2019-06-27_aallard_The Significance of Vitals ML.docx

The Significance of Blood Pressure, Pulse and Respiration


Blood pressure, pulse and respirations are imperative guides to a person’s state of health. They are critical indicators of a change in a person’s physical and also psychological well-being. For health professionals, taking and documenting vital signs allows for the daily assessment required to keep patients well.

1) What is a pulse?
The heart is a pump that regularly ejects blood into the arteries. The normal pulse, or resting heart rate, can rage anywhere between 60-100 beats per minute. The lower the heart rate at rest, the more efficient the heart functions. The pulse can be palpated over arterial sites that are close to the skin and are backed by firm structures, such as bone. The most common site is the “radial pulse” in adults. The radial pulse is located on the lateral part of the wrist. It is the most accessible and is usually taken for routine vitals. 
The “apical pulse” is auscultated over the fifth intercostal space of the persons heart.
The “temporal pulse” is by the temporal artery, between the eye and the hairline. This pulse is more commonly used in children
The “carotid pulse” lies between the trachea at the side of the neck. It is taken often when a person has had a cardiac arrest or any other emergency, as it is the most accessible without removing any clothing.
The “brachial pulse” can be felt between bicep and tricep muscles, right above the elbow. This site is used more for blood pressure readings.
The “femoral pulse” lies in the groin between the muscles on the side in the “femoral triangle”
The “popliteal pulse” is located by the femoral artery and also difficult to locate, in the back of the knee.
The “dorsalis pedis pulse: is located on the top of the foot and must be palpated gently.
The “posterior tibial pulse” is behind the inner ankle bone.

Woman usually have a faster rate than men and infants. Children have a higher norm. The peripheral pulse can be counted for a full minute or counted for 15 seconds and the multiplied by 4 If the rhythm is irregular, or there are any skipped beats, pulse should be measures for an entire minute.

An increased heart rate/pulse, over 100 beats per minute, is called tachycardia. A decreased heart rate is called bradycardia and is usually under 50-60 beats/minute.

Pulse rhythm can also be irregular. “Sinus arrythmia” is a pule that can cause fluttering in the chest, tachycardia, bradycardia, sweating and even fainting. Another pulse irregularity is “premature beats” It occurs when there are extra heart beat that begin in the heart’s ventricles. These extra beats disrupt the regular heart rhythm causing a fluttering feeling or skipped beat feeling in the chest.

2) Respirations

Respiration is the most critical and fundamental body mechanism. The main functions of respiration is to provide oxygen to the body cells and remove carbon dioxide, which is a lethal waste product.
Breathing is automatic and involuntary. Some respiratory system illnesses include asthma, pneumonia, pleural infusion, lung cancer, emphysema, bronchitis and chronic obstruction pulmonary disease. 
Essential assessment tools for health providers are:
-Quality of respirations (stridor, stertor, wheezing, sigh)
-Types of respirations (rate and depth)
-Pattern of respirations ( Cheyne-stokes, biots, kussmauls, apneustic) 
-and skin color.
The normal rate of respirations per minute is 12-20 breaths. 

3) Blood pressure

Blood pressure is an important guideline of the cardiovascular system and the body fluid balance. Blood pressure is “the force exerted by the blood against any unit area of the vessel wall.” It is expressed in millimeters of mercury and the goal is to take an accurate “systolic pressure” (top number) which is the maximum pressure excited on the arteries, and “diastolic pressure” (bottom number) which is the pressure of the blood in arteries when the heart is filling. The average adults blood pressure is 120/80. Pressure can increase with age, especially after 50.
Blood pressure is lower in the mornings and rises and peaks in the early evening. Exercise, activity, pain and fear can increase blood pressure, but should always return to normal within 5 minutes after excersion. 
Blood pressure is lower when lying down, then when sitting or standing. Blood pressure can decrease quickly upon standing or sitting. This condition is called “Orthostatic Hypotension.” This can occur normally or with anti-hypertension medications. It is important to have a person sit for a couple of minutes before standing to avoid fainting.  Losing weight, exercise, low alcohol intake, eating healthy with a diet rich in fruits and vegetables, and a low salt diet are all factors that can help people with high blood pressure (hypertension).

As a health care professional, monitoring vital signs is an important skill and cornerstone of assessment. These must be documented as it is crucial to see patterns, especially when our patients have an illness that requires monitoring, or when we are trying to make a diagnosis. 


                                                                                                                                            Maria Licoudis