Pulse Sites

jasmine's version from 2015-09-23 14:02

Section 1

Question Answer
RadialReadily accessible: Location at thumb side of the inner aspect of the wrist
TemporalUsed when radial pulse is not accessible: Location at above and lateral to the eye
CarotidUsed during cardiac arrest/shock in adults. Used to determine circulation to the brain. Location at side of neck where carotid artery runs between trachea and sternocleidomastoid muscle
ApicalRoutinely used for infants and children up to 3 years of age. Used to determine discrepancies with radial pulse. Used in conjunction with some medications. Location at the apex of the heart.
BrachialUsed to measure blood pressure. Used during cardiac arrest for infants
FemoralUsed in cases of cardiac arrest/shock
PoplitealUsed to determine circulation to the lower leg
Posterior TibialUsed to determine circulation to the foot
Dorsalis Pedis (Pedal)Used to determine circulation to the foot

Section 2

Question Answer
Adult Apical LocationOn the left side of the chest, about 8 cm (3 in.) to the left of the sternum and at the fourth, fifth, or sixth intercostal space
Older Adult Apical LocationMay be further left if any health conditions have led to an enlarged heart
Child 7-9 Years Old Apical LocationOn left side at the fourth or fifth intercostal space
Child 4-6 Years Old Apical LocationOn left side on the mid-clavicular line by the fourth and fifth intercostal space and to left of the apical pulse for an adult
Child Under 4 Years Old Apical LocationOn left side, left of the mid-clavicular line and right of the anterior axillary line, by the fourth intercostal space-above and to left of the apical pulse for an adult
Assessing Pulse In Child Under 4 Years OldTake apical pulse rate before assessing body temperatures due to crying and restlessness will increase pulse rate
Assessing Pulse In Older Adult With Hand or Arm TremorsRadial pulse may be difficult to count
Assessing Pulse In Older AdultObtaining apical pulse will be more accurate
Older Adult Decreased Peripheral CirculationDorsalis Pedis (Pedal) pulses also should be checked for regularity, volume, and symmetry
Older Adult After ExercisePulse returns to baseline more slowly than with other age groups
Safety AlertNever press both carotids at the same time due to can cause a reflex drop in blood pressure or pulse rate

Section 3

Question Answer
Blood PressureCan be assessed directly (Invasive) or indirectly (Non-Invasive)
Two Non-invasive Methods Of Measuring Blood PressureAuscultatory and Palpatory
AuscultatoryMost commonly used in hospitals, clinics, and homes. Relatively accurate and requires a sphygmomanometer, cuff, and stethoscope
PalpatoryMay be used if Korotkoff sounds cannot be heard and electronic equipment to amplify the sounds is not available. May also be used to prevent mis-direction from the presence of an auscultatory gap.
Auscultatory GapIt is the temporary disappearance of sounds normally heard over the brachial artery when the cuff pressure is high followed by the reappearance of the sounds at a lower level. Occurs particularly in hypertensive clients.
Temporary Disappearance Of Sounds From Auscultatory GapOccurs in the latter part of phase 1 and phase 2 and may cover a range of 40mmHg
Blood Pressure Determination in the Palpatory MethodInstead of listening for the blood flow sounds, a nurse uses light to moderate pressure to palpate the pulsations of the artery as the pressure in the cuff is released. The pressure still is read from the sphygmomanometer when the first pulsation is felt
Direct (Invasive) Blood Pressure MeasurementInsertion of a catheter into the brachial, radial, or femoral artery. Arterial pressure is represented as wavelike forms displayed on a monitor, and the reading is Highly accurate
How Many Phases in the Korotkoff Phases5 from high to low with phase 1 on the high side (i.e., 140 mmHg) and phase 5 on the low side (i.e., 80)
Phase 1A sharp tapping
Phase 2A swishing or whooshing sound
Phase 3A thump softer than the tapping in phase 1
Phase 4A softer blowing muffled sound that fades
Phase 5Silence

Section 4

Question Answer
Infant Blood PressurePediatric stethoscope with a small diaphragm, and lower edge of cuff can be closer to the antecubital space of an infant
Children Blood PressureShould be measured in all children over and under 3 years of age with certain medical conditions (i.e., congenital heart disease, renal malformation, medications that affect blood pressure)
Older Adults Blood PressureCuff pressure should not remain high any longer than necessary due to possible fragile skin
HypotensionBelow normal blood pressure reading. Consistently between 85 and 110 mmHg in patient whose baseline BP is typically Higher
Orthostatic HypotensionBP decrease when patient sits or stands.
HypertensionAbove normal blood pressure reading. Consistently and above 140 over 90 mmHg
Causes For HypotensionIncludes dehydration, bleeding, severe burns, and analgesics such as meperidine hydrochloride (Demerol).
Assessing Orthostatic Hypotension Place patient in supine position for 10 minutes; Record patient's pulse and blood pressure; Assist patient to slowly sit or stand, and support patient in case of faintness
Infant PalpationGenerally is the technique. Is used when auscultation with a stethoscope or DUS is unsuccessful
Arm And Thigh Pressures for InfantsEquivalent in children under 1 year of age
One Quick Way To Determine Normal Systolic Blood Pressure Of A ChildNormal systolic BP = 80 + (2 x child's age in years)
When Assessing Blood Pressure In ChildrenExplain each step and what it may feel like. Demonstrate on a doll
Cuff Width and Length For ChildrenShould be 40 percent wide and 80-100 percent long depending on the arm circumference
Assessing Blood Pressure In ChildrenShould be taken prior to uncomfortable procedures due to possible artificial elevation by discomfort
Thigh Blood Pressure In Children About 10 mmHg Higher than the arm pressure
Diasystolic Blood Pressure In ChildrenConsidered to be onset of phase 4 where the sounds become muffled
Anti-hypertensive Medications In Older AdultsCause vasodilation. Determine if patient on anti-hypertensive medications and when last dose was taken
Anti-hypertensive Medications Along With Loss Of Baroreceptor EfficiencyIncreased risk for having orthostatic hypotension
Older Adult PalpationShould be taken when patient has arm contractures, and if not possible to take, take thigh blood pressure
Assessing Orthostatic Hypotension In Older AdultsMeasuring blood pressure while patient is in the lying, sitting, and standing positions, noting any changes can determine this
Orthostatic Hypotension Results FromPeripheral vasodilation in which the blood leaves the central body organs, especially the brain, and moves to the periphery, often causing the patient to feel light-headed or faint.
Blood Pressure Readings At The HomeUse same equipment. Readings may differ from a physician's office or clinic
Uncontrolled Hypertensionincreases risk of serious health problems, including heart attack and stroke

Section 5

Question Answer
Two possible reasons For Blood Pressure ErrorsHaste on the part of the nurse and subconscious bias (i.e., influenced by patience previous blood pressure measurements)
Bladder Cuff To NarrowErroneously High
Bladder Cuff To WideErroneously Low
Arm UnsupportedErroneously High
Insufficient Rest before The AssessmentErroneously High
Repeating Assessment Too QuicklyErroneously High systolic and Low diastolic readings
Cuff Wrapped Too Loosely Or UnevenlyErroneously High
Deflating Cuff Too QuicklyErroneously Low systolic and High diastolic readings
Deflating Cuff Too SlowlyErroneously High diastolic reading
Failure To Use the Same Arm ConsistentlyInconsistent measurements
Arm Above Level Of The HeartErroneously Low
Assessing Immediately After A Meal Or While Client Smokes Or Has PainErroneously High
Failure To Identify Ausculatory GapErroneously Low systolic pressure and erroneously Low diastolic pressure

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