Pulse and Abnormalities
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Questions and Answers

In the context of respiration, what is the term for normal breathing?

  • Eupnea (correct)
  • Tachypnea
  • Bradypnea
  • Hyperpnea
  • Which of the following best describes internal respiration?

  • The act of breathing in oxygen and giving out carbon dioxide
  • Breathing that occurs only in upright positions
  • The exchange of gases between the blood and the tissues (correct)
  • The exchange of gases between the alveoli and the blood
  • What condition is characterized by rapid, deep breathing?

  • Cheyne-Stokes respiration
  • Kussmaul breathing (correct)
  • Air hunger
  • Orthopnea
  • What is the range for a normal pulse pressure?

    <p>40 mmHg (D)</p> Signup and view all the answers

    If a blood pressure cuff is too narrow for the patient's arm, what is a likely consequence?

    <p>A falsely high reading (A)</p> Signup and view all the answers

    Why is the thumb not used to assess a pulse?

    <p>The thumb contains vessels that can interfere with accurate pulse readings. (D)</p> Signup and view all the answers

    Which pulse rate is classified as bradycardia in an adult?

    <p>50 beats per minute (C)</p> Signup and view all the answers

    Besides the radial artery, which is another common site for pulse assessment?

    <p>Temporal artery (B)</p> Signup and view all the answers

    Why should both carotid arteries not be pressed simultaneously?

    <p>It can cause a reflex drop in blood pressure and pulse. (D)</p> Signup and view all the answers

    In which situation would the brachial or femoral artery be the most appropriate for pulse assessment?

    <p>With cardiac arrest in infants. (D)</p> Signup and view all the answers

    When should a pulse be counted for a full minute instead of a shorter period?

    <p>When assessing infants and young children. (A)</p> Signup and view all the answers

    What is a 'water hammer' pulse indicative of?

    <p>Aortic regurgitation. (C)</p> Signup and view all the answers

    What is the characteristic feature of a 'paradoxical pulse'?

    <p>A pulse that feels weaker when the client inhales. (D)</p> Signup and view all the answers

    What is the recommended width of a blood pressure bladder for an adult limb?

    <p>13 cm (A)</p> Signup and view all the answers

    What percentage of the limb circumference should the length of the bladder be when taking a blood pressure reading?

    <p>80% (B)</p> Signup and view all the answers

    In what circumstance should a blood pressure reading NOT be taken from a patient's arm?

    <p>The patient is receiving an IV infusion (D)</p> Signup and view all the answers

    How is diastolic blood pressure identified when using the auscultatory method?

    <p>When the fourth Korotkoff sound just disappears (C)</p> Signup and view all the answers

    What is the typical infusion time for one unit of packed red blood cells (PRBCs)?

    <p>2-4 hours (A)</p> Signup and view all the answers

    Approximately how much can one unit of transfused packed red blood cells (PRBCs) be expected to raise a patient’s hemoglobin level?

    <p>1 gm/dL (A)</p> Signup and view all the answers

    What is the recommended storage temperature for fresh frozen plasma (FFP)?

    <p>-40°C (A)</p> Signup and view all the answers

    Which blood product does NOT require cross-matching before administration?

    <p>Platelets (C)</p> Signup and view all the answers

    In which of the following patient conditions should blood salvage NOT be considered?

    <p>A patient with active leukemia and bacteremia (D)</p> Signup and view all the answers

    How soon after the start of blood transfusion is a blood donation from the patient acceptable, according to the content?

    <p>Within 5 weeks of transfusion (C)</p> Signup and view all the answers

    What is the most appropriate size of cannula (gauge) used to administer a blood transfusion?

    <p>18G (D)</p> Signup and view all the answers

    Which intravenous solution is the ONLY one that can be administered alongside or mixed with blood products?

    <p>Normal saline 0.9% (A)</p> Signup and view all the answers

    How soon after receiving blood from the blood bank should that blood be administered? (according to the text)

    <p>Within 30 minutes (A)</p> Signup and view all the answers

    What is the priority nursing action during a suspected immediate transfusion reaction?

    <p>Stop the transfusion immediately (D)</p> Signup and view all the answers

    When should vital signs be monitored initially during a blood transfusion?

    <p>Before, every 15 minutes for the first 15 minutes, then every 30 minutes for the next half hour, then hourly (A)</p> Signup and view all the answers

    Which sign is NOT associated with circulatory overload from blood transfusions, according to the document?

    <p>Hypotension (A)</p> Signup and view all the answers

    Flashcards

    What is a pulse?

