Jugular Venous Pressure
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Heart Rate Information Sheet Finding Your Pulse Taking Your Pulse
Heart rate In this activity you will measure your heart rate and investigate the effect that other things have on your heart rate. Information sheet You can measure your heart (pulse) rate anywhere on your body where a major artery is close to the surface of your skin. The easiest places are: • on the front of your forearm • just above your wrist on your thumb side • on the side of your neck about half way between your chin and your ear. Finding your pulse Try to locate your pulse in one of these places, using the tips of your index and middle fingers. You should feel a gentle, regular beat. This is your heart rate. Do not use your thumb, as your thumb has a pulse of its own. Taking your pulse When you find your pulse, use a stopwatch or a watch with a second hand to count how many beats there are in a full minute (60 seconds). In most situations, taking your pulse rate over one minute will give a reasonably accurate result, but if you want to take your pulse after exercise, you should do so over a much shorter time interval. After exercise your pulse rate will be changing rapidly. To get a reasonably accurate result, start to measure the rate immediately after the exercise and count the number of beats in 10 seconds. Multiply this number by six to find your heart rate. For an adult, a normal resting heart rate is between 60–100 beats a minute. The fitter you are, the lower your resting heart beat will be. -
Heart to Heart - STEAM Activity
Heart to Heart - STEAM Activity Purpose: The main objective of this exercise is to introduce how the human heart works. This lesson will be divided into four different lessons, including an introduction to heart anatomy, heart beats and pulses, and the circulatory system. We will be using coloring activities, stethoscopes, and handmade pumps to reinforce the concepts seen in this lesson. Vocabulary ● Artery: A blood vessel that carries blood high in oxygen content away from the heart to the farthest reaches of the body. ● Vein: a Blood vessel that carries blood low in oxygen content from the body back to the heart. ● Atrium: One of the two upper cavities of the heart that passes blood to the ventricles. ● Ventricles: One of the two lower chambers of the heart that receives blood from the atria. ● Valves: Tissue-paper thin membranes attached to the heart wall that constantly open and close to regulate blood flow. ● Pulse: A rhythmical, mechanical throbbing of the arteries as blood pumps through them. ● Heart Rate: The number of times per minute that the heart contracts - the number of heart beats per minute (bpm). ● Taquicardia: A high resting heart rate that is usually higher than 100 beats per minute. ● Bradycardia: A low resting heart rate that is usually lower than 60 beats per minute. ● Circulation: The movement of blood through the vessels of the body by the pumping action of the heart. It distributes nutrients and oxygen and removes waste products from all parts of the body. ● Pulmonary Circulation: The portion of the circulatory system that carries deoxygenated blood from the heart to the lungs and oxygenated blood back to the heart. -
Blood Volume and Circulation Time in Children
Arch Dis Child: first published as 10.1136/adc.11.61.21 on 1 February 1936. Downloaded from BLOOD VOLUME AND CIRCULATION TIME IN CHILDREN BY H. SECKEL, M.D., Late of the University Children's Clinic, Cologne. This paper is based mainly on the results of the author's own research work on blood volume and circulation time in cases of normal and sick children. The following methods were used:- 1. The colorimetric method for determining the circulating plasma volume, and the haematocrit method for estimating the volume of the total circulating blood; and 2. The histamine rash method for estimating the minimum circulation time of the blood. By means of these two methods there is determined only that portion of the total blood volume which is in rapid circulation, the other part, the so-called stored or depot blood, which is moving slowly or is almost stationary, being neglected. The organs which may act as blood depots are the spleen, the liver, the intestines, the sub-papillary plexus of the skin http://adc.bmj.com/ and possibly the muscles. The greater part of the capillary system of these organs is quite extensive enough to supply stored-up blood as and when required to the more rapid circulation or alternatively, withdraw rapidly circulating blood and store it. This action is regulated by the autonomic nervous system. The circulating blood volume as de-termined by the above methods is not absolutely fixed in quantity but chatnges within wide limits, according to the physiological or pathological conditions under on September 25, 2021 by guest. -
