LESSON STRUCTURE
1. INTRODUCTION
2. PULSE AND ITS RECORDING.
3. RESPIRATION RATE AND ITS RECORDING.
4. TEMPERATURE AND ITS RECORDING.
5. BLOOD PRESSURE AND IT'S RECORDING.
6. QUESTIONS FOE EXERCISE
1. INTRODUCTION
The students on completion of this course shall be working with some medical practitioners either clinic Or in this nursing homes. Where they will be called upon to record the pulse. respiration. temperature and blood pressure of the patients as part of their duty. lt is. therefore. important that the students should have some knowledge about pulse. respiration. body. important and blood pressure and should also be able to record pulse rate. respiration rate. body temperature and blood pressure. They should should also be able to differentiate between normality and abnormalities of these observations. ln this unit students shall learn what is meant by pulse rate. respiration rate. body temperature and blood pressure and also how to record them. They shall also learn about their normal range and common abnormalities. So that they are able to inform the doctors about any abnormality observed by them
4.2.1 what is pulse?
The arteries on account of their elastic muscular wall distend everytime blood is forced through them due to the contraction of the ventricle of the heart. This distention can be easily felt by pressing the finger gently over an artery which has come up superficially such as the Radial Artery. Femoral artery. Carotid artery and the Dorsalis pedis artery. Thus the pulse may be defined as the alternate expansion and elastic recoil of the wall of the artery during ventricular systole
4.2.2 where to feel the pulse?
To asses the rate and rhythm of the pulse. the Radial pulse at the wrist is usually used. lt is best felt with the tips of the fingers. the patient' s forearm being pronated and the wrist slightly flexed. For studying the character of the pulse a central pulse in either the carotid of Brachial artery is preferable
4.2.3 Observations to be made whille examining the pulse
The following observations should be made while examining the pulse
(a) Rate of pulse (pulse rate).
(b) Rhythm.
(C) Character.
(d) Volume.
(e) Condition of the vessel wall.
A. Rate of pulse (pulse rate) : when the tips of the fingers are put at the radial side of the wrist as indicated above (4.2.2) the throbbing pr the pube is felt. The rate of the pulse is indicated as so many beats (throbs) per minute. It is counted not immediately when the fingers are laid upon the pulse, but should wait till any quickening due to nervousness oof the patient has subsided and the pulse has resumed it's normal rate. The beats or the pulse should be counted for not less then half minute, though it is advisable to count it for full one minute. The pulse rate is increased during physical exercise emotional circumstances, in fever and in Thyrotoxicosis.
(B) THE RHYTHM OF THE PULSE : After counting the pulse rate, it should be decided whether rhythm is regular or irregular (irregularity regular) or the irregularity has a recurring pattern (regularly irregular) or whether an otherwise regular rhythm has a recurring pattern of these are occasional irregularities, these are likely to be due to extra systoles. An EXTRASYSTOLE is a beat which occurs prematurely, is small and is followed by an induly long pause before the next beat occurs
(C). CHARACTER OF THE PULSE: It is not usually possible to detect slight variations from normal, but in certain diseases the character of the pulse is detectably abnormal. The most important of these are anacrotic pulse, Collapsig pulse and pulses paradoxus (The pulse became smaller or even disappears at the end of inspiration) etc. However a basic medical Assistant need not go into the detail of the character of pulse.
(D). Volume of the pulse beat: volume of the pulse beat is the amplitude of movement of the arterial wall during the passage of a pulse wave.
(E). Condition of the vessel wall: Sufficient pressure should be exerted on the Brachial Artery to abolish pulsation in the radial Artery which should be rolled beneath the fingers against the underlying bone. In young persons, the arteries can not be felt or are soft. In older person, they are early palpable. In arteriosclerosis they may feel like whip cord and may be tortuous.
4.2.4 DESCRIPTION OF A TYPICAL PULSE: The typical pulse of a healthy adult man should be described is the following terms :
# The rate in 70 minute
# The beats are regular in rhythm and equal in volume
# The pulse is of normal volume.
# The arterial wall is just palpable but is neither thickened nor tortuous.
3. RESPIRATION RATE:
4.3.1 The respiratory cycle: The Respiratory cycle consists of inspiration (breathing in), expiration (breathing out ) and a very short respiratory pause.
