
By Springhouse
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Sample text
Checking radial pulse If you suspect cardiac disease, palpate for 1 full minute to detect arrhythmias. Normally, an adult’s pulse ranges from 60 to 100 beats/minute. Its rhythm should feel regular, except for a subtle slowing on expiration, caused by changes in intrathoracic pressure and vagal response. Note whether the pulse feels weak, normal, or bounding. Abnormal findings A weak pulse may indicate increased peripheral vascular resistance or decreased stroke volume. A bounding pulse can indicate increased stroke volume, as with aortic insufficiency, or stiffness of arterial walls.
Emotional stress caused by physical examination may elevate blood pressure. If the patient’s blood pressure is high, allow him to relax for several minutes and then measure again to rule out stress. When assessing a patient’s blood pressure for the first time, take measurements in both arms. If blood pressure is elevated in both arms, measure the pressure in the thigh. qxd 8/17/08 4:03 PM Page 31 P E R F O R M I N G A C A R D I O VA S C U L A R A S S E S S M E N T above the knee. Place the stethoscope over the popliteal artery, located on the posterior surface slightly above the knee joint.
It’s lowpitched and dull. S1 occurs at the beginning of ventricular systole. It may be split if the mitral valve closes just before the tricuspid. Abnormal findings Auscultation may detect S1 and S2 that are accentuated, diminished, or inaudible. These abnormalities may result from pressure changes, valvular dysfunctions, and conduction defects. A prolonged, persistent, or reversed split sound may result from a mechanical or electrical problem. Auscultation may also reveal an S3, an S4, or both.