S1_L5_Obj - 1-2 Flashcards
OBJECTIVE ASSESSMENT (3)
● Systems Review
● Physical examination
● Tests and Measures
rate at which the heart beats, or contracts (direct)
HR
number of times your arteries create a noticeable “pulse” due to increase
in blood pressure as a result of your heart contracting (indirect)
PR
Direct performance of the heart; rhythm
HR
Observing the peripheral arteries
PR
_ is essentially the HR for normal, healthy heart
PR
In CPR pts, There are discrepancies between the HR and the PR. t or.f
t
times when HR is higher than PR:
obstructions
normal PR:
60-100 bpm (resting value for adults)
for healthy pts, HR should be higher than PR t or f
f, equal lang dapat
> 100 bpm
Tachycardia
<60 bpm
bradycardia
<60 bpm for athletes/very active
individuals is considered bardycardia t or f
f
Irregular rate is called:
dysrhythmia
how to measure HR?
use of stethoscope, ECG recording
ECG leads are placed over the _ to get _ activity of the heart
chest, electrical
how to measure PR?
palpation of pulse, pulse oximeter/pulsemeter
Mobile phones cannot detect PR through sensors
(pulse meters) t or f
f, can detect
Pulse oximeter is placed in _
fingers
Pulse Strength / Amplitude Grading:
0, 1+, 2+, 3+, 4+
pulse strength: absent, not palpable
0
pulse strength: Bounding, too strong to obliterate
4+
pulse strength: Easily palpable, normal
2+
pulse strength: Full pulse, increased strength
3+
pulse strength: Pulse diminished, barely palpable; weak, thready
1+
2+ of brachial is different from 2+ of popliteal t or f
t
Having a _ experience is important for
establishing how to assess what the normal is.
baseline
Pulse sites for PR (8):
temporal
carotid
brachial
radial
femoral
popliteal
dorsalis pedis
posterior tibial
at the temple
temporal
found at the neck
carotid
found at the forearm
radial
found in the femoral triangle
femoral
difficult to palpate;
popliteal
deepest among the
others
popliteal
popliteal pulse is palplated in what position?
palpated in prone c flexed knee
popliteal pulse is found deep in the _
popliteal fossa
t or f dorsalis pedis is hard to palpate
f, easy to palpate
dorsalis pedis pulse is found where
dorsal aspect between 1st and 2nd metatarsal
found behind the medial malleolus
posterior tibial
Can be documented on either palpation of vital signs
but should be reflected only ONCE
PR
Assess each pulse for: (4)
strength
rate
rhythm
equality
check if weak or bounding
strength
check if normal rate, too fast or slow
rate
check for regularity or irregularity; skipped beats
rhythm
how to document rhythm?
80 bpm c 2 skipped beats
right versus left; should be equal
equality
Pts with vascular disorders, compare only one side t or f
f, Pts with vascular disorders, compare each side since there might be unilateral affectation
Apply gentle pressure for all pulse sites t or f
f, except for popliteal pulses
the more pressure you apply the more you will be able to feel it t or f
f, Less pressure you apply the more you will be able to feel it
If too hard = will obliterate the flow (push hard, feel less) t or f
t
If pulses are diminished, use the _ of the stethoscope,
listen for bruit
bell
Bell of the stethoscope is used for _
for low pitch sounds
Diaphragm is used for _
high pitch sounds
Full 60-second count is recommended for
cardiopulmonary patients vs 30-sec multiplied by 2 t or f
t
HEART RATE (HR) also callled as _
apical pulse
what is used to get the HR
Stethoscope
how to locate the HR?
Locate the site of the apical pulse
how to locate the apical pulse?
(~3.5 inches to the left of mid-sternum, in the 5th ICS, within an inch
of the midclavicular line drawn parallel to sternum)
Athletes; how to count their HR
15-second count multiplied by 4
Cardiovascular patients; how to count their HR
full 60-second count
may not be even (esp in CPR patients) hence it must
be compared simultaneously
Apical and radial pulse
Typically, apical pulses and radial pulses are the different t or f
f, Typically, apical pulses and radial pulses are the same
if Apical > Radial, what is it?
Blood pumped from left ventricle doesn’t reach the peripheral site or too weak
Every beat of heart, should go to _
pulse sites
pulse deficit is the difference betweeen _ and _
apical and radial
Procedures for apical-radial pulse
2 Examiners: 1 for apical (stethoscope), 1 for radial (palpation)
Count the pulse for 60 seconds
Compare results
apical radial pulse should be done simultaneously t or f
t
HOW TO Document?
O: VS > PR: Apical radial pulse = 2 bpm deficit
BP CLASSIFICATION
JNC 8
ACC/AHA 2017
JNC 8: Normal BP
<120/<80
JNC 8: Pre-Htn
120-129/<80
JNC 8: Pre-Htn
130-139/80-89
JNC 8: Stage 1 Htn
140-159/90-99
JNC 8: Stage 2 Htn
≥160/≥100
ACC/AHA: <120/<80
normal BP
ACC/AHA: 120-129/<80
elevated BP
ACC/AHA: 130-139/80-89
Stage 1 Htn
ACC/AHA: 140-159/90-99
Stage 2 Htn
ACC/AHA: ≥160/≥100
Stage 2 Htn
Only the systolic must be within normal values to be
considered as normal t or f
f, Both systolic AND diastolic must be within normal values
to be considered as normal
Hypertensive Crises (2)
Htn Urgency
Htn Emergency
> 180/>110; no acute end-organ damage
Htn Urgency
> 180/>110; c acute end-organ damage
Htn Emergency
Htn Emergency:
> 180/>110; c acute end-organ damage
Htn Urgency:
> 180/>110; no acute end-organ damage
Pt has past medical history of kidney disease: htn urgency or emergency?
htn emergency
end-organ damage examples
kidney failure, serious lung/heart problems
BP Measurements (2)
Home BP Monitoring
24 Hour Ambulatory BP Monitoring
Usual monitoring system we have; we get BP as necessary
Home BP Monitoring
BP cuff is attached to pts throughout the day
24 Hour Ambulatory BP Monitoring
the BP cuff in 24 hr ambulatory BP monitoring is removed during _
self-care activities
24 hour ambulatory BP monitoring is usually seen in _
in-pts / ICU
Prior to phase 1, the first sound that we hear is the _
SBP
Between phases _ & _, sound disappears, representing
the _
4, 5, DBP
t or f there is sound before the phase 1 in korotkoff sounds
f, only silence
phase 1 is known as the _
tapping sound
