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# Junior cycle semester 2 CC8 Examination of Pulse and Blood Pressure Introduction

These simple procedures require minimal time and equipment, but provide valuable information to the clinician on the condition of the patients cardiovascular system. They do however need to be practiced many times, so that accurate results are obtained.

A full examination of the radial pulse includes evaluation of rate, rhythm, character, volume, vessel wall and comparison with both the contralateral radial pulse and the femoral pulse. These will be explored further in the Intermediate Cycle and for the purposes of this tutorial; we consider rate & rhythm only.

Examination Explain to the patient what you are going to do, and ask them to relax. We generally examine the right radial pulse - we examine the patient from the right hand side of the bed. Locate the radial pulse, and apply a firm pressure with your first 2 fingers.

Rate If the pulse is regular, you should count the number of beats that occur in 30 seconds, and double your answer. If the pulse is irregular, you should count for a full minute. Normal 60-100 beats per minute Bradycardia < 60 beats per minute Tachycardia > 100 beats per minute

Rhythm As you count, you will notice if the pulse is regular or irregular. The pulse is normally in regular sinus rhythm (controlled by the SA node). If the pulse is irregular, it may be caused by an ectopic (extra) beat. In this case, the irregularity would be felt on the background of a normal rhythm. The commonest cause of a more chaotic and truly irregular rhythm is atrial fibrillation.

## Measuring Blood Pressure

Blood pressure is the pressure exerted by blood as it travels in the main arteries, and as this varies throughout the cardiac cycle, we have to record both systolic and diastolic pressures. BP is measured with a sphygmomanometer.

Ensure the patient is relaxed and sitting comfortably, and that their upper arm is at the same level as the heart. Assess their knowledge of the procedure and explain if necessary. Ask the patient to roll their sleeve up to expose the upper arm. If the sleeve folds into a restrictive band around the upper arm, you will need to ask them to remove their arm from the sleeve. Choose an appropriate sized cuff (too small will over estimate BP and too large will under estimate it). Wrap the cuff around the upper arm with the bladder over the brachial artery, leaving the lower border of the cuff about 2cm above the antecubital fossa.

Palpation

Locate the radial artery, and with your other hand, squeeze the bulb to inflate the cuff until the pulse is no longer felt. Release the valve and note the pressure at which the pulse returns. This gives you an estimate of what the systolic pressure is. Auscultation

Close the valve and reinflate the cuff to 20-30mm Hg higher than your estimate of systolic BP. Place the diaphragm of your stethoscope over the brachial artery. Remember that it can be uncomfortable for the patient to have the cuff inflated to this pressure do not forget this and do not waste time. Release the valve a little so that the pressure drops very slowly. Meanwhile you should listen intently for the Korotkoff sounds faint thudding sounds. Note the pressure at which you first hear the sounds this represents systolic pressure. Note the pressure at which the sounds disappear this represents diastolic pressure. (Cuff pressure is now less than diastolic pressure and flow is continuous throughout the cardiac cycle.) Once the sounds have completely disappeared, open the valve fully to completely deflate the cuff. Using a Stethoscope It has 2 settings Bell This is designed for listening to low-pitched sounds Diaphragm This is designed for listening to higher-pitched sounds. Before you place the earpieces in your ears, angle them forwards to match the direction of the auditory canals. Gently tap the diaphragm to decide which setting it is at and adjust if necessary.