1. Pulse and Blood Pressure
Essentials of Healthcare

2. Pulse
The pressure of the blood felt against the wall of an artery as the heart beats
Felt most easily in arteries, especially those that can be gently pressed against a bone
The pulse lets us know how the cardiovascular system is meeting the body’s needs

3. Pulse
Radial pulse is most commonly used and is found in the inner aspect of the wrist
You must note 3 things when checking a pulse
Rate or speed
Rhythm (regular or irregular)
Volume (strong, weak, thready, bounding)
You must record date and time pulse was taken in addition to the above findings

4. Pulse Pulse rate is measured as the number of beats per minute
Counted for one full minute and recorded as a number
Followed by the abbreviation bpm (beats per minute)
Varies by individual
age, sex, body size and illness

5. Pulse Normal Ranges You must report Adult 60-80 Children 7+ 70-100
Infants
You must report
Tachycardia (over 100 beats per minute)
Bradycardia (below 60 beats per minute)
Irregularities in rhythm or volume

6. Pulse May be affected by many things illness Emotions Age Exercise
Elevated temperature
Drugs
position

7. Apical Pulse Measured by counting the heart contractions
Left side of chest
Between 5/6 ribs
Just below left nipple
Under left breast in
a female
Listen for lub dub…
The sound you hear are the heart valves opening and closing

8. Apical Pulse Always count for one full minute
Who needs an apical pulse checked?
Whenever pulse deficits exists or is suspected
Before meds that change heart rate or rhythm
On any child 12 months or younger
Can be hard to feel/count a faster pulse
Whenever radial pulse if irregular or if you are uncertain of the accuracy of the radial pulse
On any child in which it is difficult to get a radial pulse

9. Pulse Deficit
This occurs when the heart is too weak and does not pump enough blood to produce a pulse or when the heart beats too fast, not allowing the heart to fill with blood between beats.
The apical rate would be greater than the radial rate.
How do you check a pulse deficit?
One person checks apical rate while another checks radial rate. If the rates are different, a pulse deficit exists.

10. Blood Pressure Measures the force of blood against the artery walls
Blood pressure is measured in mmHg (millimeters of mercury)
Systole (systolic reading)-the force of blood against the artery walls during ventricular contraction-working pressure
Diastole (diastolic reading)-the constant pressure in the walls of the arteries-resting pressure

11. Blood Pressure What elevates the BP? Exercise Eating Stimulants
Stress, fear, anxiety
Arteriosclerosis, high cholesterol, diabetes
Pain
Obesity

12. Blood Pressure What lowers BP? Rest Depressants Weight loss Shock
Grief
Dehydrations
Diuretics

13. Blood Pressure What does the equipment look like? Stethoscope
Aneroid sphygmomanometer
Mercury sphygmomanometers
Electronic sphygmomanometers

14. Blood Pressure
Cuff is placed directly over the brachial artery (1 inch above the antecubital space)
Systolic pressure is the first regular sound you hear
Diastolic pressure will be the change or last sound you hear
Pulse pressure will give you information on the condition of the arteries in the body
The difference between the systolic and diastolic pressure

15. Blood Pressure Normal Ranges-recorded as a fraction
Average resting pressure120/80
Normal Systolic Pressure Range
Normal Diastolic Pressure Range60-90
Hypertension-pressure above 140/90
Hypotension-pressure below 100/60
The systolic and diastolic values should be looked at separately to determine normal

16. Blood Pressure Can you use any arm to check BP?
No. When would you not use an arm?
If it has an IV line or other device inserted
Is being treated for burn, fracture, etc
Has dialysis access device
Is on the same side as a recent mastectomy or other surgical procedure
If the arm is paralyzed, injured or has edema
If the arm has a pulse oximeter on it

17. Blood Pressure
Inaccurate or erroneous blood pressure readings are due to:
Wrong size cuff
Improperly wrapped cuff
Incorrect positioning of the arm
Not using the same arm each time
Not having the gauge at eye level
Deflating the cuff too slowly
Mistaking an auscultatory gap for the diastolic pressure

18. Blood Pressure Make sure the gauge is at eye level
It should not be tilted
The gauge
Each small line represents 2mm Hg
Each large line represents 10mm Hg

19. Blood Pressure What do I report? If you were unable to get the reading
If it is higher than a previous reading
If it is lower that a previous reading
If the site where the BP was taken was other than the brachial artery
The position of the patient (sitting, standing, lying down)

20. Position is important…
Orthostatic, or postural, hypotension occurs when there is a sudden drop in both systolic and diastolic pressures when an individual moves from a lying to a sitting or standing position
Your blood vessels can’t compensate quickly enough to the change in position
Dizziness, lightheadedness and blurred vision may happen
Patients may need orthostatic blood pressures taken to see if this condition is occurring
We do them lying, sitting then standing to determine if there is a drop

21. Blood Pressure Electronic blood pressure monitors are not for everyone
Do not use on those with:
Extreme hypertension or hypotension
Very rapid heart rates
Excessive body movements or tremors
Irregular heart rhythms or dysrhythmias

22. What now???
Practice measuring pulse and blood pressure following your check off sheets