2. Vital Signs Pulse

3. What is the Pulse? A blood wave created by contraction of the left ventricle

4. Compliance : Ability of the arteries to contract and expand. Cardiac output: the volume of the blood pumped in the arteries = SV X HR.

5. Factors affecting the pulse AgeGenderExerciseFeverMedicationsHypovolemiaStress Position changes Pathology

6. PERIPHERAL PULSE APICAL PULSE -infants and children up to 3 years of age -used once there is discrepancies with radial pulse -in conjunction w some medications such as Digoxin.

7. Pulse sites Temporal-when radial not accessible Carotid-cardiac arrest, circulation to the brain Apical Brachial-Bp, cardiac arrest in infants Radial- most common and accessible Femoral-cardiac arrest, infant and children, POVD Popliteal, POVD, Posterior tibial, Foot circulation Pedal (dorsalis pedis), foot circulation

8.  Arteries in the arm –Brachial –Ulnar –Radial  Arteries in the leg –Femoral – Popliteal –Posterior tibial –Dorsalis Pedis  Arteries in the arm –Brachial –Ulnar –Radial  Arteries in the leg –Femoral – Popliteal –Posterior tibial –Dorsalis Pedis Peripheral blood vessels

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

10. Assessing Apical pulse 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 Warm diaphragm before use Assess for “lub-dub”

11. Assessing pulse Rate : tachycardia (100B/m), bradycardia (60B/m) Rhythm : dysrhythmia, arrhythmia (ECG) Volume : full bounding, weak, feeble, thready elasticity : straight, smooth, soft, pliable elasticity : straight, smooth, soft, pliable Pulse deficit : any discrepancy b/w apical- radial pulses.

12. Assessing Peripheral temperature

13. Assessing Peripheral pulses

18. Nursing Dx. Ineffective peripheral tissue perfusion r/to…..