can you feel it? karen george clinical nurse advisor/independent providers

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Can you Feel it? Karen George Clinical Nurse Advisor/Independent Providers

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Can you Feel it?Karen George

Clinical Nurse Advisor/Independent Providers

Overview of the session Atrial Fibrillation Early signs and symptoms of stroke and

TIA Theory of taking a pulse Practical session on taking pulses Recording findings when to refer

Karen GeorgeClinical Nurse Advisor/Independent Providers

Learning Outcomes

Define Atrial Fibrillation (AF) Understand the causes of AF List some of the common symptoms Recognise the complications associated with

AF

Can You Feel it? Atrial Fibrillation is the most common heart

rhythm disturbance and affects up to 500,000 people in the UK

AF can affect adults of any age and becomes more common the older you get

In the over 75–year- old age group it affects about 10% of people

It accounts directly for over 96,000 hospital admissions per year

It consumes 1% of the NHS total budget Left untreated AF can lead to serious

complications such as heart failure and stroke

The Heart The heart is a muscular organ that generally situated

in the middle of the chest, slightly towards the left Structurally, the heart consists of two sides, a right

and left The right side pumps the blood through the lungs to

collect oxygen before travelling to the left side of the heart

From here it is pumped through the body. To return eventually to the right side once more

Both sides of the heart contract at the same time in a single coordinated action to produce a heart beat

What happens in AF? When the heart beats normally, its muscular

walls contract (tighten and squeeze) to force blood out and around the body. Then they relax, so that the heart can fill with blood again. This process is completed every time the heart beats

In AF, the upper chambers of the heart (the atria) contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions

What causes AF? High blood pressure Coronary heart disease Mitral valve disease (caused by rheumatic

heart disease, valve problems at birth, or infection)

Congenital heart disease (abnormality of the heart present since birth)

Pneumonia Lung cancer Pulmonary embolism Overactive thyroid

Symptoms of AF Palpitation Tiredness Shortness of breath Dizziness Chest pain (angina) Low blood pressure Heart failure Some AF patients have no symptoms at all and it

is only discovered at a routine medical examination

Complications of AF When the atria (upper chambers of the heart) are

not pumping efficiently, as in AF, there is a risk of blood clots forming

The blood clots may move into the ventricles (lower chambers of the heart) and get pumped into the lungs or the general blood circulation

Clots in the general circulation can block arteries in the brain, causing a stroke

The risk of stroke in people with AF is about double that of the general population

Complications of AF However the risk depends on a number of

factors, including: Your age Whether you have high BP Heart failure Diabetes Previous history of embolism

Karen GeorgeClinical Nurse Advisor/Independent Providers

Learning Outcomes Define what a Stroke and TIA is Understand the causes of a stroke/TIA Recognise the signs and symptoms of a

Stroke/TIA Understand why recognition of the onset of

signs and symptoms is essential Justify the need to access emergency/urgent

services for prompt assessment. Understand F.A.S.T

Stroke/TIA causes and risk factors High blood pressure Cardiovascular

disease Diabetes Age Gender Ethnic background Genetic inheritance

Smoking Unhealthy diet Lack of exercise Alcohol

What is a Stroke/TIA? A stroke is an attack on the brain. It happens when the blood supply to part of

your brain is cut off. For the brain to function, it needs a constant

blood supply. Which supplies vital nutrients and oxygen. A stroke happens when the blood supply to

part of the brain is cut off. The brain cells die or are damaged.

Types of Stroke There are two main types of stroke. The most common type of stroke (about 80% of

cases) is caused by a blockage. This is called an Ischaemic stroke and may be caused by:

cerebral thrombosis - when a blood clot (thrombus) forms in a main artery to the brain.

cerebral embolism - when a blockage forms in a blood vessel somewhere else in the body . Caused by a blood clot, air bubble or fat globule (embolism) and is carried in the bloodstream to the brain.

Types of Stroke The second type of stroke is caused by a bleed (in

about 20% of cases). This is called a Haemorrhagic stroke and happens

when a blood vessel bursts, causing bleeding (haemorrhage) in the brain. May be caused by:

1. intracerebral haemorrhage, when a blood vessel bursts within the brain.

