vital signs and jvp

7/31/2019 Vital Signs and JVP

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VITAL SIGNS AND JUGULAR VENOUS PRESSUREDr. Esther Estrellado

Normal heart rate: 60-100 bpm

For a healthy individual, you can

get it by measuring for 15

seconds, and then multiply by 4.

For conditions such as atrial

fibirillation, measure in 1 full

minute.

BP CONSIDERATIONS:

1. Type: Mercurial BP (the best

type)

2. Check the calibration, must be at

zero.

3. Inflate to 200.

4. Note whether mercury rises and

falls smoothly.

5. Length of bladder:

75-80% (circumference)

More than 50% of length

(width)

6. Conditions wherein you are not

supposed to take the BP 1 hour

before:

Food intake

Exercise

Coffee (its a stimulant)

Smoking ( another

stimulant)

Must be in a cool

environment

(54 degrees Fahrenheit)

7. No talking, (patient and doctor

must shut up I guess? Hihi )

TECHNIQUES:

1. Patient must sit properly and

upright, feet flat on the floor and

legs not crossed.

2. Use right arm if possible.

During BP taking, there is a

difference of 10mm between the

right arm and left arm. (Its still

acceptable)

3. Always use the right cuff.

Bottom edge must be 2 cm

above the antecubital fossa.

4. Use the bell of the stethoscope.

5. Get the average. Feel the radial

pulse, and inflate until 160.

Deflate slowly, average must be

2-3 mmHg.

PHASES:

Phase 1

-Korotkoff sound 1st faint sound

- Systolic

Phase II

-murmur, swishing sound

Phase III

-sound is more intense, crispier

Phase IV

-abrupt muffling sound

Phase V


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-pressure when last sound was

heard

-heart sound is no longer audible

JUGULAR VENOUS PRESSURE

Must be measured at the right

side of the neck, at the right

carotid artery.

Normal: 8 cm water

It denotes the right

hemodynamic state of the right

atrium and right ventricle.

Height from sternal angle: 3 cm

Patient must be at a 45 degree

angle.

Observe the neck.

SIGNIFICANCE: Reflects anything

happening at the right atrium of

the heart.

An elevation denotes CHF.

- decreased compliance in

the R. ventricle

- hypervolemia

- obstruction in the tricuspid

valve and sup. vena cava

Made up ofWAVES:

This is observed during

auscultation.

A wave

- Atrial contraction

- Most prominent whenpatient inspires

- Occurs before S1

Y wave

- After S1

- Decline in atrial pressure

when the tricuspid valveopens

-

V wave

- At S2

- Rise in atrial pressure

when blood flows in right

atrium

X descent

- Atrial relaxation

- Floor of r. atrium

descends toward

ventricle at ventricular

systole

Diathesis

- Between Y and A wave

- Slow flow of blood in the

right atrium and

ventricle.

Kussmaul sign


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- Pradoxical rise in venous

pressure

- Indicates chronic

constrictive pericarditis,

CHF, tricuspid stenosis

Prominent A wave

- Right ventricular

hypertrophy

- Tricuspid stenosis (in

children)

- Pulmonary hypertension

Cannon A wave

- A/V dissociation

- No sequence in

contraction of atrium and

ventricles

Absence A wave

- Atrial fibrillation.

- In irregular heartbeats.

Connection in the neck

- Involves the right atrium.

Wide pulse pressure

- Aortic regurgitation.

ATRIAL PULSE

Normal:

- gradual rise precussion

wave

- rounded wave

- nicrotic and decrotic

wave

vital signs and jvp

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