Vital sign , Bsc nursing 1st year .. Nursing foundation

2.  Alternate expansion & recoiling of an artery. Normal range of
pulse for an adult is 60-100 bpm.
 It can be felt on a point where an artery crosses a bone close
to the surface of skin.
 The pulse wave begins when the left ventricle contracts &
ends when it relaxes.
 Each contraction forces blood into already filled aorta,
increasing pressure within arterial system.

3.  The intermittent pressure & expansion of the arteries causes
the blood to move in a wave like motion towards the
capillaries.
 The stroke volume is the quantity of blood forced by each
contraction of the left ventricle which is about 70 ml.
 Cardiac output is the total quantity of blood pumped per
minute.
 Cardiac output= stroke volume x pulse rate.

5.  CHARACTERISTICS OF PULSE
• Rate
• Rhythm
• Volume
• Tension RATE: No. of beats/min
. normal pulse rate is 60-100/m
. Pulse >100/m = tachycardia pulse
<60/m= bradycardia

6.  FACTORS AFFECTING PULSE RATE
 AGE:
• Before birth 140-150/m
• At birth 130-150/m
• First yr 115-130/m
• Second yr 100-115/m
• Third yr 90-100/m
• 4 to 8 yr 86-90/m
• 8 to 15 yr 80-86/m
• Adult 60-100/m
• Old age 60-70/m

7.  Sex: (female has rapid pulse than male)
• Physique: short & small build have rapid than tall
• Exercise: increase muscular activity
• Food: indigestion of food causes
• Posture: in standing
• Emotions: strong emotions
• Application of heat:
• Pain
• body temp
• Diseased condition:
• Drugs: caffine, atropin, thyroid h. ^. Sedatives lowers the
rate.

8.  RHYTHM: It means regularity of pulse. Heart beats
spaced at equal interval called regular pulse. If interval is
varies it is irregular. Count the pulse for full 1 min.
 VOLUME: fullness of an artery. It is the force of the
blood felt at each pulse. Normal vol. of blood in arteries
is called full or normal pulse, but when vol. of bld is low
it is called weak, thready feeble or flickering pulse.
Increase in vol. like in stroke, exercise anxiety, hepatic
failure, heart block is called bounded pulse.
 TENSION: It is said high tension when artery is difficult
to compress & low tension when easy to compress.

9.  Equipment:
 stethoscope
• Parts
• Ear piece
• Binaurals
• Tubing about 12 inches
• Diaphragm: high pitched sound
• Bell: low pitched sound

11.  Procedure for Assessing Pulses
• Peripheral – place 2nd, 3rd & 4th fingers lightly on skin where
an artery passes over an underlying bone. Do not use your
thumb (feel pulsations of your own radial artery). Count 30
seconds X 2, if irregular – count radial for 1 min. and then
apically for full minute.
• Apical – beat of the heart at it’s apex or PMI (point of
maximum impulse) – 5th intercostal space, midclavicular line,
just below lt. nipple – listen for a full minute “Lub-Dub”
• Lub – close of atrioventricular (AV) values – tricuspid & mitral
valves • Dub – close of semilunar valves – aortic & pulmonic
valves

13.  Respirations
 One respiration consists of one inspiration and one expiration
 the chest rises during inspiration (breathing in) and falls
during expiration (breathing out)
 count each time the chest rises count for 30 seconds and
multiply x 2
 do not let the person know you are counting their respirations
 count after taking the pulse – keep your fingers on the pulse
site
 normal respiratory rate for adult is 12 – 16 breaths per min.

15.  ABNORMAL RESPIRATIONS
 Tachypnea – respiratory rate over 16
 bradypnea – respiratory rate below 12
 dyspnea – shortness of breath /difficulty in breathing
 apnea – no breathing
 hyperventilation – fast and deep respirations
 hypoventilation – slow and shallow respirations

16.  The measurement of the amount of force the blood exerts
against the artery walls.
 systolic pressure – pressure exerted when the heart muscle is
contracting
 diastolic pressure – pressure exerted when the heart muscle is
relaxing between beats
 blood pressure is recorded as a fraction with the systolic
pressure on top and the diastolic pressure on the bottom
 systolic /diastolic 120/80bp is measured in mm (millimeters)
of hg (mercury)

19.  NORMAL BLOOD PRESSURE
A.Average adult systolic range – 100 to 140
B.average adult diastolic range – 60 to 90
 ABNORMAL BLOOD PRESSURE
A. hypertension – measurements above the normal systolic or
diastolic pressures
B.hypotension – measurements below the normal systolic or
diastolic pressures

20.  Age – blood pressure increases as a person grows older.
 Gender – women usually have lower blood pressure than
men
 blood volume – severe bleeding lowers the blood
pressure
 stress – heart rate and blood pressure increase as part of
the body’s response to stress
 pain – increases blood pressure
 exercise – increases heart rate and blood pressure
 weight – blood pressure is higher in overweight persons
 race – black persons generally have higher blood
pressure than white persons do

21.  diet – a high-sodium diet increases the fluid volume in the
body which increases blood pressure
 medications – can be taken to raise or lower blood pressure
 position – blood pressure is lower when lying down

22.  Clean the stethoscope earpieces and diaphragm with
alcohol.
 Locate the brachial pulse.
 This is where the stetoscope will be placed.
 Wrap the cuff above the elbow with the arrow pointing to
the brachial artery.
 Place the diaphragm of the stethoscope flat on the pulse
site, holding it in place with the index and middle fingers of
one hand.
 Locate the radial pulse.
 Close the valve on the bp cuff by turning it to the right
(clockwise).Inflate the cuff until you can no longer feel the
radial pulse.

23.  Deflate the cuff slowly by opening the valve slightly and
turning it counterclockwise (to the left) with your thumb and
index finger.
 Allow the air to escape slowly while listening for a pulse
sound.
 Note the reading at which you hear the first clear, regular
pulse sound. This number is the systolic pressure.
 Continue listening until the sound disappears. This is the
diastolic pressure. Note this reading.
 Open the valve completely to deflate the cuff. Remove the cuff
from the patient.

25.  do not take a blood pressure on an arm with an iv, a cast, or a
dialysis shunt.
 Do not take a blood pressure on the side that a person has had
breast surgery on.
 Measure blood pressure with the person sitting or lying.
 Apply the cuff to the bare upper arm.
 Do not apply the cuff over clothing.
 Make sure the cuff is snug.
 Use a large cuff if necessary.
 Make sure the room is quiet.
 If you do not hear the blood pressure, wait 30 to 60 seconds and
try again. If you still can not hear it or are unsure of your
readings, have the nurse check your measurements.