Inspiration is the result of increase in the size of the thoracic cavity and this increase is due tto combined action of the ribs and the diaphragm. The ribs are moved upwards and outwards by the muscles (Intercostal muscles) stretched between them, thus enlarging the chest cavity all around. The contraction of the diaphragm results in its flattening thus contributing to the enlargement of the chest cavity lengthwise. As the diaphragm flattens, it presses the organs inside the abdomen and with the abdominal muscles relaxed, the abdominal wall movie outwards. When the thoracic cavity increases in size its internal pressure is decreased, the lungs expand and as a result, the pressure inside the lungs is lowered below the atmospheric pressure, as a result the outside air which is at greater pressure rushes in to equalise the pressure.
Expiration is the result of reverse movement of the ribs and the diaphragm. As a consequence of the reverse movement the cavity of the thorax is diminished and the lungs are compressed, forcing the air out into the atmosphere, completing the respiratory cycle.
4.3.2 NORMAL AND ABNORMAL RAPIRATION
RATE:
The number of respiratory cycles taking place in a minute is the Respiration rate per minute. It is counted by watching the chest and abdomen of the patent and counting the number of time that the chest expands and the anterior abdominal wall moves outwards in a minute.
The Respiration rate for a normal adult is about 14-18 per minute but may be upto 22 if the patient is nervous during examination. In new born it is about 60 minutes.
Increased rate of respiration or tachypnoea may result from exertion, ever, nervous excitement or hypoxia (diminished oxygen supply). Such hypoxia may be due to alteration in the oxygen carrying power of the blood or due to interference with the normal reflex control of respiration. Tachyphoea may also arise from the association of pain with breathing as in pleurisy or peritonitis, when the breathing becomes shallow and must therefore, be more frequent to make up for the slighter expansion of the chest. Increased respiration rate or tachyphoea is an important sign of pulmonary (pertaining to lungs) diseases, which is frequently missed owing to lack of observation or inaccurate counting.
4.3.3 RATIO BETWEEN RESPIRATION AND PULSE RATE:
The ratio between respiration rate and pulse rate in health is about 1 to 4. In severe penumonia respiration rate may be equal to pulse rate. In certain cases of narcotic poisoning, the ratio may become 1 to 6 or 7.
4.3.4 THE RHYTHM OF RESPIRATION:
The rhythm of respiration varies very considerably even in health and if the act is performed consciously it may became very irregular. It should, therefore, be observed and studied when the patient is off his guard, as only then accurate observation can be made. Either inspiration for expiration may be unduly prolonged, the former being commonly associated with largyngeal or tracheal diseases, the latter with bronchial or pulmonary diseases A peculiar type, where successive respirations gradually get deeper till a maximum is reached and then fall of again untill a pause of complete apnoea occurs, to be followed by another wave of gradual deepening and then diminishing respiration is known as CHEYNE- STOKES BREATHING. The pause (apnoea) may last for fully half a minute, though usually it is often shorter, and the whole cycle is usually completed is less than two minute. It is most conspicuous when the patient, who exhibits it, is asleep or unconscious, but may be overlooked if the patient is awake and particularly so if he is talking. Cheyne-stokes breathing occurs most commonly in cardiac and renal failure, severe pneumonia, increased intracranial pressure and narcotic drug poisoning.
4. BODY TEMPERATURE
All mammals including humans are warm blooded. They all maintain a more or less constant body temperature even if it is very cold or very hot outside.
4.4.1 RECORDING OF BODY TEMPRETURE:
The human body temperature is recorded with the aid of a clinical thermometer. A clinical thermometer has an elongated bulb filed with mercury at one end and is graduated in celcius (centigrade) or Fahrenheit scale or may be both on two sides of the thermometer. While taking the temperature the following practical points must be remembered:
(a). The thermometer must be acurate.
(b). The thermometer must be kept in position long enough to allow the mercury to reach the body temperature. The ordinary half minute thermometer should be left in position for one to two minutes.
(C). Before using the thermometer make it an invariable rule to wash it in an antiseptic solution and cold water. Ensure that the mercury is well shaken down. It should be washed again before replacing it in its case.
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