Clinical Observations; Pulse, Respiration, Pulse Oximetry Flashcards
What is the pulse?
An impulse transmitted to arteries by contraction of the left ventricle. Usually palpated where an artery crosses a bone. Eg the radial artery
Why take a Pulse?
- Find beats per minute
- Determine strength of pulse
- Rythm/regularity of beats (arrhythmias)
- Elasticity of artery wall (more rigid with age)
- Determine colour and warmth of skin
Causes of bradycardia
being extremely fit, heart rhythm abnormalities, patient being asleep/over sedated, drugs, hypothyroidism
What bmp is classed as bradycardia
<60bmp
Causes of Tachycardia
pain, anxiety, hypovolaemia, dehydration, pyrexia, shock, drugs, hyperthyroidism
What bpm is classed as Tachycardia?
> 100bmp
Where is the Carotid Artery and what is it used for?
In the neck, used for basic life support for unresponsive patients
Where is the Brachial Artery and what is it used for?
In the upper arm, used for blood pressure
Were is the Radial Artery and what is it used for?
In the wrist, used for most pulse rates when patient is concious
Where are the Femoral and Ulnar artery + what are they used for?
Femoral - groin area used for basic life support
Ulnar - back of wrist, hard to find so not useful
Which three pulses are used for checking Leg injuries, where are they?
Popliteal (behind knee), Posterior Tibial (ankle), Dorsalis Pedis (foot)
Where is the Apical pulse and how to we find it?
Heart, only done with stethoscope
6 Steps to Taking a Pulse
- Patient should be at rest
- Explain you’ll be taking pulse
- Make patient comfortable
- Press gently the index and middle finger along artery
- Count for full 60 seconds
- Write down number before you forget it
What is the normal resting heart rates of Newborns and Infants?
Newborn (resting) 100-180 Infant (resting) 80-150
What is the normal resting heart rates of Child (2-6) and Child (6-12)
Child 2-6 75-120 Child 6-12 70-110
What is the normal resting heart rates of Adolescents, Adults and Athletes?
Adolescent 60-90 Adult 60-90 Athlete 50-100
When assessing respiration rate, what are you looking for?
- rate
- depth
- pattern/regularity
- effort
Why is taking a Respiration Rate Important?
Breathing is one of the first symptoms to change in patient deterioration. So, respiration rate should be taken at the start to see if there is any change.
Steps to taking a Respiration Rate
- Patient should be at rest
- If patient ‘alert’ count respiration rate while pretending to take pulse as to not alert them of their breathing pattern
- Count number of breaths taken in one minute using chest/shoulders/stomach moving to count
What does taking a pulse oximetry do?
Measures O2 Saturation of arterial blood. This provides a guide to O2 therapy.
What and where are the percentages of O2 found in the body?
97% of O2 in arterial blood is carries, attached to Haemoglobin (Hb) and 4% of O2 is dissolved in the plasma. Pulse oximetry only measures the 97%
How does a Pulse Oximeter Work?
- A pulse oximeter has 2 probes - 2LED’s (one red, one Infared)
- They transmit light to a photo detector on the opposite side
- Measures absorption of light wave lengths associated with oxygenated Hb
- A processor then calculates and tells you the O2 saturation in Sa/SpO2
How to Take a Reading of a Pulse Oximeter
- Clean/dry the equipment + patient’s finger
- Place probe as per diagram
- Wait a while (can do other observations while waiting)
- Reclean equipment
Reasons Why we get Inaccurate Readings on a Pulse Oximeter
- Weak pulse as good perfusion needed
- Low perfusion states eg hypothermia
- Carbon monoxide poison will give false positive result
- Shivering/Vibration eg bumpy road
- Bright light on Sensor
- Probe too tight/lose
- Cardiac Arrythmias
- Abnormal skin colourations
- Dirty sensors
- Nail Polish
Normal, Acceptable and Concern levels on Pulse Oximeter + COPD Patients level
Normal 97-99% Acceptable 95-96% Concern <95% -Patients with chronic respiratory diseases won’t have normal values so ask whatever their normal range is. BTS/JRCALC aim for 94-98%
