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Circulation
NP 1, Unit 2 Circulation
| Question | Answer |
|---|---|
| Pulse | The rhythmic expansion of an artery. Produced when blood flow is forced into it by contraction of the heart. |
| T or F - you can both auscultate and palpate a pulse. | True. |
| Pulse rate | Number of contractions (beats) per minute. |
| Normal pulse rate | 60-100 beats per minute (BPM) |
| Why assess pulse? | Provides info about the cardiovascular system Establishes baseline to assess for changes. Assess for adequacy of blood flow Compare left and right extremity circulation |
| T or F - Whatever you do to one side, do to the other side | True. |
| Factors that affect pulse rate. | Elevates - Exercise, fever, pain, stress. Lowers - Old age. Can affect either way - medications, position changes, hypovolemia (blood loss - raises pulse then lowers), disease, environmental temperature. |
| Pulse sites | Central or Peripheral |
| Central pulse site | Central = Apical. Only one site, located at apex of heart. |
| Peripheral pulse sites | Where artery can be pressed against a bone. 8 sites. |
| When to assess apical pulse | When heart rate is irregular elsewhere With use of some cardiac drugs With children and infants When pulse deficit is noted With hard to palpate peripheral pulse. |
| How long should you listen for an apical pulse? | One full minute. |
| What are the peripheral pulse sites? | Temporal Carotid Brachial Radial Femoral Popliteal Posterior Tibial Dorsalis Pedis |
| Palpation of a peripheral pulse | Use tips of three middle fingers Apply moderate pressure over pulse site Count for 30 seconds and multiply by 2 to obtain bpm |
| Auscultation of peripheral pulses | Listening with doppler ultrasound stethoscope (DUS) Use for pulses difficult to palpate Use transmission gel. Hold probe against skin over pulse site Light pressure |
| T or F - It's normal for there to be a difference between the apical and radial pulse. | False. They are normally the same. If there is a difference, this is called a pulse deficit. |
| Pulse deficit | Apical > radial. Weak contraction of heart Vascular disease preventing transmission to radial area. |
| < 60 BPM | Bradycardia |
| > 100 BPM | Tachycardia |
| Dysrhythmia | Irregular rhythm of pulse |
| Characteristics of a pulse | Rate, Rhythm, Equality, Amplitude, Elasticity |
| Amplitude Scale | 0 = Absent 1 = Thready 2 = Normal 3 = Bounding Some hospitals use a scale that goes up to four, with both two and three being normal values. |
| Elasticity | Arterial wall - straight, smooth, soft, pliable. |
| Equality | Assess both sides, should be equal ("bilaterally equal") |
| Blood pressure | The pressure of the blood as it is forced against artery walls during cardiac contraction. |
| What measurement is used for blood pressure? | Millimeters of mercury, or mm/Hg |
| What is the importance of blood pressure? | Important indicator of cardiac health. |
| Physiological influences on blood pressure | Cardiac function Peripheral resistance Blood volume |
| How does blood volume influence blood pressure? | Higher volume = higher BP, lower volume = lower BP |
| Systolic pressure | Peak pressure as ventricle contracts Normal up to 120 mmHg |
| Diastolic pressure | Minimum pressure exerted against arterial walls when heart is at rest Normal up to 80 mmHg |
| Pulse pressure | Difference between systolic and diastolic pressures. Should be no more than 40 - 45. |
| What factors affect blood pressure? | Elevate - Exercise, Stress, Obesity, Smoking, Alcohol Race - African Americans tend to have higher BP. Gender - Men tend to have higher BP Can raise or lower - medications, disease process, diurnal variations (lower in AM, higher in PM) Lower |
| Hypertension | Blood pressure persistently above normal Diastolic > 90 mmHg Systolic > 140 mmHg |
| T or F Hypertension is usually asymptomatic. | True. |
| T or F Hypertension is not a major cause of disease and death in the US. | False. |
| Hypotension | Systolic < 100 mmHg Usually not a problem. Problematic if: patient is symptomatic, suddent onset. |
| Orthostatic hypotension | BP falls from lying to sitting or standing. Wait one minute between position changes. Positive if HR increases by 15 - 30 BPM OR BP drops 20 mmHg systolic or 10 mmHg diastolic |
| Orthostatic set | BP while lying down Wait one minute BP while sitting on side of bed Wait one minute BP while standing |
| Equipment needed to assess blood pressure | Stethoscope BP cuff Sphygmomanometer Electronic monitor |
| Cuff size too narrow | inaccurately high reading |
| Cuff size too wide | inaccurately low reading |
| Proper cuff size | Width of bladder covers 2/3 of length of the upper arm. Length of bladder encircles 80 - 100% of arm. |
| Blood pressure sites | Arm (Brachial Artery)- Most common Thigh - popliteal artery |
| When is BP taken in thigh? | Arm injury, removal of lymph nodes, IV infusion, A-V fistula |
| Palpating blood pressure - steps | Cuff on upper arm 1" above antecubital space. Palpate brachial pulse. Inflate cuff until you NO LONGER feel pulse, note reading. Inflate another 30 mmHg Release pressure slowly Where pulse reappears - systolic BP |
| Auscultating Blood Pressure - Steps | Position stethoscope over brachial pulse. Inflate 30 mmHg higher than palpated reading. Release valve slowly, 2-3 mm per second. Listen for "tapping" First clear sound is systolic Disappearance of sound is diastolic |
| Korotkoff Sounds | The sounds of blood pulsating through arteries. |
| When should pulse and blood pressure be taken? | As scheduled in care plan Before/After ambulating Upon admission Any change in health status Pt. reports symptoms Before/after surgery or invasive procedure Before/after intervention/medication |
| Before taking a patient's temperature, what should you ask? | "Have you had any hot or cold fluids in last 15- 30 mins? Have you smoked a cigarette?" |
Created by:
christyness
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