Pulse Rate Factors and Influences

• Vital signs are measurements of the body's basic functions.
• Medical professionals routinely monitor body temperature, pulse rate, respiration rate (rate of breathing), and blood pressure.

Pulse Rate

• Counting heartbeats per minute is how pulse is measured.
• Normal resting pulse rate for the average adult is 60 to 100 bpm.
• Athletes tend to have lower resting heart rates because exercise strengthens the heart muscle.
• This allows more blood to be pumped with each beat.
• This requires fewer beats per minute to deliver the same amount of oxygen.
• Lower resting heart rate is a sign of good cardiovascular health.
• Average resting heart rates based on age:
  • Children (ages 6 to 15): 70 to 100 bpm
  • Adults (ages 18 and older): 60 to 100 bpm
• Factors that influence pulse rate:
  • Age
  • Children usually have higher pulse rates (Infants and toddlers: between 100 and 160 bpm, Adults: between 60 and 100 bpm)
  • As people age, hearts become less efficient leading to a slightly higher resting pulse rate than younger people
  • Health
  • Such as cardiovascular health, high blood pressure, heart disease, or arrhythmias can cause abnormal pulse rates (faster or irregular pulse)
  • Fitness Level
  • Healthy and active individuals often have lower resting pulse rates due to better cardiovascular conditioning
  • Regular exercise strengthens the heart, which allows more efficient pumping with each heartbeat, leading to a lower heart rate
  • Illness or Fever
  • Can cause an elevated pulse rate as the body deals with fighting off the condition
  • Lifestyle
  • Regular physical activity and aerobic exercise can reduce resting pulse rate Exercise results in lower resting heart rates due to the heart's increased efficiency
  • Stress and Emotions:
  • Activation of the sympathetic nervous system leads to an increased heart rate known as the "fight or flight" response Chronic stress/anxiety can also contribute to increased pulse rates
  • Substances
  • Caffeine, alcohol and nicotine
  • Stimulants like caffeine can temporarily elevate heart rate
  • Alcohol and nicotine may have immediate and long-term effects
  • Sleep
  • Body's parasympathetic nervous system dominates, which leads to a slower heart rate
  • Sleep deprivation or poor sleep quality can result in a higher resting pulse rate during waking hours

Pulse Points

• Most common pulse points for taking a pulse:
• Brachial: Inner upper arm
• Radial: Each wrist
• Carotid: Side of the neck
• Palpable spots for pulse:
• Below the jaw angle, beside the trachea
• Bottom of the wrist, near the base of the thumb
• At the apex of the heart
• Below the inguinal ligament, or the groin crease
• Back of the knee
• Along the top of the cheekbone
• Inner side of the bicep muscle
• Inside of the ankle
• Top of the foot
• Peripheral Pulse: found at sites away from the heart, typically in the arms and legs.
• Radial Pulse: wrist on the thumb side, used for routine checks
• Brachial Pulse: inside of the upper arm, often used in infants or for blood pressure measurements.
• Femoral Pulse: groin area, used in emergency situations or when other peripheral pulses are weak.
• Dorsalis Pedis Pulse: top of the foot, often checked in patients with vascular concerns.

Significance of Pulses

• Peripheral pulses help assess circulation in the limbs, which is used when evaluating blood flow or detecting signs of peripheral artery disease.

Equipment

• Watch or Timer: used to measure time in beats per minute (BPM)
• Alcohol Swabs (optional): to disinfect areas before palpating.
• Pen and Paper or Digital Device (optional): to record the pulse rate if needed.
• Stethoscope: Helps listen to the heartbeats, often used by healthcare professionals.
• Sphygmomanometer: Blood pressure monitor that also measures pulse rate as part of the reading.
• Pulse Oximeter: to measure pulse rate and oxygen levels.
• Heart Rate Monitor: chest strap or wristband, useful during exercise.
• Smartwatches and Fitness Trackers: containing heart rate monitoring functions.

