Certified Nursing Assistant Easy and Fun Tutorial Part Twenty
**********Normal Pulse Rates
The adult pulse beats 60-100 BPM or beats per minute. For newborns it is 110 to 180 BPM.
The heart rates for children fall between those for adults and newborns according to each child’s size and range.
Normal pulses: as you get older your heart rate slows down.
Alterations in pulse rate or rhythm are due to cardiac arrhythmia.
A pulse rate over 100 BPM is tachycardia.
A pulse rate below 60 is bradycardia.
Activity affects pulse rate. When you are taking peripheral pulses such as the pedal pulse you need to note the characteristics of the pulse as well. 0 = absent pulse, 1 = weak pulse, 2 = diminished pulse, 3 = strong pulse, 4 = full and bounding pulse.
All images are from Photobucket.com.
When peripheral pulses cannot be palpated, a Doppler ultrasound stethoscope is used to amplify the sound. The bottom line is if the foot is warm as in taking a pedal pulse and the right color is there in the foot then there is blood flow to that foot but if their foot is blue then tell the nurse because it may be a circulation problem.
**********The Strength and Speed of A Pulse
Tachycardia is when the heart is beating quicker but the same amount of blood is flowing which is indicated by a weak and thready pulse. Often with tachycardia it reflects decreased cardiac output.
A bounding pulse occurs with very active people these are know as hyperkinetic states.
Note the volume and the amplitude of the pulse.
To record a pulse deficit then you would need two people. One person takes the pulse at the apex of the heart for a full minute and at the same time the radial pulse is taken by another person.
The results are subtracted and the pulse deficit (the slower radial pulse than the apical pulse) is the difference between the two.
There is no way the radial pulse can be greater than the heartbeat or the apical pulse.
Take a full pulse for one minute, all pulses are one minute.
CHF is congestive heart failure.
Note: If you get a pulse deficit then take the blood pressure.
Palpating peripheral pulses the radial, carotid and brachial pulse. In this case you would compare with two to three finger pads and compare right to left.
For special cases after carotid surgery palpate the temporal pulses also.
You will use conductive jelly to listen to peripheral pulses.
Important! If this peripheral pulse is absent start checking for other things such as is the foot blue? Is the foot cold? Check for capillary refill: press the fingernail of the person does it turn white briefly after you press it and then when you let it go it should come right back to red briskly. You can do a brisk capillary refill check. If no, then get a nurse immediately.
**********Evaluation of Breathing
To evaluate someone’s breathing you must know that one inhalation and one exhalation is one respiration.
1 inhalation + 1 exhalation = 1 respiration.
Normal breathing is almost effortless it is quiet automatic and regular. However, breathing needs to be evaluated if the pattern varies from normal. The quantity of someone’s breathing is important.
So take the patient’s pulse for one full minute and if the arm is elevated support the joint and have the arm support the elbow.
The shoulder takes care of itself and you take the pulse of one finger and then very sneaky like you keep your fingers there and watch the rise and the fall in your patient’s chest and count that for one full minute.
Remember to take the pulse and keep your fingers on the pulse but count the respirations. Respirations can be conscious so you must be sneaky about getting the respiration count.
For respiration you count for 60 seconds the rise and the fall of the chest.
Once the patient knows that you are listening to their chest then they are going to change their pattern of breathing and that is why you need to be sneaky.
*********Problems with breathing
Asthma and pneumonia are respiratory obstructions and these people are laboring to breathe.
As the carbon dioxide in a person’s body goes up, the breathing rate goes up. There are peripheral receptors located in the carotid and aortic arch that responds to the level of oxygen in the blood.
When oxygen levels are going down we do not breathe faster because oxygen is going down but we breathe fast because carbon dioxide is increasing.
The voluntary controls of respiration is holding your breath.
The diaphragm and the intercostal muscles are the main muscles used for breathing.
When watching someone breathing note the quality of the sounds: are they grunting, is their nose flaring that means that something is not right so tell the nurse.
Also note the breathing pattern does the person breathe and stop or breathe and stop or is everything the same?
Note whether the rate and depth of respirations are the same.