fundamental of nursing

2. Physiology and regulation (conduction
system of heart)

3. Function of conducting system of the
Heart
Responsible for generating rhythmical cardiac impulses
Conducting this impulses rapidly throughout the myocardium of the
heart
Thus it aids in coordinated and efficient contraction of different
chambers of the heart.

4. Physiology and regulation

5. Physiology and regulation
An excitation
signal (an
action
potential) is
created by SA
node
Spreads
across the
atria, causing
them to
contract
AV node
receives
impulses from
SA node and
sends
impulses to
bundle of His
Spreads the
wave
impulses
along the
ventricles,
causing them
to contract
Aretrial wall
expand to
compensate
for the
increase in
pressure
with the
ventricular
diastole,
arterial walls
return to
original
status
Expansion and retraction of the
aorta sends a waves through the
walls of the arterial system that
can be felt as a light tap on
palpation Pulse

6. Physiology and regulation

7. Hear rate
• One complete sequence of contraction and relaxation of the heart is
known as heart beat.
• Hear rate is the number of times a person`s heart beats per minute. The
average normal heart rate at rest for adult ranges from 60-100b/min.

8. pulse
• The regular expansion of an artery caused by the ejection of blood into
the arterial system by the contraction of the heart is known as pulse.

9. pulse
 Generally the pulse wave represents the stroke volume output and the
amount of blood that enters the arteries with each ventricular
contraction.
Stroke volume: the volume of blood pumped out of the left ventricle of
the heart during each systolic cardiac contraction.

10. pulse
 Pulse is the wave of expansion and recoil occurring in an artery in
response to the pumping action of the heart.
 The pulse is a wave of blood created by contraction of the left
ventricle of the heart.”

11. Characteristic
1. Rate:
 Number of pulse beats per minute.
 A normal resting heart rate for adults ranges from 60 to 100 beats per
minute.

12. Characteristic
1. Rate:
 Two common abnormalities in pulse rate are tachycardia and
bradycardia.
 Tachycardia is an abnormally elevated HR, above 100beats/min in
adults. Bradycardia is a slow rate, below 60 beats/min in adults.

13. Characteristic
2. Rhythm
 The regularity of the pulse.
 An interval interrupted by an early or late beat or a missed beat
indicates an abnormal rhythm or dysrhythmia.
 Pulse should be counted for one full minute to detect dysrhythmia.

14. Characteristic
3. Strength:
 The strength or amplitude of a pulse reflects the volume of blood ejected against
the arterial wall with each heart contraction
 It can be either full or weak.
 Normal amount of blood in artery causes the pulse to be full.
 If the amount of blood in artery is decreased , the pulse becomes feeble thready or
weak

15. Characteristic
4. Tension:
 Degree of compressibility and depends upon the resistance of the wall of the
artery.

17. Factors affecting pulse

18. Factors affecting pulse
• As age increases, the pulse rate gradually decreases
1. Age
• Females have slightly higher pulse rate than males
2.Sex
• It is much higher during exercise
3.Exercise

19. Factors affecting pulse
• When body temperature is elevated, the pulse rate usually increases
4. Fever
• Some medications decrease the pulse rate, and others increase.
5. Medication
• Loss of blood from the vascular system increase the pulse rate.
6. Hypovolemia/dehydration

20. Factors affecting pulse
• Increases the rate as well as the force of the heartbeat.
7. Stress
• Slow while lying down and rapid while standing
8. Position
9. Disease condition

22. Peripheral and Apical pulse
 A peripheral pulse is a pulse located away from the heart, for example,
in the foot or wrist.
 The apical pulse, in contrast, is a central pulse; that is, it is located at
the apex of the heart. It is also referred to as the point of maximal
impulse

24. Sites of pulse

26. Sites of pulse

27. Sites of pulse

28. Sites of pulse

29. Sites of pulse

30. Sites of pulse

31. Sites of pulse

32. Sites of pulse
Dorsalis pedis

33. Reasons for using specific pulse site

35. Scientific principles for taking pulse
Exercise, emotions and anxiety will cause increased pulse rate so take pulse when
the patient is at rest.
There is pulsation in the thumb, which may mistaken for patient`s pulse so thumb
is not used to count pulse.
Count the pulse for one full minute, especially when there is irregularity.
Always assess rate, rhythm, volume and tension of the pulse.

36. Scientific principles for taking pulse
Choose suitable site for taking pulse.
Nurses to be aware if patient is on medication that can interfere with heart rate.
Always note the apical pulse for patients with cardiovascular disease, on cardiac
medications and critically ill.

38. procedure

39. procedure

40. procedure

41. procedure
• Place 2 or 3 fingers tips lightly over pulse site.
• Do not use thumb, because it has its own pulse that you may feel.

42. procedure

43. procedure
 Assess for rate, rhythm, amplitude and any other observations.
 Inform patient`s finding.

44. procedure

45. procedure

46. report
 Pulse rate (Above or Below Normal)
 Value specific to client.
 Irregular pulse rhythm
 Weak or feeble pulse.

47.  Date
 Time
 Pulse rate
 Rhythm
 Strength
 Any other abnormalities.

48. Special consideration
• Never press both carotids at the same time, as this cause reflex drop in blood
pressure.
• Carotid pulse is used for victims of shock and cardiac arrest when pulse is not
palpable at other sites.
• When the patients are in digitalis treatment, count pulse before giving the drug.
• The pulse should not be taken immediately after exercise, in emotional stress or
during and after painful treatment.
• Encourage client to relax.