Cardio vascular system
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Cardio vascular system. Assessment of cardiovascular system. General assessment Skin colour - cyanosis, pallor Skin temperature Oedema Dyspnoea Monitoring of Pulse Blood pressure. Pulse. Each beat of the heart ejects blood from the left ventricle into the aorta

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Assessment of cardiovascular system
Assessment of cardiovascular system

  • General assessment

  • Skin colour - cyanosis, pallor

  • Skin temperature

  • Oedema

  • Dyspnoea

  • Monitoring of

  • Pulse

  • Blood pressure


Pulse
Pulse

  • Each beat of the heart ejects blood from the left ventricle into the aorta

  • This creates a wave of expansion and recoil within the arteries as the heart beats

  • This wave of expansion can be felt when a superficial artery is compressed with a finger against a bone or firm tissue

  • In most people , the pulse is an accurate measure of heart rate.


Pulse principles of assessment
Pulse – Principles of assessment

  • Pulse can be felt at any point where an artery crosses a bone

  • Can usually be observed visually in the neck

  • Normally synonymous with the HR

  • Gives information about the rate & rhythm of the heart, state of the circulation and condition of the arteries

  • DO NOT USE THUMB – may feel own pulse!

  • Normal range – 60-88 BPM at rest (adult)

  • Records over time are more accurate than one isolated reading

  • Use apical beat if radial pulse not available or client has heart disease


Pulse1
Pulse

  • Problems detecting pulse may indicate –

    • Heart contraction is not strong enough to generate a pulse wave

    • Heart contractions are too rapid

    • There is an occlusion in a peripheral artery (eg. In peripheral disease in diabetes or heart disease)


Pulse2
Pulse

  • Under some circumstances, including arrhythmias, some of the heat beats are ineffective and the aorta is not stretched enough to create a palpable pressure wave.

  • The pulse is irregular and the heart rate can be (much) higher that the pulse rate.

  • In this case, the heart rate should be determined by auscultation of the heart apex, in which case it is not the pulse.

  • The pulse deficit (difference between heart beats and pulsations at the periphery) should be determined by simultaneous palpation of the radial artery and auscultation at the heart apex

  • .


Common pulse points
Common pulse points

  • Radial pulse

  • Brachial pulse


Common pulse points1
Common pulse points

  • Temporal pulse


Common pulse points2
Common pulse points

  • Carotid pulse

  • Located in the neck (carotid artery)

  • The carotid artery should be palpated gently.

  • Stimulating its barorecptors with vigorous palpation can provoke server bradycardia or even stop the heart in some sensitive persons.

  • Also a person’s two carotid arteries should not palpated at the same time , to avoid a risk of fainting or brain ischemia.


Common pulse points3
Common pulse points

  • Brachial pulse- located between the biceps and triceps, on the medial side of the elbow (brachial artery).

  • Frequently used in place of carotid pulse in infants.


Common pulse points4
Common pulse points

  • Femoral pulse – located in the thigh (femoral artery).


Popliteal pulse
Popliteal pulse

  • located behind the knee in the Popliteal fossa, found by holding the knee bent.

  • The patient bends the knee of approximately 120 degrees and the nurse holds it in both hands to find the Popliteal artery in the pit behind the knee.


Common pulse points5
Common pulse points

  • Dorsalis pedis pulse- located on top of the foot (Dorsalis pedis artery).


Posterior tibial artery
posterior tibial artery

  • – located in the back of the ankle behind the medial malleolus)


Factors that affect the pulse
Factors that affect the pulse

  • Age

  • Sex

  • Body build

  • Level of physical activity

  • Emotions

  • Disease states-arterial disease thyrotoxicosis, febrile conditions, altered electrolytes (esp K, Ca, Mg)


Characteristics of pulse
Characteristics of pulse

  • Rate

  • Tachycardia- abnormally fast heart rate, over 100 bpm in an adult.

  • Causes haemorrhage, fever, thyrotoxicosis,

    Bradycardia - a heart rate slower than 60 bpm

  • Causes – fitness, heart block , cerebral haemorrhage, digoxin toxicity.


Characteristics of pulse1
Characteristics of pulse

  • Rhythm – should be regular

  • Arrhythmia or dysrhythmia may be due to electrolyte imbalance or cardiac tissue disease.

  • Ectopic beats are premature beats

  • Coupled beats (bigeminal beats)- two beats occur in close succession followed by a pause.

  • Atrial fibrillation- random , rapid contraction of the atria cause irregular pulse.


Normal ecg
Normal ECG

  • Normal


AF

  • Undulating baseline, irregular beat.


AF

  • Conduction pathways

mykentuckyheart.com


Atrial flutter
Atrial flutter

  • Flutter – regular beat, with undulating baseline.


Sinus tachycardia
Sinus Tachycardia

  • Regular, rapid beat > 100 BPM.


Sinus bradycardia
Sinus Bradycardia

  • Regular, slow beat < 60 BPM.


Ectopic beats
Ectopic Beats

  • Irregular beat, noted at odd intervals.


Characteristics of pulse2
Characteristics of pulse

  • Volume – is the feel of the strength of the beat. How full or how much the artery fills with blood. It is usually strong and easily felt.

  • Full and bounding – strenuous exercise, strong emotion, thyrotoxicosis

  • Weak and thready –hemorrhage, shock, cardiac failure.


Regular monitoring of pulse
Regular monitoring of pulse

  • Post operatively

  • Critically ill patients

  • Patient receiving a blood transfusion

  • Patient with a local or systemic infection or inflammatory reactions

  • Patient has a cardiac condition


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