Lab 4 - Pulse and Blood Pressure

Question 1

Describe the scale for measuring pulse

Answer 1

Question 2

Name and identify the 8 areas of the body to palpate pulse

Answer 2

Question 3

What is resting heart rate for infant

Answer 3

over 160

Question 4

What is resting heart rate for child

Answer 4

70-120

Question 5

What is resting heart rate for adult

Answer 5

60-100

Question 6

Tachycardia

Answer 6

Abnormally fast heart rate

Question 7

Bradycardia

Answer 7

Abnormally slow heart rate

Question 8

When assessing heart rate, name 2 reasons you might want to palpate longer than 30 seconds?

Answer 8

1. To check rhythm if abnormal
2. When starting off as student and want to increase accuracy
3. White coat syndrome/anxiety

Question 9

When assessing heart rate, name 3 reasons you might want to palpate shorter than 30 seconds?

Answer 9

1. Emergency situations
2. Uncomfortable position
3. Chronic pain

Question 10

Why could it be unsafe to palpate both carotid pulses simultaneously?

Answer 10

Because it will block blood flow to the brain

Question 11

Under what circumstances would you choose to assess a patients femoral pulse?

Answer 11

1. To determine if blood is flowing to lower extremities
2. No access/weakness of other pulses as femoral is a very strong pulse

Question 12

A patient is 66 years old with MS and frequently falls. Their heart rate is 88bpm with a regular rhythm, should you be concerned?

Answer 12

No

Question 13

What are the 4 classifications of blood pressure and their average SBP and DBP?

Answer 13

Question 14

9 steps for measuring blood pressure

Answer 14

1. Seated with back support, feet on floor, arm supported at heart level (supine and standing may occur sometimes)
2. Use appropriate cuff size (the bladder needs to circulate 80% of arm)
3. Wrap cuff on upper arm 2.5 cm above antecubital crease aligned with brachial artery
4. Determine how high to inflate by palpating radial pulse until there is no longer a pulse. Deflate and let patient rest 1 minute.
5. Place stethoscope over brachial artery
6. Reinflate cuff 30-44 mmHg greater than palpatory occlusion pressure
7. Slowly deflate cuff at 2-3 mmHg per second
8. Once hear Kortikoffs = SBP
9. When sounds disappear = DBP
   **Recommended to repeat steps 1 more time and average them both for better accuracy of BP

Question 15

Hypotension

Answer 15

Low blood pressure

Question 16

Hypertension

Answer 16

High blood pressure

Question 17

Is low blood pressure a contraindication to exercise?

Answer 17

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

Question 18

Orthostatic Hypotension

Answer 18

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.

Question 19

how to test for orthostatic hypertension

Answer 19

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.

Question 20

What conditions cause orthostatic hypertension

Answer 20

Any illness that results in bed rest, dehydration, pregnancy, medications, autonomic dysfunctions

Question 21

When might you assess BP in supine?

Answer 21

When bed ridden, chronic pain, whatever is most comfortable

Question 22

When might you assess BP standing

Answer 22

Snapshot during exercise, orthostatic hypertension, most comfortable

Question 23

What conditions would contraindicate taking blood pressure of a specific limb?

Answer 23

1. Amputation
2. Diabetics
3. Casting
4. Injuries
5. Lymphedema (breast removal)
6. Dialysis

Question 24

What are some potential sources of error when assessing blood pressure

Answer 24

1. White coat syndrome/anxiety
2. Reading values themselves
3. Arm/leg positions
4. Misalignment of cuff
5. Wrong size of cuff

Question 25

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?

Answer 25

Systolic will increase (greater the exercise the greater the increase), and diastolic remains the same

Question 26

Review information about the stethoscope

Answer 26

Question 27

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.

Answer 27

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.

Question 28

Stroke Volume

Answer 28

Strength of pulse

Question 29

Peripheral Pulse

Answer 29

Pulse located on periphery of body

Question 30

Apical Pulse

Answer 30

Pulse located centrally on apex of heart

Question 31

Palpitation

Answer 31

Sensation of rapid or irregular HR

Question 32

Arrythmia/Dysrhythmia

Answer 32

Irregular rhythm in which pulses are not evenly spaced

Question 33

Vasomotor Centre

Answer 33

Found in the lower pons and upper medulla that regulates blood pressure

Question 34

Blood pressure is a function of 2 elements:

Answer 34

1) Cardiac output
2) Peripheral Resistance

Question 35

Pulse Pressure

Answer 35

The mathematical difference between the systolic and diastolic pressures (eg. 119/79 means pulse pressure is 40 mmHg)

Question 36

9 Factors that influence blood pressure:

Answer 36

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

Question 37

Name the 8 pulses and identify their location that we would take them?

Answer 37

Question 38

What is the scale used to measure pulse

Answer 38

Question 39

Create the SOAP note

Answer 39