Central Venous Pressure Venous Examination but Underestimates Ultrasound Accurately Reflects the Jugular
Ultrasound Accurately Reflects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol, Nicole Collett, Andrew Ashby and Gregory A. Schmidt Chest 2011;139;95-100; Prepublished online August 26, 2010; DOI 10.1378/chest.10-1301 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/139/1/95.full.html Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright2011by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692 Downloaded from chestjournal.chestpubs.org at UCSF Library & CKM on January 21, 2011 © 2011 American College of Chest Physicians CHEST Original Research CRITICAL CARE Ultrasound Accurately Refl ects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol , MD ; Nicole Collett , MD ; Andrew Ashby , MD ; and Gregory A. Schmidt , MD , FCCP Background: Bedside ultrasound examination could be used to assess jugular venous pressure (JVP), and thus central venous pressure (CVP), more reliably than clinical examination. Methods: The study was a prospective, blinded evaluation comparing physical examination of external jugular venous pressure (JVPEXT), internal jugular venous pressure (JVPINT), and ultrasound collapse pressure (UCP) with CVP measured using an indwelling catheter. We com- pared the examination of the external and internal JVP with each other and with the UCP and CVP. -
Central Venous Pressure: Uses and Limitations
Central Venous Pressure: Uses and Limitations T. Smith, R. M. Grounds, and A. Rhodes Introduction A key component of the management of the critically ill patient is the optimization of cardiovascular function, including the provision of an adequate circulating volume and the titration of cardiac preload to improve cardiac output. In spite of the appearance of several newer monitoring technologies, central venous pressure (CVP) monitoring remains in common use [1] as an index of circulatory filling and of cardiac preload. In this chapter we will discuss the uses and limitations of this monitor in the critically ill patient. Defining Central Venous Pressure What is the Central Venous Pressure? Central venous pressure is the intravascular pressure in the great thoracic veins, measured relative to atmospheric pressure. It is conventionally measured at the junction of the superior vena cava and the right atrium and provides an estimate of the right atrial pressure. The Central Venous Pressure Waveform The normal CVP exhibits a complex waveform as illustrated in Figure 1. The waveform is described in terms of its components, three ascending ‘waves’ and two descents. The a-wave corresponds to atrial contraction and the x descent to atrial relaxation. The c wave, which punctuates the x descent, is caused by the closure of the tricuspid valve at the start of ventricular systole and the bulging of its leaflets back into the atrium. The v wave is due to continued venous return in the presence of a closed tricuspid valve. The y descent occurs at the end of ventricular systole when the tricuspid valve opens and blood once again flows from the atrium into the ventricle. -
Practical Cardiac Auscultation
LWW/CCNQ LWWJ306-08 March 7, 2007 23:32 Char Count= Crit Care Nurs Q Vol. 30, No. 2, pp. 166–180 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Practical Cardiac Auscultation Daniel M. Shindler, MD, FACC This article focuses on the practical use of the stethoscope. The art of the cardiac physical exam- ination includes skillful auscultation. The article provides the author’s personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs. It should be used as a brief introduction to the art of auscultation. This article also attempts to illustrate heart sounds and murmurs by using words and letters to phonate the sounds, and by presenting practical clinical examples where auscultation clearly influences cardiac diagnosis and treatment. The clinical sections attempt to go beyond what is available in standard textbooks by providing information and stethoscope techniques that are valuable and useful at the bedside. Key words: auscultation, murmur, stethoscope HIS article focuses on the practical use mastered at the bedside. This article also at- T of the stethoscope. The art of the cardiac tempts to illustrate heart sounds and mur- physical examination includes skillful auscul- murs by using words and letters to phonate tation. Even in an era of advanced easily avail- the sounds, and by presenting practical clin- able technological bedside diagnostic tech- ical examples where auscultation clearly in- niques such as echocardiography, there is still fluences cardiac diagnosis and treatment. We an important role for the hands-on approach begin by discussing proper stethoscope selec- to the patient for the purpose of evaluat- tion and use. -
