Pulse 1 Pulse Is a blood wave created

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Pulse 1

Pulse 1

Pulse Is a blood wave created by contraction of the left ventricle of the

Pulse Is a blood wave created by contraction of the left ventricle of the heart n It represents the stroke volume output. n Compliance : Ability of the arteries to contract and expand. n Cardiac output: the volume of the blood pumped in the arteries = SV X HR. n 2

Pulse n PERIPHERAL PULSE n APICAL PULSE 3

Pulse n PERIPHERAL PULSE n APICAL PULSE 3

Factors affecting the pulse n n n n n Age: ↓ with age Gender:

Factors affecting the pulse n n n n n Age: ↓ with age Gender: after puberty male slightly < than female. Exercise: ↑ with exercise Fever: ↑ with fever Medications: e. g ↑ with epinephrine and ↓ with digitalis. Hypovolemia: ↑ with blood loss Stress: ↑ with stress Position changes: sitting or standing → pooling of blood in dependent vessels → ↓BP & ↑ HR. Pathology 4

Pulse sites Radial Readily accessible Temporal When radial pulse is not accessible Carotid During

Pulse sites Radial Readily accessible Temporal When radial pulse is not accessible Carotid During cardiac arrest/shock in adults Determine circulation to the brain Apical Infants and children up to 3 years of age Discrepancies with radial pulse Monitor some medications 5

Pulse sites Brachial Blood pressure Cardiac arrest in infants Femoral Cardiac arrest/shock Circulation to

Pulse sites Brachial Blood pressure Cardiac arrest in infants Femoral Cardiac arrest/shock Circulation to a leg; Popliteal Circulation to lower leg Posterior tibial Circulation to the foot Dorsalis pedis Circulation to the foot 6

Figure 29 -12 Nine sites for assessing pulse. 7

Figure 29 -12 Nine sites for assessing pulse. 7

Assessing pulse Palpation (60 sec. ) n Middle three fingers n Using stethoscope n

Assessing pulse Palpation (60 sec. ) n Middle three fingers n Using stethoscope n Doppler ultrasound n Moderate pressure n Aware of (medications, activity, position) n 8

Assessing pulse n n n Rate : tachycardia (>100 B/m), bradycardia (< 60 B/m)

Assessing pulse n n n Rate : tachycardia (>100 B/m), bradycardia (< 60 B/m) Rhythm : Equality of beats and intervals between beats. dysrhythmia, arrhythmia (ECG) Volume (strength or amplitude) : full or bounding, weak, feeble, thready (Normal: felt with moderate pressure). Elasticity: should be straight, smooth, soft, pliable Pulse deficit : any discrepancy b/w apical-radial pulses. 9

Assessing Apical pulse n n n Explain procedure Privacy Supine, or sitting position Point

Assessing Apical pulse n n n Explain procedure Privacy Supine, or sitting position Point of maximal impulse (PMI) 5 th. Intercostal space MCL. Clean ear piece and diaphragm by antiseptic gel n n Warm diaphragm before use Assess for “lub-dub”

Assessing Peripheral pulses

Assessing Peripheral pulses

Assessing Peripheral pulses

Assessing Peripheral pulses

Assessing Peripheral pulses

Assessing Peripheral pulses

Nursing Diagnosis n Ineffective Cerebral Tissue Perfusion related to cerebral ischemia 14

Nursing Diagnosis n Ineffective Cerebral Tissue Perfusion related to cerebral ischemia 14