6) Pulse & BP

radial pulse

• on wrist along thumb side

• palpate for amplitude/strength of pulse, rhythm of pulse, and rate of pulse

brachial pulse

• medial aspect/inside of elbow

• anterior & posterior compartment of arm

carotid pulse

1. Adams apple → (laterally) sternomastoid muscle

2. angle of mandible moving inferiorly

blood pressure

• stethoscope ear pieces angled away from you

• diaphragm side

• legs and back supported while we support the arm

• 1st sound = systolic

• last sound = diastolic

yes

should BP be routinely assessed in an otherwise healthy, asymptomatic individual w a common musculoskeletal complaint?

yes

should BP be routinely assessed in an patient post stroke

yes

should BP be routinely assessed in an patient w heart failure?

too small = greater BP
too large = smaller BP

what are the potential impacts of inappropriate cuff size on the accuracy of BP assessment?

the vertical lines up with index mark

how can you ensure that the cuff is of appropriate size

• seated

• resting for 5 min prior to BP

• feet flat on floor

• legs not crossed

• back supported

• arm @ level w heart & supported

how should the pt be positioned when assessing BP

systolic

• top number

• heart contracting = blood rushes to aorta

diastolic

• bottom number

• ventricles contracting

• pulse = 60-100

• respirations = 12-10

• BP = 120/80

avg vitals

rate, rhythm, & amplitude

what is measured in pulse

• increase in a linear fashion

• increase

we expect that vitals should ______ during exercise and _____ after exercise

really always but before exercise and after and maybe even a little later to ensure vitals are responding properly to work, the patient is safe, and that the patient is truly working

when should PTs assess vital signs and why

• super high or super low = medical emergency

• chest pain

• light headed

• pale

• exhausted

• shortness of breath

• blurred vision

• severe headache

what vital sign values and or conditions would cause you to pause rather than initiate or continue treatment

We know the aerobic “dose” is appropriate if the person shows gradual cardiovascular improvements, recovers well, and tolerates progressive overload.

It’s excessive if it causes maladaptation signs like persistent fatigue, abnormal physiological responses, or injury.

how do we know that our “dose” of aerobic activity is appropriate to induce adaptation in the cardiovascular and or pulmonary systems? what would indicate that our dose was too excessive

0. at rest

1. very easy

2. somewhat easy

3. moderate

4. somewhat hard

5. hard

6. …

7. very hard

8. …

9. …

10. very, very hard

rating of perceived exertion (RPE)

normal BP

less than 120, less than 80

elevated BP

120-129 & less than 80

high BP / HTN stage 1

130-139 OR 80-89

high BP / HTN stage 2

140 or higher OR 90 or higher

hypertensive crisis

higher than 180 and/or higher than 120