2. subarachnoid haemorrhage, when a blood vessel on the surface of the brain bleeds into the area between the brain and the skull (subarachnoid space).

Transient ischaemic attack (TIA) A Transient Ischaemic Attack (TIA) happens when

your brain’s blood supply is interrupted for a very brief time. This is often called a mini-stroke.

It is an episode where some brain function is temporary lost due to a short lived disruption in the blood supply to the brain.

With a TIA, part of your brain goes without oxygen for just a few minutes.

A TIA is a sign that this part of your brain is not getting enough blood and that you may be at risk of a more serious stroke in the future.

What are the common symptoms of stroke?

Sudden, severe headache Numbness, weakness or paralysis on one

side of your body (signs of this may be a drooping arm, leg or lower eyelid, or a dribbling mouth)

Slurred speech or difficulty finding words or understanding speech

Sudden blurred vision or loss of sight Confusion or unsteadiness

Recognition !

Karen GeorgeClinical Nurse Advisor/Independent Providers

The opportunistic detection of Atrial Fibrillation (AF) to prevent the risk of stroke and other serious medicalconditions associated with the presence of AF

Learning Outcomes Understand how to detect a pulse Identify /describe a regular pulse Identify/ describe an irregular pulse Demonstrate manual palpation of a radial

pulse Explain how to document your residents

pulse readings Identify what action to take when an irregular

pulse is detected Record outcome of action taken

What is your pulse? When the heart beats blood is pushed out of

the heart into the body causing a bulge in the arteries. This bulge of pressure is called a pulse, and the pulse can be felt anywhere an artery passes close to the skin.

The pulse indicates the heart rate and the heart rhythm. Being aware of your pulse is important because it may indicate an abnormal heart rate or rhythm. The pulse can be taken in several points on your body. Can you name two of the easiest places?

On the neck: below the earlobebetween the muscle of the neckand the wind pipe (carotid pulse)

On the wrist: between the endof the thumb and where a watchstrap would rest (radial pulse)

Regular/Irregular Pulse The pulse should be regular, i.e. the bulges

caused by the heart beating occur with the same rhythmical timing.

Irregular pulse when palpated will not have the rhythmical timing of the regular pulse and therefore should be palpated for longer.

Bom – bom – bom – bom – bom – RegularBom – bom – bombom – bom –bombom - Irregular

Why it is important? An irregular pulse strongly indicates that the

heart is not beating in a uniformed way and moving the blood through its chambers swiftly, this can result in the blood flow becoming sluggish and lead to clots which can break loose and travel to the brain or to other parts of the body.

Can you think of things that can affect our pulse rate?

AgeMedicationCaffeineLevel of fitnessAnxietyStressExercise

Using three fingers, place them on the inside of the wrist between the watch strap and the base of the thumb.Keep firm pressure on the wrist with your fingers in order to feel the pulse.The rate of the pulse can be found by counting for 60 seconds and multiplying by two, this can give the number of beats per minute The heart rate naturally varies, depending on activity and time of day.Normal pulse rate falls between 60 bpm and 100 bpm.

To assess the resting pulse rate in your wrist, sit down for 5 mins beforehand. Remember that any stimulus taken before the reading will affect the rate. You will need a watch/clock with a second hand.

With your hand, place your index and middle fingers on your wrist at the base of your thumb. Your fingers should sit between the bone on the edge of your wrist and the stringy tendon attached to your thumb. Once you have found your pulse, keep firm pressure on your wrist with your fingers in order to feel your pulse

Tendon

Bone

Pulse

GROUP ACTIVITY

Count for 30 seconds and multiply by 2 to get your heart rate in beats per minute. If your heart rhythm is irregular, you should count for 60 seconds and do not multiply.

Record your findings and follow the pathway.

GROUP ACTIVITY

Pulse Check Pathway

[email protected]

Further Information:

www.nice.org.ukwww.heartrhythmcharity.org.ukwww.bhf.org.uk