LECTURE 4 (Pulse measurement)

Question 1

What is the Pulse?

Answer 1

A pressure wave that is transmitted through the arterial tree with each heart beat following the alternating expansion and recoil of arteries during each cardiac cycle

Question 2

Where is the Pulse strongest?

Answer 2

In arteries closer to the heart

Explanation: It becomes weaker in the arterioles and disappears in the capillaries altogether

Question 3

Where are the clinically important arterial pulse points?

Answer 3

• Carotid
• Brachial
• Radial
• Ulnar
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis

Question 4

The pulse is palpated to note what?

Answer 4

• Rate
• Rhythm
• Amplitude

Question 5

The arterial pulse is measured to assess what?

Answer 5

• Effects of activity
• Postural changes
• Emotions on heart rate
• Effects of disease
• Treatments & Response to therapy

Question 6

Explain the physiology of heart beats

Answer 6

Each time the heart beats, it pushes blood through the arteries -> Pumping action causes walls of arteries to EXPAND and DISTEND -> Causes a wave-like sensation which can be felt as the pulse

Question 7

What are some factors that could act on heart rate?

Answer 7

• Age
• Sex
• Exercise
• Body temperature
• Hormones
• Electrolytes
• Activation of sympathetic and parasympathetic nervous system

Question 8

What is Tachycardia?

Answer 8

Abnormally fast heart rate over 100 bpm in adults

Question 9

What is Bradycardia?

Answer 9

Heart rate slower than 60 bpm

Question 10

When is Bradycardia considered normal?

Answer 10

In fit athletes

Question 11

When is Bradycardia considered abnormal?

Answer 11

• Normal individuals -> result in inadequate blood circulation to body tissues
• Warning of brain oedema after head trauma -> indication of raised intracranial pressure

Question 12

What is the Sinoatrial node?

Answer 12

The pacemaker initiating each wave of contraction and sets the rhythm of the heart as a whole. Characteristic rhythm is called SINUS RHYTHM

Question 13

What do defects in the conduction system of the heart cause?

Answer 13

Irregular rhythms/Arrythmias

[results in uncoordinated contraction of the heart]

Question 14

What is Fibrillation?

Answer 14

Rapid and irregular contractions of heart muscle

[A fibrillating heart is ineffective as a pump]

Question 15

What is Atrial Fibrillation?

Answer 15

A disruption of rhythm in the atrial areas of the heart occurring at extremely rapid and uncoordinated levels -> Rapid impulses result in the ventricles not being able to respond to every atrial beat -> Ventricles contract irregularly

Question 16

What is Ventricular Fibrillation?

Answer 16

Irregular heart rhythm characterised by chaotic contraction of the ventricles at very rapid rates

Question 17

What are the most common causes of Fibrillation?

Answer 17

• Ischaemic heart disease
• Acute illness
• Electrolyte disbalance
• Thyrotoxicosis

Question 18

What is distinguishable about Atrial Fibrillation?

Answer 18

Impulses are not generated by the SA node by from different locations of the atria -> Chaotic atrial fibrillating impulses

Question 19

What is Amplitude?

Answer 19

Reflection of pulse strength and the elasticity of the arterial wall

[varies because of the alternating strong and weak ventricular contractions]

Question 20

What is a Paradoxical pulse?

Answer 20

A pulse that markedly decreases in amplitude during inspiration

[usually normal but with HYPOTENSION and DYSPNEA -> indicates life-threatening conditions]

Question 21

What do you do is there is a gross pulse irregularity?

Answer 21

One nurse should use diaphragm of stethoscope to assess APICAL HEARTBEAT and a second should count the RADIAL PULSE at the same time -> Compare results

Question 22

What are the indications for Pulse measurement?

Answer 22

• Post-op & Critically ill (cardiovascular stability)
• Blood transfusions
  (incompatible blood transfusion may lead to a rise in pulse rate early into transfusion)
• Patients with local or systemic infections/inflammatory reactions
• Patients with cardiovascular conditions

Question 23

What do you do if no pulse is palpable?

Answer 23

Incorrect positioning of fingers -> Find palpation sites

Question 24

What do you do if absent or faint pulse?

Answer 24

• Poor perfusion -> Assess patient’s existing co-morbidities -> identify causes of hypovalemia
• Perform neuromuscular assessment on pulse sites -> feel for warmth, sensation & capillary refill
• Perform VTE assessment

Question 25

What do you do if the pulse is too fast and irregular to palpate manually?

Answer 25

• Patient may have an abnormal rhythm -> use electronic recording device
• Haemodynamic assessment
• Monitoring and maintenance of electrolyte imbalance