1. Pulse & Respiration
Unit III: Ch. 19

2. Pulse & Respiration p. 321
Counted together, first pulse, then respirations
Keep fingers on pulse while counting respirations
Tell pt you are taking her/his pulse and continue counting respirations after obtaining pulse – why?
Respirations are partly voluntary and if the pt knows they are counted, the breathing pattern is altered
Count both for a full minute!
Need 2nd hand on watch for this

3. Pulse p. 321
Pressure of blood against an artery wall when heart beats (pulse) and relaxes (no pulse)
Easier felt in arteries close to surface that can be pressed against a bone
Is the same in all arteries throughout body
Indication of how well the cardiovascular system works
Stethoscope p. 322
Used to listen to sounds inside body by intensifying sounds
Parts: see Figure 19-3 p (need to know)
ALWAYS clean earpieces, diaphragm, bell and tubing with alcohol or cavy wipes before and after use
Used for obtaining apical pulse, blood pressure, listening to heart, lungs, abdomen
See p. 324: Guidelines for using a stethoscope!
Inspect for damages
Clean, clean, clean
Always use directly against skin, not over clothing!

4. Radial pulse p. 322 Most commonly measured pulse
Measured at radial artery on wrist, count for 1 full minute
Pt arm should be in comfortable position, palm down, arm resting on flat surface
Use tips of your fingers, never thumb
Only used on conscious patients
Unconscious pt: carotid artery or apical pulse
See Figure for common pulse sites
Record as: beats per minute (bpm) ex. Pulse 85bpm R

5. Pulse rate/character p. 322
Procedure 37: counting radial pulse p. 323
Rate/speed: see Table 19.1 for normal pulse rates; need to know adult!!!!
Adult: 60-80
General: the smaller the body, the higher the pulse rate ex. Hummingbird 1000bpm
Bradycardia: unusually slow pulse rate; below 60 beats per minute (bpm)
Tachycardia: unusually fast pulse rate; over 100 bpm
Character:
Rhythm: regular or irregular (normal: regular)
Volume/fullness: weak, strong, thread
Always report any abnormalities to the nurse:
Bradycardia
Tachycardia
Irregular pulse
Threaddy/ weak pulse
Procedure 37: counting radial pulse p. 323

6. Influencing factors p. 322 Rate can be affected by: Disease Emotions
Age
Exercise
Elevated temp
Gender
Position
Physical training
Low temp
Drugs

7. Apical pulse p. 322
Measured by counting heart contractions using a stethoscope
Measured at the apex (tip) of the heart at left side of front of chest, for 1 full minute
Rate should be same as pulse
When documenting: write AP after the bpm ex. 80 bpm AP
Sound: lub/dub
Lub: contraction of ventricles pushing blood out
Dub: relaxation of ventricles when they fill back up with blood
Used when:
There is a pulse deficit (see next slide)
Before RN gives heart rate altering medicine
In children when rapid pulse rate is difficult to count at radial artery
Everyone 12 months or younger
Irregular radial pulse or uncertain of accuracy of radial pulse

8. Apical-radial pulse rate p. 324
Comparing apical and radial pulse rate
Should be the same
If heart contracts to weekly, can’t send enough blood through the arteries for pulse to be felt
One person takes apical pulse while other person takes radial pulse
see Procedure 38 p. 324
Difference between apical and radial pulse = pulse deficit; found in some forms of heart disease

9. How to record pulse:
ex. 76 beats per minute, regular, strong _____________/minute, ____________, _________________

10. Respirations p. 325 Function: supply O2, discard CO2
If ineffective: less O2 for body, too much CO2 in body
Cyanosis: bluish or dusky color of the skin
2 parts of respiration: Inspiration (inhalation), expiration (exhalation)
Breathing patterns:
Normal: regular; breaths per minute
Tachypnea: rapid, shallow
Shallow: breaths only fill lungs partially
Apnea: period of no respirations (ex. Sleep apnea)
Dyspnea: difficult or labored breathing
Cheyne-Stokes respiration: period of dyspnea followed by periods of apnea
Stertorous: snoring-like respirations
Rales (crackles): moist respirations; air has to bypass mucus / wet passage ways; common in dying pt
Wheezing: difficult breathing by whistling or sighing sound due to narrowing of bronchioles (ex. asthma)

11. What to look for p. 325 Check respirations for:
Rate: number of respirations per minute
Rhythm: should be regular/ even
Symmetry: chest should expand and retract equally
Volume: depth of respiration
Character: regular, irregular, shallow, deep, labored (difficult)
Normal: even, unlabored
Rate: see norms in Table 19-2 p. 326
Normal for adult: respirations per minute
Accelerated: over 25 respirations per minute
Too slow: under 12 per minute
Report: accelerated or too slow breathing (i.e. Over 25 or under 12)
Affected by:
Illness
Emotions
Elevated temp
Gender
Age
Exercise
Position
Drugs

12. How to measure p. 325 How to record: Procedure 39 p. 326
Continue counting respirations after pulse, without letting pt know you are counting respirations
Record rate, depth and regularity eg. 18 respirations per minute, unlabored, regular
How to record:
Ex breaths per minute, even, unlabored
_____________________/minute, ____________, _______________

13. Wash hands, get supplies (eg. Paper, pen, watch)
Introduce yourself by name, call pt by name, explain that you will measure her/his pulse, lock bed/WC if in bed or WC
Privacy curtain
Wash hands, get supplies (eg. Paper, pen, watch)
Wash hands before touching pt
Position pt’s arm comfortably, palm down
Position your fingertips on radial artery
Use 2nd hand on watch, say start, count pulse for 1 full minute (remember number), say stop
Immediately, count respirations for 1 full minute, say stop
Call bell in reach? Pt feels ok or needs anything else?
Privacy curtain open
Wash hands
Record pulse and respirations as:
Pulse: ____________ beats per minute, regular, strong
Respirations: _______________breaths per minute, even, unlabored

14. Homework: Textbook: Read Unit 19 Workbook: p
Homework: Textbook: Read Unit 19 Workbook: p. 119 read Unit Summary, Nursing Assistant Alert; Vocabulary Exercise, True/False