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Pulse & Blood Pressure

PULSE

*Pulse/Pressure Wave
- wave of blood created by contraction of the left ventriole of the heart.
- Mitral closes- aortic opens
- Tricuspid closes- mitral opens
* Healthy person- pulse is equal to heart beat.
* pulse and heart rate may not coincide with each other.
* Point of Maximum Impulse- Apical pulse
- Palpatory: 2 fingers
- Auscultatory: stethoscope
- Doppler: for babies; fetal heart tone. Also used when you cannot find the pulse.

Pulse Sites

* Temporal Artery- palpated on the temple; superficial temporal artery which is the major artery of the
head.
* Carotid Artery- for brain circulation, cardiac arrest; for adults only. Specific
* Apical Artery- on the chest
* Radial Artery- most accessible. On the wrist
* Femoral Artery- checking after cardiac arrest. Supplies oxygenated blood to the lower extremity
structures.
* Brachial Artery- can be felt on the elbow’s front side
* Popliteal Artery- for the lower leg circulation
* Dorsalis Pedis Artery- On the foot. Directly above the big toe and second toe.

Factors Affecting Pulse

* Age
Infant 80-160 bpm
Adult 60-100 bpm

-Tachicardia: has a pulse greater than 100 bpm.


-Bradycardia: has a pulse lesser then 60 bpm.
* Sex
* Exercise
- Athletes: have a lower heart rate; normal for them is bradycardic.
* Fever- higher pulse rate
* Medication- high epinephrine, athropin
- lower beta blockers & digitalis drugs
* Dehydration- blood vessels decrease pulse rate
* Stress- sympathetic secretes norepinephrine and epinephrine
- Vasoconstricticts. Blood Pressure increases and heart pump increases
* Position- Sitting and standing decreases pulse rate
* Pathology- fats
Assessment

1. Pulse can be felt by applying in a supine of sitting position.


- Warm fingers
- Relaxed
- Ask permission

BLOOD PRESSURE

*Systolic Pressure- pressure of the blood as a result of contraction of the ventricles.


120/180 Normal
Pulse pressure=40
140/90 Hypertension
130/80 Pre hypertension
90/60 Hypotension
- millimiter mercury: unit of pressure

Factors Affecting Blood Pressure

* Age
* Exercise
* Stress
* Race- Africans & Americans have high blood pressure
* Sex- females have lower blood pressure than males; when females become menopausal, their blood
pressure increases.
* Medication- epinephrine and norepinephrine
* Obesity- fats accumulate vein
- stroke: clots in brain; hypertension
* Temperature- cold: constrict
- hot: dilate; decreases blood pressure
Stethoscope
- bell: low pitch sound
- Diaphragm: high pitch sound

Palpatory Method
* Rod Coff sound
- Systole: first
- Diastole: second
- Last: phase 4
-line tubing in the brachial artery. Add 30mm

* Left ventricle- supplies blood to the body


* Short term regulator- baroreceptor reflexes (help maintain bp)
* Hypotension- low blood pressure, 90/60
- 120/80 is said to be pre hypertensive
* Orthostatic Hypertension- laying flat; suddenly stand up. Sudden increase in blood pressure
(baroreceptors are at work)
* Long term regulator- RAAS (Renin Aldosterone Angiotensin System)
- Renin: In the kidneys, produced by the juxtaglomerular kidney cell. Triggered when you have low
blood pressure
- Angiotensinogen: in the liver, converted by Renin
- Angiotensin I: converted by Renin; vasoconstrictor
- Angiotensin II: converted by the Angiotensin Converting Enzyme (ACE)
: in the lungs; a strong vasocontrictor where the blood vessels decreases, and the
pressure increases.
- Posterior Pituitary Gland in triggered
- Anti Diuretic Hormone
- Urine excretion increases
- Circulating fluid decreases
- Lower pressure
- Releases ADH
- Decreases urine. Increase circulating fluid; increase in blood pressure

- Aldosterone: causes water and sodium retention; where sodium goes, water follows. Increase water
and sodium of blood.
- Kidneys, Liver, and Lungs: help blood pressure. One of these organs damaged, can affect the blood
pressure. (ie. jaundice, end stage of renal disease)