Pulse Oximeters

• A pulse oximeter is a small device that clips onto a finger to measure pulse rate and oxygen levels.
• Preparation:
• Hands should be clean and warm.
• Remove nail polish or artificial nails as they can affect the reading.
• Placement:
• Turn on the pulse oximeter, place on fingertip.
• Reading:
• Keep your hand still for a moment while the device calculates its readings.
• Once it's stable, you will find numbers to show your oxygen saturation (SpO2) and your pulse rate (BPM).
• Recording:
• Record the readings if you need to keep track of your pulse rate over time or to share the information with a healthcare provider.
• Things that can affect pulse oximeter readings:
• Cold hands
• Movement while taking a reading
• Nail polish (especially black, blue, or green)
• Artificial nails
• Extremely low oxygen saturation (below 80%)
• Thicker-than-normal skin
• Low oxygen saturation (hypoxemia):
• Symptoms can include shortness of breath, bluish skin, headache, and dizziness.
• Low oxygen saturation (hypoxemia):
• Conditions can include lung conditions (asthma, COPD), heart conditions (heart failure), blood conditions (anemia), sleep disorders (sleep apnea), medications that lower breathing rate, and high altitudes with less oxygen.
• The conditions that affect pulse oximetry include respiratory distress syndrome (ARDS), interstitial lung disease, collapsed lung, pulmonary edema, and pulmonary embolism (blood clot in the lung).

Self-Breast Exam (SBE)

• Adipose tissue: extends from collarbone to armpit and across ribcage.
• Lobes: Each breast contains 15-20 lobes that surround the nipple.
• Glandular tissue (lobules): located inside the lobes and contain glands that create milk.
• Milk (mammary) ducts: tubes or ducts that carry milk from glandular tissue.
• Nipples: located in the center of your areola. Each nipple contains milk ducts, vessels, and nerves.
• Areolae: the circular darker area of skin, that has Montgomery's glands that secrete lubricating oil.
• Blood vessels: circulate blood throughout your breasts, chest and body.
• Lymph vessels: vessels transport lymph, connecting to lymph nodes in the armpits and chest.
• Lymph nodes: lymph nodes are small organs that help fight infection.
• Nerves: contains nerve endings, which makes them sensitive to touch.
• The male breast structure is nearly identical to the female breast otherwise
• Three types of breast tissue in women:
• Glandular (lobules): produces milk for lactation.
• Connective/fibrous: holds glandular and fatty tissue.
• Fatty: fills spaces between tissues, determines breast size.
• Why SBE is important:
• Aids in early detection, self-awareness, and helps professional screening.
• Breast Examination Details:
• Recommended to perform monthly.
• During menstrual cycle, between 7-10 days after the start.
• Post-Menopausal Women: Perform on any day of the month, consistently.
• Benefits include understanding the normal breast shape and composition, empowerment, and the chance of early detection.
• Myths and debunked facts:
  • Myth: Self-breast exams cause breast cancer.
  • Fact: SBEs do not increase the risk of cancer.
  • Myth: SBEs are only for older women.
  • Fact: All ages should know their breasts.
  • Myth: A breast lump always means cancer.
  • Fact: Many lumps are benign.

Breast Inspection Steps

1. Visual Inspection Objective:

• Check for any visible changes in the breast, skin, or nipple. - Procedure: Stand with should straight and relaxed

1. Look for changes in:

• Shape: Look for the size, shape, and symmetry of both breasts.
• Skin texture: Check for dimpling, redness, puckering, or swelling.
• Nipples: Look to see if the the nipples are inverted (turned inward), or discharge/crusting
• Surface: Look for any abnormal lumps, rashes, or veins.

2. Raise both arms over your head and repeat inspection.
   • This helps identify any changes that cannot be seen at the sides of the breast

Breast Palpation

• To feel for lumps or changes in the breast tissue while lying down:

• 1. Lie down with a pillow under your right shoulder to spread the breast tissue
• 2. Place your right arm behind your head.
• 3. Use the pads of your fingers (not fingertips) to feel for lumps or changes.

• 4.Start at outer part of the breast and around to nipple To feel for lumps or changes in the breast tissue while standing up or sitting down:

• When standing or putting arm slightly overhead it can reveal more:

• This also requires examination during standing or sitting.

What to look for

• Pain: Unexplained pain can indicate other issues.
• Nipple Changes: Look for changes in the appearance of the nipple
• Swelling: Swelling, even if it is not painful, may be a sign of infection.