Assessing Heart Rate & Blood Pressure

Your pulse represents arterial palpation of the heartbeat using your fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone:

• at the neck (carotid artery), • on the inside of the elbow (brachial artery), • at the wrist (radial artery), • at the groin (femoral artery), • behind the knee (popliteal artery), • near the ankle(posterior tibial artery), • on the foot (dorsalis pedis artery).

Pulse is equivalent to measuring the heart rate. The heart rate can also be measured by listening to the heart beat directly (auscultation), traditionally using a stethoscope and counting it for a minute.

Normal Pulse Rates at Rest

newborn(0–3 months old)

infants(3 – 6 months)

infants(6 – 12 months)

children(1 – 10 years)

children over 10 years& adults, including seniors

well-trainedadult athletes

100-150 90–120 80-120 70–130 60–100 40–60

The pulse rate can be used to check overall heart health and fitness level. Generally lower is better, but bradycardia can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting.

Characterizing the Pulse

• The strength of the pulse can be reported:• 0 = Absent• 1 = Barely palpable• 2 = Easily palpable• 3 = Full• 4 = Aneurysmal or Bounding Pulse

Terms used to characterize the pulse

• regular, • irregular, • thready, • bounding, • absent [peripherally and/or centrally])

Pulse Points

Practice taking a patient’s pulseUsing the following points:

• Temporal artery• Carotid artery• Brachial artery• Radial artery• Popliteal artery• Posterior tibial artery

Characterize the pulse at each point.

Apical Pulse

Heart Sounds

Heart Sounds

• LUB = Systole– a force that drives blood out of the heart by

the contraction of the Left Ventricle

• DUB = end of Systole/beginning of Diastole– the period of time when the heart refills with

blood after systole

Sinus Rythym• sinus rhythm is the normal

beating of the heart, as measured by an electrocardiogram

• There are typically six distinct waves (identified by the letters P, Q, R, S, T, and U) in a single beat of the heart in sinus rhythm, representing the electrical activity in a beating heart

Blood Pressure

• sometimes referred to as arterial blood pressure, is – the pressure exerted by circulating blood

upon the walls of blood vessels as a result of muscular contractions of the heart

During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure• Blood pressure varies in healthy people,

but its variation is under control by the nervous and endocrine systems.

• Blood pressure that is unusually low is called hypotension, and that which is abnormally high is hypertension.

Classification of blood pressure for adults[4][5]

Category systolic, mmHg diastolic, mmHg

Hypotension < 90 < 60

Desired 90–119 60–79

Prehypertension 120–139 80–89

Stage 1 Hypertension 140–159 90–99

Stage 2 Hypertension 160–179 100–109

Hypertensive Emergency ≥ 180 ≥ 110

Reference ranges for blood pressure in children[19]

Stage Approximate age Systolic Diastolic

Infants 1 to 12 months 75–100 50–70

Toddlers and preschoolers

1 to 5 years 80–110 50–80

School age 6 to 12 years 85–120 50–80

Adolescents 13 to 18 years 95–140 60–90

Physiological Factors affecting BP

• Blood Volume – the amount of blood present in the body– The more blood present in the body, the

higher the rate of blood return to the heart and the resulting cardiac output

• Resistance – blood vessels present some resistance to the flow of blood– Smaller, longer blood vessels offer more

resistance than larger, shorter vessels

• Viscosity – the thickness of blood– Thicker blood will result in higher blood

pressures as the heart must work harder to force the thicker, heavier fluid through arteries, arterioles and capillaries

Stroke Volume

• The amount of blood expelled from the left ventricle of the heart during a single systolic contraction

Pulse Pressure

• Determined by the interaction of the stroke volume of the heart, flexibility of the aortic walls and resistance to blood flow in the arteries.– By expanding under pressure, the aorta absorbs

some of the force of the blood surge from the heart. In this way, the pulse pressure is reduced from what it would be if the aorta wasn't flexible.

– Pulse pressure is simply the difference between systolic and diastolic pressures