Toolbox-Talks--Blood-Pressure.Pdf
TOOLBOX Toolbox Talk #1 TALKS Blood Pressure vs. Heart Rate While your blood pressure is the force of your blood moving through your blood vessels, your heart rate is the number of times your heart beats per minute. They are two separate measurements and indicators of health. • For people with high blood pressure (HBP or hypertension), there’s no substitute for measuring blood pressure. • Heart rate and blood pressure do not necessarily increase at the same rate. A rising heart rate does not cause your blood pressure to increase at the same Quarter: rate. Even though your heart is beating more times a minute, healthy blood BLOOD vessels dilate (get larger) to allow more blood to flow through more easily. PRESSURE When you exercise, your heart speeds up so more blood can reach your muscles. It may be possible for your heart rate to double safely, while your blood pressure may respond by only increasing a modest amount. Talk Number: Heart Rate and Exercise 1 In discussions about high blood pressure, you will often see heart rate Blood mentioned in relation to exercise. Your target heart rate is based on age and Pressure can help you monitor the intensity of your exercise. vs. • If you measure your heart rate (take your pulse) before, during and after Heart Rate physical activity, you’ll notice it will increase over the course of the exercise. • The greater the intensity of the exercise, the more your heart rate will increase. • When you stop exercising, your heart rate does not immediately return to your normal (resting) heart rate. -
Bates' Pocket Guide to Physical Examination and History Taking
Lynn S. Bickley, MD, FACP Clinical Professor of Internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics Chief, Division of General Pediatrics University of Rochester School of Medicine and Dentistry Rochester, New York Acquisitions Editor: Elizabeth Nieginski/Susan Rhyner Product Manager: Annette Ferran Editorial Assistant: Ashley Fischer Design Coordinator: Joan Wendt Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Indexer: Angie Allen Prepress Vendor: Aptara, Inc. 7th Edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1995, 1991 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Bickley, Lynn S. Bates’ pocket guide to physical examination and history taking / Lynn S. -
1- Assessing Pain
Foundations of Assessing and Treating Pain Assessing Pain Table of Contents Assessing Pain........................................................................................................................................2 Goal:..............................................................................................................................................2 After completing this module, participants will be able to:..............................................................2 Professional Practice Gaps............................................................................................................2 Introduction............................................................................................................................................. 2 Assessment and Diagnosis of Pain Case: Ms. Ward..........................................................................3 Confidentiality..........................................................................................................................................4 Pain History: A Standardized Approach..................................................................................................4 Evaluating Pain Using PQRSTU: Steps P, Q, R, S T, and U..............................................................5 Ms. Ward's Pain History (P, Q, R, S, T, U)..........................................................................................6 Video: Assessing Pain Systematically with PQRTSTU Acronym........................................................8 -
Mosby: Mosby's Nursing Video Skills
