Clinical skills

• what is respiratory rate


  • Diffusion of gases between the air in the alveoli of the lungs and blood in the alveolar capillaries
  • Rate of how someone is breathing
  • Unconscious action
• what does respiratory rate indicate

  • Indicates cardiovascular status e.g. pulmonary oedema and metabolic acidosis
• Why respirations should be taken

  To assess quality, rate and depth
• Normal breathing for adults


  Effortless (12-18 breaths per min)
• How to measure respirations

  1. Watch with a second hand (timing it)

  2. Observe movements of chest wall

  3. Count chest movements for 60 secs

  4. Record the number of respirations
• why should you never explain procedure when doing resps

  will give inaccurate information
• what is Peak flow


  Maximal expiration rate that is achieved during a forced exhalation
• How to measure peak flow


  1. Use Wright's peak flow meter (small portable device)

  2. Measure in liters per min
• Peak flow


  • Indicates asthma: reduction in the diameter of air passing causing obstructions
  • Factors to consider: size, age, sex, race
• How to carry out peak flow procedure


  1. Explain procedure

  2. Ensure patient sitting or standing

  3. Ensure sliding marker or arrow is at the bottom

  4. Ask patient to blow hard for one breath

  5. Document findings

  6. Do this three times
• how is Oxygen saturation (02 saturation)measured?

  pulse oximeter, also measures pulse rate
• Factors that can alter 02 saturation readings


  • Patient's breathing is poor
  • Heavy blood loss (less haemoglobin circulating)
• How to carry out 02 saturation procedure

  1. Explain procedure

  2. Charge the pulse oximeter

  3. Ensure it calibrates

  4. Position the probe

  5. Ensure no nail varnish is worn

  6. Be mindful of when machine gives faulty readings
• Blood pressure


  Measurement of force exerted by blood on the walls of arteries as the heart pumps blood through the body
• Equipment used to take blood pressure


  Sphygmomanometer (sfignamoeter) and stethoscope
• Factors that influence blood pressure readings

  • Equipment
  • Accuracy and efficiency
  • Correct technique
• Cardiac cycle


  Complete heart beat
• Components of cardiac cycle

  • Systole (heart contracting)
  • Diastole (heart relaxing)
• How blood pressure is measured


  • Millimetres of mercury (mmHg)
  • Systolic over diastole
• Factors that affect blood pressure


  • Volume of blood
  • Strength and rate of heartbeat
  • Elasticity of artery walls
  • Return of blood from the veins
• Hypertension


  Consistently high blood pressure (over 150/90mmHg)
• Controllable factors for hypertension


  • Excessive body weight
  • Lack of activity/exercise
  • Smoking
  • Stress
• Uncontrollable factors for hypertension


  • Heredity (family history)
  • Sex (higher risk for men)
  • Age (increase risk above 35)
  • Secondary hypertension (other medical conditions)
• Hypotension


  Consistently low blood pressure (under 100/60mmHg)
• Symptoms of hypotension


  • Dizziness
  • Light-headedness
  • Lack of energy
• How to carry out blood pressure procedure


  1. Explain the procedure

  2. Use a 14cm cuff

  3. Ensure patient is comfortable, arm slightly flexed

  4. Arm above the heart produce false low readings

  5. Cuff needs to be positioned 2.5cm above the brachial artery

  6. Inflate the cuff to 30mmHg above systolic reading

  7. Release the valve 2mmhg per second

  8. Note the point on the sphygmomanometer when first clear sound is heard (Korotkoff sound – systolic pressure)

  9. Note the sound when it is muffed (fourth Korotkoff sound – diastolic pressure)

  10. If required to re-do wait 30 seconds
• Korotkoff sounds


  • Initial tapping sound – systolic pressure
  • Sounds that increase in intensity
  • Sounds at maximum intensity
  • Sounds that are muffled – diastolic pressure
  • Sounds disappear
• Pulse


  Left ventricle of the heart contracts oxygenated blood into the aorta causing arterial walls to dilate and creating pulse waves
• Common sites for pulse measurements


  • Radial artery: surface of the thumb side of the wrist
  • Brachial artery: elbow cavity
  • Carotid artery: on side of neck
  • Femoral artery: groin
  • Popliteal artery: behind the knee
  • Posterior tibial: inner aspect of the foot
  • Dorsalis pedis: on top of the foot
  • Apical pulse: auscultation of the heart
• What must be observed when taking pulse


  • Rate: count for 15 secs and multiply by 4
  • Rhythm: if irregular assess how abnormal this is, detected by an apical pulse
  • Volume: should remain consist with each beat, a weak pulse is often more rapid than normal
• Factors that affect pulse rate


  • Position: from lying, to sitting, to standing
  • Age: higher in children
  • Gender: female slightly higher than males
  • Exercise: strenuous exercise increases heart rate
  • Temperature: increased temp will cause increased pulse
  • Disease: heart disease can cause irregular pulse rate
  • Haemorrhage: blood loss will increase pulse rate
  • Medications: digitals will slow pulse rate, digoxin never given less than 60bpm
• Tachycardia


  Consistently high pulse (above 100 bpm)
• Symptoms of tachycardia


  • Strenuous exercise
  • Anxiety
  • Infection
  • Shock
• Bradycardia


  Consistently low pulse (bellow 60 bpm)
• Symptoms of bradycardia


  • Raised intercranial pressure
  • Decreased metabolic rate (hypothyroidism)
  • Heart block (infarction – heart attack)
• How to carry out pulse procedure


  1. Wash hands

  2. Select pulse site
• Advantages and disadvantages of pulse sites


  • Radial artery: Most accessible site, easily palpated. Disadvantage: Cast may block the site, less accurate on babies
  • Carotid pulse: Easily accessible, quickest for finding pulse
  • Apical pulse: Most accurate for assessing heart function, requires auscultation
• Temperature


  Maintains heat production and heat loss through temp control mechanisms found in hypothalamus
• Equipment used to record temperature

  Clinical thermometer
• How heat is produced


  Metabolism, Muscular activity, Thyroid hormone secretion