VITAL SIGNS
Part two
Les 4-5
Msc.lech.sadiq A.taiae
The Pulse
The pulse is a wave of blood created by contraction of the left ventricle of
the heart.
A peripheral pulse is a pulse located away from the heart, for example, in
the foot or wrist.
The apical pulse, in contrast, is a central pulse; that is, it is located at the
apex of the heart. It is also referred to as the point of maximal impulse
(PMI).
Normal Pulse Rate
The normal pulse rate for
adolescents and adults ranges
from 60 to 100 beats/min. The
pulse rate increases and
decreases in response to a
variety of physiologic
mechanisms.
Factors Affecting the Pulse
1.Age 5.certain medications
6. hypovolemia/dehydration
2.Sex
7.Stress
3.Exercise
8.position changes
4.presence of fever
9. pathology
Pulse Sites
Assessing the Pulse
A pulse is commonly assessed by palpating (feeling) the peripheral
arteries using the middle three fingertips, and using the stethoscope for
auscultating (hearing) apical pulse .
When assessing the pulse, the nurse collects thefollowing
data:
1. The rate
2. Rhythm
3. Volume
4. arterial wall elasticity
5. presence or absence of bilateral equality.
The rate
• An excessively fast heart rate (e.g., over 100 beats/min in an adult) is
referred to as tachycardia.
• A heart rate in an adult of less than 60 beats/minis called bradycardia.
Pulse rhythm
• Pulse rhythm is the pattern of the intervals between the beats normally be
regular.
• A pulse with an irregular rhythm is referred to as a dysrhythmia or
arrhythmia.
Pulse volume,
also called the
pulse strength or
amplitude, refers
to the force of
blood with each
beat.
The elasticity of the arterial wall reflects its expansibility or its
deformities. A healthy, normal artery feels straight, smooth,
soft, and pliable.
Presence or absence of bilateral equality
When assessing a peripheral pulse to determine the
adequacy of blood flow to a particular area of the body
(perfusion), the nurse should also assess the corresponding
pulse on the other side of the body.
Respirations
Respiration involves ventilation, diffusion, and perfusion.
• Ventilation (or breathing): is movement of gases in and out of the lungs.
• Inspiration (or inhalation): is the act of breathing in.
• Expiration (or exhalation): is the act of breathing out.
• Diffusion: is the exchange of oxygen and carbon dioxide
between the alveoli of the lungs and the circulating blood.
• Perfusion: is the exchange of oxygen and carbon dioxide between the
circulating blood and tissue cells.
Mechanics and Regulation of Breathing
Respiration is controlled by:
(a)respiratory centers in the medulla oblongata and the
pons of the brain
(b)chemoreceptors located centrally in the medulla and peripherally in
the carotid and aortic bodies.
These centers and receptors respond to changes in the concentrations
of oxygen (O2), carbon dioxide (CO2), and hydrogen (H+) in the
arterial blood.
Factors affecting respirations
These factors include
• Exercise
• respiratory and cardiovascular disease
• alterations in fluid, electrolyte, and acid–base
balances
• Medications
• Trauma
• Infection
• pain
• emotions.
Assessing Respirations
The nurse assesses:
• Respiratory rate (breaths per minute)
• Depth (deep or shallow)
• Rhythm (regular or irregular)
by inspection (observing and listening) or by
listening with the stethoscope.
• Normal respiratory rate in healthy adult is about 12 to 20
breath per minute.
• Breathing that is normal in rate and depthis called
eupnea.
• Abnormally slow respirations are referred to as bradypnea.
• Abnormally fast respirations are called tachypnea.
• Apnea is the absence of breathing.
Blood pressure
Arterial blood pressure is a measure of the pressure exerted by the blood as
it flows through the arteries.
There are two blood pressure measurements.
• Systolic pressure is the highest pressure of the blood
resulting from contraction of the ventricles.
• Diastolic pressure is the lowest pressure present on arterial walls
occur during the heart rests between beats during diastole.
Determinants of Blood Pressure
1. Pumping action of the heart
When the pumping action of the heart is weak, less blood is
pumped into arteries (lower cardiac output), and the blood
pressure decreases.
2. Peripheral vascular resistance
As the peripheral resistance increases and flow decreases.
blood pressure increases,
3.Blood volume
When the blood volume decreases (for example, as a result
of a hemorrhage or dehydration), the blood pressure
decreases because of decreased fluid in the arteries.
4.Blood viscosity
Blood pressure is higher when the blood is highly viscous.
Factorsthe blood pressure including:
• Age • Medications
• Exercise • Obesity
• Stress • diurnal variations
• medical conditions
•Race
• temperature
• Sex
Normal blood pressure
Blood pressure is measured in millimeters of mercury (mm
Hg) and is recorded as a fraction. The numerator is the
systolic pressure; the denominator is the diastolic pressure.
The normal blood pressure is 120/80 mm Hg, 120 represents
the systolic pressure, and 80 represents the diastolic
pressure. The pulse pressure, in this case, is 40 mm Hg.
Classification of Blood Pressure
Hypertension is a blood pressure that is consistently
higher than normal.
• Hypotension is a blood pressure below the normal.
• Orthostatic
hypotension (postural hypotension) is a drop
in blood pressure when stand up after lying or sitting
down.
Assessing Blood Pressure
Blood pressure is measured with a blood pressure cuff with
appropriate size, a sphygmomanometer, and a stethoscope.
• When taking a blood pressure from the arm using a
stethoscope, the nurse identifies phases in the series of
sounds called Korotkoff’s sounds.
• Five phases occur but may not always be audible .
• The systolic pressure is the point where the first tapping
sound is heard (phase 1).
•
• In adults, the diastolic pressure is the point where the
sounds become inaudible (phase 5).
Korotkoff’s phases
Thank You For
Listening
