1. Pulse

2. Pulse • Is a blood wave created by contraction of the left ventricle of the heart • It represents the stroke volume output. • Compliance : Ability of the arteries to contract and expand. • Cardiac output: the volume of the blood pumped in the arteries = SV X HR.

3. Pulse • PERIPHERAL PULSE • APICAL PULSE

4. Factors affecting the pulse • Age: ↓ with age • Gender: after puberty male slightly < than female. • Exercise: ↑ with exercise • Fever: ↑ with fever • Medications: e.g ↑ with epinephrine and ↓ with digitalis. • Hypovolemia: ↑ with blood loss • Stress: ↑ with stress • Position changes: sitting or standing → pooling of blood in dependent vessels → ↓BP & ↑ HR. • Pathology

5. Pulse sites

6. Pulse sites

7. Figure 29-12 Nine sites for assessing pulse.

8. Assessing pulse • Palpation (60 sec.) • Middle three fingers • Using stethoscope • Doppler ultrasound • Moderate pressure • Aware of (medications, activity, position)

9. Assessing pulse • Rate : tachycardia (>100B/m), bradycardia (< 60B/m) • Rhythm : Equality of beats and intervals between beats. dysrhythmia, arrhythmia (ECG) • Volume (strength or amplitude) : full or bounding, weak, feeble, thready (Normal: felt with moderate pressure). • Elasticity: should be straight, smooth, soft, pliable • Pulse deficit : any discrepancy b/w apical-radial pulses.

10. Explain procedure Privacy Supine, or sitting position Point of maximal impulse (PMI) 5th. Intercostal space MCL. Clean ear piece and diaphragm by antiseptic gel Warm diaphragm before use Assess for “lub-dub” Assessing Apical pulse

11. Assessing Peripheral pulses

12. Assessing Peripheral pulses

13. Assessing Peripheral pulses

14. Nursing Diagnosis • Ineffective Cerebral Tissue Perfusion related to cerebral ischemia