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Cardiovascular Assessment: Cardiac Output Blood Pressure Systolic / Diastolic Pulse Perfusion

This document outlines how to assess the cardiovascular system, including measuring blood pressure, pulse, and perfusion. Key aspects are normal ranges for systolic and diastolic blood pressure, factors that affect stroke volume and cardiac output, and signs of adequate or inadequate perfusion.

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eliseudesafate
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267 views39 pages

Cardiovascular Assessment: Cardiac Output Blood Pressure Systolic / Diastolic Pulse Perfusion

This document outlines how to assess the cardiovascular system, including measuring blood pressure, pulse, and perfusion. Key aspects are normal ranges for systolic and diastolic blood pressure, factors that affect stroke volume and cardiac output, and signs of adequate or inadequate perfusion.

Uploaded by

eliseudesafate
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Cardiovascular Assessment

 Cardiac Output
• Blood Pressure
–Systolic / Diastolic
• Pulse
 Perfusion
Blood Pressure
 Systolic - Normal 95 - 140 mmHg
 Diastolic - Normal 60 - 90 mmHg
 Children vary with age
 Neonate 60 - 90 over 30 - 60
mmHg
Systolic

 Maximum pressure exerted on


arterial wall during ventricular
contraction
Diastolic

 Pressure in vasculature during


ventricular relaxation
Indirect Blood Pressure
Measurement via Cuff
 Wrap blood pressure cuff around
upper arm
 Auscultate over artery in
antecubital fossa
 Inflate cuff rapidly
 Deflate cuff slowly while listening
Mechanism
 Cuff inflated - occludes artery - no
sound
 Slowly deflate cuff - first sound =
systolic
 Continue to deflate cuff until sound
disappears = diastolic
 Tapping sounds heard with each
heart beat called Korotkoff’s sounds
(Ko rot kof)
Technique
 Usually use non-dominant arm
 Inflate to approx 160 mmHg
 Drop pressure approximately 3
mmHg/sec
 Standard adult cuff 5 inches wide
 Pediatric 3 inches wide
Sources of Error Resulting in
High BP Measurements
 Cuff too narrow
• Width of cuff approx 40% circumference
of arm
 Applied too tight or too loose
 Excessive cuff pressure
• should start 30 mmHg above systolic
 Pressing stethoscope too tightly over
artery will affect diastolic pressure
Hypertension
 BP persistently > 140-160 / 90
 Secondary means cause is known
• May be a side-effect of medication

 Primary Hypertension means cause


is unknown
Hypotension
 BP < 95 / 60
 Late sign of hypovolemia, cardiac
failure, shock
 90 / 60 not uncommon in young
females
Low blood pressure results in
inadequate perfusion
 Brain
 Heart - (70% coronary artery
perfusion occurs during diastole)
(Diastolic pressure < 50 mmHg
compromises perfusion of heart)
 Kidneys
Low blood pressure a late sign
of circulatory problems

 Normal compensatory mechanisms


maintain blood pressure initially
 When these fail - pressure falls
Use blood pressure to
calculate Mean Arterial
Pressure
 S-D+D
3
 MAP is average pressure for circulation
 Indicator of adequate tissue perfusion
 Normally 70 - 105; 90 average
Mean arterial pressure (MAP)

 MAP < 60 mmHg inadequate


 Resistance = Pressure gradient /
Flow
 or re-arranged: MAP = C.0. x SVR
Two factors determine blood
pressure

 Cardiac output = stroke volume x


heart rate
 Systemic vascular resistance (SVR)
Stroke Volume (SV) determined
by

 Preload
 Contractility
 Afterload
Increased Preload Increases
SV
 Preload = filling volume of ventricles
 Increased blood volume stretches
muscle fibers
 Increases strength of contraction
 Requires longer time for ventricular
filling
Increased Contractility
Increases SV
 Contractility = force of muscle
contraction
 No change in muscle fiber length
 Increase force of contraction over
same time period
 Inotropic drugs
Decreased Afterload Increases
SV
 Afterload = resistance ventricles
contract against
 Primarily systemic vascular
resistance
 Systemic vasodilation reduces
afterload
Factors afftecting Systemic
Vascular Resistance

 Radius of arterioles
 Blood volume
 Blood viscosity (Hematocrit)
Factors affecting Cardiac Output
primarily affect systolic blood
pressure
 Ex. Exercise using large muscle mass
(legs) will require increase in cardiac
output to supply more oxygen to
working muscles
 Will see an increase in systolic
 Diastolic will stay the same or
decrease since arteries of large
muscle mass dilated
Factors affecting Systemic
Vascular Resistance will primarily
affect diastolic pressure
 Ex. Exercise using small muscle
mass (arms)
 Vasoconstriction of large muscle
mass not being used
 Vasoconstriction increases
vascular resistance
 Diastolic will increase
Maximal Heart Rate correlates
with Maximal O2 Consumption
 HR max = 220 - age
 75% HR max ------ 60 % VO2 max
 80 ------- 70
 90 ------- 82

 Aerobic exercise 75 - 80% HR max


Heart Rate or Pulse - Evaluate
for
 Rate
 Rhythm
 Strength
Normal Heart Rate

 60 - 100 Adults
 90 - 120 Children
 70 - 170 Newborns
 < normal = bradycardia
 > normal = tachycardia
Tachycardia

 One of the cardinal signs of hypoxemia


 Increasing heart rate increases cardiac
output
 Increase oxygen delivery to tissues
Increasing HR increases C.O.

 Until HR > 150


 C.O. decreases due to inadequate
filling time
Rhythm
 Regular or irregular
 Irregular beat may
indicate arrhythmias
Strength
 Bounding?
• Arteriosclerosis
 Weak and thready?
• shock
Pulsus Paradoxus
 Strength decreases with
spontaneous inhalation
 Increases with exhalation
 normal unless extreme
 Common in COPD
 Seen in 50% patients with
pericarditis
Pulsus Alterans

 Alternating strong and weak pulses


 May be sign of left ventricular
failure
 Not related to respiratory disease
Pulse Pressure
 Systolic - Diastolic
 Normal 35 - 40 mmHg
 < 30 mmHg pulse hard to detect
 Decreasing pulse pressure early
sign of inadequate circulating
blood volume
Can estimate systolic blood
pressure if can palpate

 Carotid pulse - then systolic is at


least 60 mmHg
 Femoral 70 mmHg
 Radial 80 mmHg
Pulse sites
 Radial
 Brachial
 Carotid
 Femoral
 Dorsalis pedis
Check radial pulse before and
after administering therapy
 Aerosol medication may produce
side-effects
 First cardinal sign of hypoxemia is
tachycardia
 After taking pulse, continue
palpating pulse as count respiratory
rate
Assessment of Perfusion
(microcirculation)
 Peripheral skin temperature
• cold extremities indicate reduced
perfusion
 Urine Output
• one of the best indicators of C.O.
and arterial pressure
• < 20 ml/ hr oliguria ( o lig uria)
 Sensorium
• Brain sensitive to lack of oxygen
and/or lack of glucose
• Both depend on blood supply to
the brain - perfusion
• Confusion may signal inadequate
perfusion or hypoxemia
Determine patient’s level of
consciousness (LOC)
 Oriented to person - know who they
are
 Oriented to place - know where they
are
 Oriented to time - know what today is,
what year
 Will typically see “Alert and oriented
to PPT” in chart
Summary
 Patient assessment includes
evaluating patient’s cardiovascular
system
• Cardiac Output
• BP/Pulse
• Perfusion
 Many of the therapeutic
interventions of respiratory care will
affect the cv system

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