Wiry Pulse Pathophysiology

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

Tachycardia: Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate. When the heart beats rapidly, the heart pumps less efficiently and provides less blood flow to the body and the heart. The rapid heartbeat increases the workload and oxygen demand of the heart. Problems will occur with the heart as tachycardia persists over time. The heart is maintaining less oxygen, which will lead to an MI due to death of the myocardial cells. Patient will start to have angina because of this. Tachycardia is noted in many diseases and disorder like: fever endocarditis, anemia, HTN, pericarditis, abnormal heart impulses, anxiety, older age, sleep apnea, COPD, electrolyte imbalances, and many more.

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

Pulse oximeter used to check his oxygen saturation level, which was 98% on air with no central or peripheral cyanosis. Since Mr Devi, does not seem to have any sign of abnormal respiration. The next assessment is circulation, where there are many physical signs to look for. The colour of the hand and digits, are they blue, pink, pale or mottled. Also need to measure for capillary refill time (CRT) by applying cutaneous pressure for 5 Sec on a fingertip held at heart level of Mr. Devi. The normal value of CRT is usually less than 2 second prolonged CRT suggests poor peripheral perfusion. Measure his Blood Pressure (B/P), count pulse rate by listening to the heart with a stethoscope or palpate peripheral and central pulses, assessing for the presence, rate, quality, regularity and equality. All of this assessment indicates the cardiovascular system in the patient is within the normal range or is there any emergency measures should take (Resus.org.uk 2016). However, Mr Devi’s circulation is a concern because his HR was 110bpm which is higher than normal range, the normal heart beat for adults ranges from 60-100bpm. Also his BP was 190/99mmhg with mean arterial pressure (MAP) of

○ History and physical examination is suggestive of disease by explicit clinical criteria (i.e., hypertension, sudden onset of seizure, neurologic deficits, coma)·

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

I would question as to whether he has any allergies. The heart rate and respiration elevation, and low blood pressure can be present in allergic reactions.

An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared confused this could be associated with poor cardiac output. The nurse recorded the patient’s blood pressure using a dinamap it was measured at 88/50, it was then rechecked manually to ensure accuracy. The pulse was checked manually for rate and rhythm it was recorded as 98 beats per minute. Capillary refill was checked, was found to be normal.

Follow a systematic palpate the sternoclavicular, aortic, pulmonic, tricuspid and epigastric areas using a systematic sequence. Using the ball of hand find the apical pulse then tips of finger over the precordium. Note abnormal finding such as heaves, thrills and fine vibration (purring cat). Palpate the other arterial pulses by pressing with the pads of your index and middle finger. Start at the temporal artery and work down to the dorsalis pedis pulse. Abnormal finding such week pulse could be due to cold weather or can indicate sever heart failure or peripheral vascular disease. Strong or bounding pulsations usually occur in a patient with a condition that causes increased cardiac output, such as hypertension, hypoxia, anemia, exercise, or anxiety. A thrill usually suggests a valvular dysfunction.

No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts. Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge. Nose and sinus history includes clear nasal discharge “since last October”, and occasional nose bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

As I did the physical exam I explained to the patient that I would listen to the arteries with a stethoscope for an abnormal sound which will let me know if there is poor circulation due to plaque? I also explained to the patient that by checking the pulse in the ankle and legs it would also indicate if

For the pass this assignment will describe the investigations that are carried out to enable the diagnosis of these physiological disorders. For the merit this assignment will assess possible difficulties involved in the diagnosis from their signs and symptoms.

In the chart above it has five rows each row concerning different test. The first row talks about Beats per minute; in that row it ask what my beats per minute was, gives if it is over a hundred then its Tachycardia and if it is below sixty it is bradycardia and then ask if it was normal or not. My beats per minute were a hundred and fifty so it is considered Tachycardia.

Ensuring that the patient was relaxed and comfortable I began to take her pulse, using my three middle finger tips to locate the pulse. I did so for 15 second and timed by fore for the next 15 seconds I measured her respiration rate and timed by 4. I did not explain to my patient that I was taking her respirations as looking at her chest may have made her feel uncomfortable and increase her respirations. Her pulse rate ending up being 85 beats per minute and respirations were 15 breaths per minute. These results were within normal range, as her pulse rate was between 80 and 120 bpm and respirations were between 12 and 20 (Tollefson, 2010). The change in pulse and respiration rate can increase during excercise. If a pulse is recorded below 50 bpm the patient can be at risk of a heart attach. A fast pulse exceeding 100 bpm can be a sign of infection or dehydration. This can be detected quickly and appropriate action taken to prevent negative affects on the patient’s well being.