VITAL SIGNS AND JUGULAR VENOUS PRESSURE Dr.

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. 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

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)

VITAL SIGNS AND JUGULAR VENOUS PRESSURE Dr. Esther Estrellado -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 Y wave After S1 Decline in atrial pressure when the tricuspid valve opens

A wave Atrial contraction Most prominent when patient inspires Occurs before S1

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.

Made up of WAVES: This is observed during auscultation.

Kussmaul sign

VITAL SIGNS AND JUGULAR VENOUS PRESSURE Dr. Esther Estrellado 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