Mosby: Mosby's Nursing Video Skills Procedural Guideline for Assessing Apical Pulse Procedure Steps 1. Verify the health care provider’s orders. 2. Gather the necessary equipment and supplies. 3. Perform hand hygiene. 4. Provide for the patient’s privacy. 5. Introduce yourself to the patient and family if present. 6. Identify the patient using two identifiers. 7. Assess for factors that can affect the apical pulse rate and rhythm, such as medical history, disease processes, age, exercise, position changes, medications, temperature, or sympathetic stimulation. 8. Gloves are only worn if nurse will be in contact with bodily fluids or the patient is in protective precautions. 9. Help the patient into a supine or sitting position, and expose the sternum and the left side of the chest. 10. Locate the point of maximal impulse (PMI, or apical impulse). To do this, find the angle of Louis, which feels like a bony prominence just below the suprasternal notch. 11. Slide your fingers down each side of the angle to find the second intercostal space (ICS). Carefully move your fingers down the left side of the sternum to the fifth intercostal space and over to the left midclavicular line. 12. Feel the PMI as a light tap about 1 to 2 centimeters in diameter, reflecting the apex of the heart. 13. If the PMI is not where you would expect, as in a patient whose left ventricle is enlarged, inch your fingers along the fifth intercostal space until you feel the PMI. 14. Remember where you felt the PMI: over the apex of the heart in the fifth intercostal space at the left midclavicular line. -
Auscultation of Abdominal Arterial Murmurs
Auscultation of abdominal arterial murmurs C. ARTHUR MYERS, D.O.,° Flint, Michigan publications. Goldblatt's4 work on renal hyperten- sion has stimulated examiners to begin performing The current interest in the diagnostic value of ab- auscultation for renal artery bruits in their hyper- dominal arterial bruits is evidenced by the number tensive patients. of papers and references to the subject appearing in Stenosis, either congenital or acquired, and aneu- the recent literature. When Vaughan and Thoreki rysms are responsible for the vast majority of audi- published an excellent paper on abdominal auscul- ble renal artery bruits (Fig. 2). One should be tation in 1939, the only reference they made to highly suspicious of a renal artery defect in a hy- arterial murmurs was that of the bruit of abdominal pertensive patient with an epigastric murmur. Moser aortic aneurysm. In more recent literature, however, and Caldwell5 have produced the most comprehen- there is evidence of increased interest in auscultat- sive work to date on auscultation of the abdomen ing the abdomen for murmurs arising in the celiac, in renal artery disease. In their highly selective superior mesenteric, splenic, and renal arteries. series of 50 cases of abdominal murmurs in which The purpose of this paper is to review some of aortography was performed, renal artery disease the literature referable to the subject of abdominal was diagnosed in 66 per cent of cases. Their con- murmurs, to present some cases, and to stimulate clusions were that when an abdominal murmur of interest in performing auscultation for abdominal high pitch is found in a patient with hypertension, bruits as a part of all physical examinations. -
Medical Staff Medical Record Policy
Number: MS -012 Effective Date: September 26, 2016 BO Revised:11/28/2016; 11/27/2017; 1/22/2018; 8/27/2018 CaroMont Regional Medical Center Author: Approved: Patrick Russo, MD, Chief-of-Staff Authorized: Todd Davis, MD, EVP, GMO MEDICAL STAFF MEDICAL RECORD POLICY 1. REQUIRED COMPONENTS OF THE MEDICAL RECORD The medical record shall include information to support the patient's diagnosis and condition, justify the patient's care, treatment and services, and document the course and result of the patient's care, and services to promote continuity of care among providers. The components may consist of the following: identification data, history and physical examination, consultations, clinical laboratory findings, radiology reports, procedure and anesthesia consents, medical or surgical treatment, operative report, pathological findings, progress notes, final diagnoses, condition on discharge, autopsy report when performed, other pertinent information and discharge summary. 2. ADMISSION HISTORY AND PHYSICAL EXAMINATION FOR HOSPITAL CARE Please refer to CaroMont Regional Medical Center Medical Staff Bylaws, Section 12.E. A. The history and physical examination (H&P), when required, shall be performed and recorded by a physician, dentist, podiatrist, or privileged practitioner who has an active NC license and has been granted privileges by the hospital. The H&P is the responsibility of the attending physician or designee. Oral surgeons, dentists, and podiatrists are responsible for the history and physical examination pertinent to their area of specialty. B. If a physician has delegated the responsibility of completing or updating an H&P to a privileged practitioner who has been granted privileges to do H&Ps, the H&P and/or update must be countersigned by the supervisor physician within 30 days after discharge to complete the medi_cal record.