Lab 4 - Pulse and Blood Pressure Flashcards
Describe the scale for measuring pulse
Name and identify the 8 areas of the body to palpate pulse
What is resting heart rate for infant
over 160
What is resting heart rate for child
70-120
What is resting heart rate for adult
60-100
Tachycardia
Abnormally fast heart rate
Bradycardia
Abnormally slow heart rate
When assessing heart rate, name 2 reasons you might want to palpate longer than 30 seconds?
- To check rhythm if abnormal
- When starting off as student and want to increase accuracy
- White coat syndrome/anxiety
When assessing heart rate, name 3 reasons you might want to palpate shorter than 30 seconds?
- Emergency situations
- Uncomfortable position
- Chronic pain
Why could it be unsafe to palpate both carotid pulses simultaneously?
Because it will block blood flow to the brain
Under what circumstances would you choose to assess a patients femoral pulse?
- To determine if blood is flowing to lower extremities
- No access/weakness of other pulses as femoral is a very strong pulse
A patient is 66 years old with MS and frequently falls. Their heart rate is 88bpm with a regular rhythm, should you be concerned?
No
What are the 4 classifications of blood pressure and their average SBP and DBP?
9 steps for measuring blood pressure
- Seated with back support, feet on floor, arm supported at heart level (supine and standing may occur sometimes)
- Use appropriate cuff size (the bladder needs to circulate 80% of arm)
- Wrap cuff on upper arm 2.5 cm above antecubital crease aligned with brachial artery
- Determine how high to inflate by palpating radial pulse until there is no longer a pulse. Deflate and let patient rest 1 minute.
- Place stethoscope over brachial artery
- Reinflate cuff 30-44 mmHg greater than palpatory occlusion pressure
- Slowly deflate cuff at 2-3 mmHg per second
- Once hear Kortikoffs = SBP
- When sounds disappear = DBP
**Recommended to repeat steps 1 more time and average them both for better accuracy of BP
Hypotension
Low blood pressure
Hypertension
High blood pressure
Is low blood pressure a contraindication to exercise?
It depends:
1. If low blood pressure and asymptomatic you may exercise
2. If low blood pressure and symptomatic (dizziness, light headed) you should not exercise
Orthostatic Hypotension
Associated with prolonged immobility (eg. Bed rest) when an individual is moved into an upright position causing a decrease in blood pressure. Positional change causes gravitational pooling in lower extremities. Can cause dizziness, loss of consciousness or light-headedness. Use external pressure supports like abdominal bindings, full-length stockings, and gradual acclimation to upright postures.
how to test for orthostatic hypertension
Take HR and BP in supine for 5 minutes, then have patient stand and take HR and BP for 3 minutes. IF SBP drops more than 20 mmHg or DBP drops more than 10 mmHg then they have orthostatic hypertension.
What conditions cause orthostatic hypertension
Any illness that results in bed rest, dehydration, pregnancy, medications, autonomic dysfunctions
When might you assess BP in supine?
When bed ridden, chronic pain, whatever is most comfortable
When might you assess BP standing
Snapshot during exercise, orthostatic hypertension, most comfortable
What conditions would contraindicate taking blood pressure of a specific limb?
- Amputation
- Diabetics
- Casting
- Injuries
- Lymphedema (breast removal)
- Dialysis
What are some potential sources of error when assessing blood pressure
- White coat syndrome/anxiety
- Reading values themselves
- Arm/leg positions
- Misalignment of cuff
- Wrong size of cuff
You are working on an exercise with 44-year old female hockey player. Her BP is 122/84 mmHg. What would be considered a normal or expected BP response to exercise while practicing moderate skating drills?
Systolic will increase (greater the exercise the greater the increase), and diastolic remains the same
Review information about the stethoscope
Build SOAP notes for this case:
Just finished assessing resting BP and HR of a 68-year old male presented to outpatient clinic with complaints of dizziness when moving from supine to sitting to standing upon waking up in the morning. Your findings are BP: 118/76 mmHg; HR 64 bpm.
S: 68 year old male, presented with dizziness when going from supine to sitting to standing
O: BP 118/26, HR 64BPM taken at heart level when sitting
A: Suspected orthostatic hypertension, but further tests will have to be performed to determine.
P: Test for orthostatic hypertension by testing BP when going from supine to sitting to standing. If present, educate patient on the importance of gradually getting up slowly and taking a 1 minute break in between each position when going from supine to sitting to standing to ease symptoms. Refer to a general practitioner.
Stroke Volume
Strength of pulse
Peripheral Pulse
Pulse located on periphery of body
Apical Pulse
Pulse located centrally on apex of heart
Palpitation
Sensation of rapid or irregular HR
Arrythmia/Dysrhythmia
Irregular rhythm in which pulses are not evenly spaced
Vasomotor Centre
Found in the lower pons and upper medulla that regulates blood pressure
Blood pressure is a function of 2 elements:
1) Cardiac output
2) Peripheral Resistance
Pulse Pressure
The mathematical difference between the systolic and diastolic pressures (eg. 119/79 means pulse pressure is 40 mmHg)
9 Factors that influence blood pressure:
1) Blood Volume: amount of circulating blood in body
2) Diameter and Elasticity of Arteries: Vasoconstriction vs vasodilation
3) Cardiac Output: eg. Increased cardiac output = increased blood pressure
4) Age: Refer to vital sign table
5) Exercise: Physical activity increases cardiac output (mainly increases systolic blood pressure and diastolic blood pressure does not chage
6) Valsalva Maneuver: Exhaling forcibly causing a drop in blood pressure, then as breath is released it causes a rise in blood pressure and heart rate, which overall because of overshooting when venous return can cause a permanent elevated heart rate (eg. When lifting heavy and breath out to stabilize core)
7) Orthostatic Hypotension: Associated with prolonged immobility (eg. Bed rest) when an individual is moved into an upright position causing a decrease in blood pressure. Positional change causes gravitational pooling in lower extremities. Can cause dizziness, loss of consciousness or light-headedness. Use external pressure supports like abdominal bindings, full-length stockings, and gradual acclimation to upright postures.
○ Diagnosis: Take HR and BP in supine for 5 minutes, then have patient stand and take HR and BP for 3 minutes. IF SBP drops more than 20 mmHg or DBP drops more than 10 mmHg then they have orthostatic hypertension.
8) Arm Position: Arm should be horizontal at heart level
9) Risk Factors: Many factors such as obesity, pregnancy and drug or alcohol consumption can affect BP
Name the 8 pulses and identify their location that we would take them?
What is the scale used to measure pulse
Create the SOAP note
