, R, S, T, and U) in a single beat
of the heart in sinus rhythm,
representing the electrical activity
in a beating heart
Blood Pressure
• sometimes referred to as arterial blood
pressure, is
– the pressure exerted by circulating blood
upon the walls of blood vessels as a result of
muscular contractions of the heart
During each heartbeat, blood pressure
varies between a maximum (systolic) and a
minimum (diastolic) pressure
• Blood pressure varies in healthy people,
but its variation is under control by the
nervous and endocrine systems.
• Blood pressure that is unusually low is
called hypotension, and that which is
abnormally high is hypertension.
Classification of blood pressure for adults[4][5]
Category
systolic, mmHg
diastolic, mmHg
Hypotension
< 90
< 60
Desired
90–119
60–79
Prehypertension
120–139
80–89
Stage 1 Hypertension
140–159
90–99
Stage 2 Hypertension
160–179
100–109
Hypertensive Emergency
≥ 180
≥ 110
Reference ranges for blood pressure in children[19]
Stage
Approximate age
Systolic
Diastolic
Infants
1 to 12 months
75–100
50–70
Toddlers and
preschoolers
1 to 5 years
80–110
50–80
School age
6 to 12 years
85–120
50–80
Adolescents
13 to 18 years
95–140
60–90
Physiological Factors affecting BP
• Blood Volume – the amount of blood
present in the body
– The more blood present in the body, the
higher the rate of blood return to the heart and
the resulting cardiac output
• Resistance – blood vessels present some
resistance to the flow of blood
– Smaller, longer blood vessels offer more
resistance than larger, shorter vessels
• Viscosity – the thickness of blood
– Thicker blood will result in higher blood
pressures as the heart must work harder to
force the thicker, heavier fluid through
arteries, arterioles and capillaries
Stroke Volume
• The amount of blood expelled from the left
ventricle of the heart during a single
systolic contraction
Pulse Pressure
• Determined by the interaction of the stroke
volume of the heart, flexibility of the aortic
walls and resistance to blood flow in the
arteries.
– By expanding under pressure, the aorta absorbs
some of the force of the blood surge from the
heart. In this way, the pulse pressure is reduced
from what it would be if the aorta wasn't flexible.
– Pulse pressure is simply the difference between
systolic and diastolic pressures