TPR and Peripheral Pulses

1. TPR and Peripheral Pulses PN 1 Nursing Skill Labs

2. Equipment • glass thermometer - consider mercury spills • electronic thermometer • tympanic thermometer • others - patch, tape, single use • watch • paper and pen for recording

3. Sites and Methods Oral • wait 15 – 30 min after hot or cold drink smoking or chewing gum • do not use oral site if • unconscious • seizure prone • irrational • child - very young • O2 by mask • recent oral surgery

4. if using glass thermometer, shake down and wipe down!! • place in sublingual pocket and close lips • must wait 3 minuteswhen using glass thermometer; others alarm or indicate when ready • always indicate the site used in your documentation

5. Rectal (not used for newborns!!) • shake down and wipe glass thermometer and insert 1 1/2 inches (adults) after lubricating well!!! (check depth depending on age/size) - hold 2-3 mins • hold thermometer in place to ensure accurate reading • considered most accurate reflection of core temp

6. Axilla • if using glass thermometer, shake, wipe and hold for 10 mins • make sure axilla is dry • place tip of thermometer in center of axilla and place arm close to body • considered as accurate as oral or rectal when done correctly

7. Tympanic • pull pina up and back (for adults) • most common site currently used • uses infrared sensers • does not actually touch the typmanic membrane

8. Factors affecting Pulse Rate & Rhythm Tachycardia • pulse of 100 - 180 bpm • may be caused by pain, emotions, exercise, prolonged heat, decreased blood pressure, pyrexia, reduced O2 in blood, some medications

9. Bradycardia • pulse below 60 bpm • pulse is generally slower at rest • may be related to thin body size, gender ( males slower than females), increased age and some medications • this is often considered normal for people in great physical shape!!

10. Equipment • Stethoscope, doppler, cardiac monitor • cleanse earpieces with alcohol swab • warm before use • point ear pieces toward nose • ensure bell is “on” • bell – low freq. Heart & BP • diaphragm – hi freq. Resp & bowel sounds • watch with second hand

11. Sites and methods • never use your thumb to palpate a pulse • use the pads of three middle fingers • count for 1 full minute • exception - if peripheral pulse irregular or abnormal for that patient repeat at apical site and count for 1 full minute • Pulse deficit = difference between apical and radial pulse

12. Radial • ease of access, circulation of hand • make sure arm is resting comfortably • Carotid • most easily palpable if blood pressure is low (only palpate one side at a time) • Apical • audible with stethoscope • measured at 5th intercostal space, slightly left of pts. midclavicular line

13. Brachial - used in infants • Femoral - often used in cardiac arrests • Popliteal - peripheral circulation • Posterior tibial (tibial) and Dorsalis pedis (pedal) - assesses peripheral circulation • always document location of pulse assessment

14. Pulse Points

15. Respirations • one respiratory cycle = from beginning of one inspiration to beginning of the next inspiration • important that patient not be aware you are counting his/her respirations • normal ratio is 1 breath to 4 heartbeats • count for 1 full minute • document rate and depth

16. Increases  rate if in pain  in BMR exercise sympathetic stimulation smoking require more oxygen pyrexia Decreases  depth if in pain pathologies sedatives and analgesics parasympathetic relaxation increased ICP Factors affecting Respiration

17. Terms related to Respiration • tachypnea - rapid > 24 per min • bradypnea - slow < 10 per min • apnea - periods of no breathing - brain damage in 4-6 mins • orthopnea - breathing easier in upright position • dyspnea - labored or difficult breathing

18. hyperventilation - increased rate and depth • hypoventilation - decreased rate and depth • Cheyne-Stokes - deep rapid breathing followed by periods of apnea