    The expansion and recoil of an artery caused by the wave of blood pushed by the left ventricle's contraction.

    What is the normal pulse rate for adults?

    The normal range of heartbeats per minute for an adult is between 60 and 100 beats per minute.

    What is tachycardia?

    A pulse rate faster than 100 beats per minute.

    What is bradycardia?

    A pulse rate slower than 60 beats per minute.

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    What is a bounding pulse?

    A strong, forceful pulse. Often seen in conditions like increased cardiac output.

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    What is a weak or thready pulse?

    A weak pulse, often thin and difficult to feel. It can indicate conditions like heart failure or shock.

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    What is a paradoxical pulse?

    A pulse that weakens with each breath. It's a sign of a problem with the heart and lungs.

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    What is pulsus alternans?

    A pulse with alternating strong and weak beats. It's an irregular heartbeat.

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    Internal Respiration

    The exchange of gases between the blood and the tissues in the body.

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    External Respiration

    The exchange of gases between the alveoli of the lungs and the blood.

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    Eupnea

    A normal rate of breathing, typically between 12 and 20 breaths per minute.

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    Tachypnea

    Rapid breathing, usually above 24 breaths per minute.

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    Bradypnea

    Slow breathing, usually below 10 breaths per minute.

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    What is a blood transfusion?

    A blood transfusion is a routine medical procedure where donated blood is given to a patient through an IV line.

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    What are Packed Red Blood Cells (PRBCs) used for?

    Packed red blood cells (PRBCs) are blood cells used to replace erythrocytes in cases of anemia. They are typically given when a patient's hemoglobin level is below 7 gm/dl.

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    What are Platelets used for?

    Platelets are used to treat thrombocytopenia (low platelet count) and platelet dysfunction.

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    What is Fresh Frozen Plasma (FFP) used for?

    Fresh Frozen Plasma (FFP) can be used to provide clotting factors or expand blood volume. It doesn't contain platelets.

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    What is Cryoprecipitate and what is it used for?

    Cryoprecipitate is a concentrated clotting factor derived from fresh frozen plasma.

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    What is autologous blood donation?

    This type of blood donation involves a person donating their own blood before a scheduled procedure.

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    How are the systolic and diastolic blood pressures determined during an auscultatory measurement?

    The systolic blood pressure is the pressure when the first Korotkoff sound is heard, while the diastolic pressure is the pressure when the fourth Korotkoff sound is just barely audible.

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    What are the ideal width and length of a blood pressure bladder?

    The width of a bladder should be 40% of the limb's circumference at the midpoint, and the length should be 80% of the limb's circumference.

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    What is blood salvage?

    A type of blood transfusion where the patient receives their own blood, which may be collected from the body's cavities or washed.

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    What is a designated donor?

    When a recipient chooses their own compatible blood donor for a transfusion.

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    Why is an 18 gauge cannula used for blood transfusion?

    An 18 gauge cannula is used for administering blood transfusions due to its ability to provide sufficient flow rate for a blood transfusion.

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    What is the only solution compatible with blood transfusion?

    Only normal saline (0.9%) is compatible with blood for transfusion, as other solutions can cause reactions.

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    When should the blood transfusion set be changed?

    Blood transfusion set should be changed after each unit of blood to prevent contamination and infection.

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    What is the time limit for administering blood after receiving it from the blood bank?

    Blood transfusion should be administered within 30 minutes of receiving it from the blood bank to maintain blood quality.

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    What is a transfusion reaction and what are the signs?

    Blood transfusion reaction is a serious adverse event during a blood transfusion, characterized by chills, chest pain, rashes, itching, rapid pulse and changes in breathing difficulties, pallor, and cyanosis. The reaction is an immune response by the recipient's body to the transfused blood.

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    What is circulatory overload and what are the signs?

    Circulatory overload is a condition that occurs when the body receives too much blood quickly, leading to fluid overload, elevated blood pressure, and breathing difficulties.

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    Study Notes

    Pulse

    • Pulse is the alternating expansion and recoil of an artery as blood flows through it during the contraction of the left ventricle.
    • Pulse can be felt by the finger, not the thumb due to vessels in the thumb.
    • Normal adult pulse rate is 60-100 beats per minute.
    • Tachycardia is a heart rate over 100 bpm.
    • Bradycardia is a heart rate under 60 bpm.
    • Common pulse assessment sites include radial (most common), temporal, carotid, brachial, femoral, popliteal, dorsalis pedis, posterior tibial, and apical (5th intercostal space, left midclavicular line).
    • Avoid pressing both carotid arteries simultaneously, as this can cause a drop in blood pressure.
    • Cardiac and brachial/femoral arteries are used for assessing pulse in shock/cardiac arrest victims, especially in infants.

    Abnormal Pulse Volumes

    • Water hammer pulse (Corrigan's pulse/collapsing pulse) is a strong throbbing pulse, signifying aortic regurgitation.
    • Bounding pulse is a strong throbbing pulse indicating increased cardiac output.
    • Bigeminal pulse is an irregular pulse where alternating beats are weaker, often due to weak ventricular contractions.
    • Weak wiry/thread pulse indicates decreased stroke volume, possibly from heart failure, heat exhaustion, or shock.
    • Paradoxical pulse weakens on inhalation, usually due to heart conditions.
    • Pulses alternans are regular, but the strength of the pulse alternates, meaning it is strong one beat and weak the next.

    Respiration

    • Normal respiration (eupnea) is the act of breathing, taking in oxygen and releasing carbon dioxide.
    • Tachypnea/Polypnea is a respiratory rate over 24 breaths per minute.
    • Bradypnea is a respiratory rate under 10 breaths per minute.
    • Apnea is the cessation of breathing.
    • Hyperpnea involves increased breathing depth.
    • Orthopnea: breathing only in an upright position.
    • Stertorous respiration is noisy breathing from secretions.
    • Rales/Rhonchi are rattling sounds caused by mucus in the airways (e.g., bronchitis, pneumonia).
    • Wheezing is a high-pitched whistling sound (e.g., asthma).
    • Sighs are deep inhalations followed by prolonged exhalations.
    • Air hunger is deep sighing respiration accompanied by shortness of breath.
    • Cheyne-Stokes respiration is hyperpnea with periods of apnea.
    • Kussmaul breathing is rapid, deep breathing.

    Blood Pressure

    • Blood pressure (BP) is the force of blood against artery walls.
    • Systolic BP is the highest pressure during ventricular contraction.
    • Diastolic BP is the lowest pressure during ventricular relaxation.
    • Normal BP is 120/80 mmHg.
    • Mean arterial pressure (MAP) is calculated as systolic pressure + 2 x diastolic pressure. A normal MAP is between 70-100 mmHg.
    • Pulse pressure = systolic blood pressure - diastolic blood pressure; normal is approximately 40 mmHg.
    • Cuff size should be 20% greater than the limb diameter, with bladder width at 40% of the circumference and length at 80%.
    • Avoid taking BP on an arm with an IV, injury, fistula, mastectomy, or paralysis.

    Blood Transfusion

    • Blood transfusion is the transfer of donated blood into a patient through an IV line.
    • Packed red blood cells (PRBCs) are used to treat anemia.
    • Infusion time for one unit is 2-4 hours.
    • Blood is usually stored for 35-42 days at 1-6°C.
    • Platelets are used to treat thrombocytopenia and platelet dysfunction and stored at 22°C for 7 days.
    • Cross-matching is usually done prior to transfusion, but is not always necessary.
    • Infusion time should usually be 15-30 minutes, if cross-match is performed, however it can take longer depending on the needs of the patient.
    • Fresh frozen plasma (FFP) provides clotting factors and volume. FFP is stored at -40°C for 1 year.
    • Cryoprecipitate is used to replace clotting factors and is also stored at -40°C for 1 year.
    • Administration should take 15-30 minutes.

    Blood Transfusion Complications and Issues

    • Transfusion reactions (e.g., chills, rash, cyanosis, dyspnea, chest pain, fever) are dangerous and necessitate immediate intervention (stop the transfusion).
    • Circulatory overload can occur due to rapid blood infusion, characterized by symptoms like dyspnea, cough, and hypertension. Slowing the transfusion rate is crucial.
    • Septicemia (blood poisoning) is possible with contaminated blood.
    • Iron Overload is possible and may be treated with deferoxamine (chelation).
    • Hypocalcemia: citrate in transfused blood binds calcium and it's excreted, thus it's important to monitor calcium levels before and after the blood transfusion.
    • Hyperkalemia: assess pre- and post-transfusion potassium levels, especially with older blood (older blood is more likely to have undergone hemolysis, which releases K+).
    • Disease transmission risks (hepatitis B/C, HIV) are considerations with blood transfusions.

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    Description

    This quiz covers the basics of pulse, focusing on its definition, normal rates, and key assessment sites. It also delves into abnormal pulse volumes such as water hammer and bounding pulses, highlighting their significance in medical conditions. Test your knowledge on identifying and understanding pulse characteristics and their implications.

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