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BIOL 242Lab 5: Blood Vessels

Vital Signs1) Temperature2) Pulse3) Respiratory rate4) Blood pressure

1) Temperaturea. Place thermometer in mouth under tongue or in ear until beeps. Record

temperature.

2) Pulsea. Usually taken at the radial artery (located on the radial side of the wrist)b. Locate the styloid process of the radius. On the palmar side of the forearm, place

your fingers medial to the styloid process. Press down slightly to find the radial pulse.

c. Hold both wrists and compare pulses for symmetry & pliability (can detect stiffness in sclerosis)

d. Elevate rate and rhythmi. Rhythm may be regular, irregularly regular, or irregularly irregular

e. Measure for 15 sec and multiply by 4f. Normal is between 60-100bpmg. If you feel 15 beats, HR = 60pmh. 16 = 64i. 17 = 68j. 18 = 72k. 19 = 76l. 20 = 80m. etc.

3) Count respiratory ratea. Check by visual examination (can look at abdomen or clavicles moving) or listen

with stethoscope over tracheab. Can place hand on shoulder or abdomen

i. Normal 14-201. Tachy > 242. Brady < 10

c. Can count for 30 sec and multiply by 2

4) Measure blood pressurea. Estimate systolic pressure:

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i. Center the inflatable bladder over the brachial artery. The lower border of the cuff should be about 2.5cm (1 inch) above the antecubital crease. Secure the cuff snugly.

ii. Palpate radial pulseiii. Inflate cuffiv. When pulse goes away, look at # (this is the estimated systolic pressure)

and add 30 to determine how far to inflate the cuff. Deflate cuff.v. Use bell (small end) or light pressure with stethoscope and place over

brachial artery.vi. Raise patient’s L arm to heart levelvii. Inflate cuff to previously determined number.

viii. Slowly release pressure on manometer.ix. once you hear 2 consecutive beats = systolic

1. the needle on the manometer will start to jump as well.x. when you no longer hear a sound = diastolic

- JNC 7 Guidelines for BP (current as of Fall 2006)o Normal <120 <80o PreHTN 120-139 80-89o HTN, Stage 1 140-159 90-99o HTN, Stage 2 >160 >100

- Definition of Hypertensive “Crisis”o SBP >180o DBP >115-120o Allopathic standard of care in this case give 25 mg Hydrochlorothiazide

immediately

- Cuff sizeo Must be correct, otherwise:

Cuff too short may give falsely high readings.o A loose cuff will lead to falsely high readings.o If the brachial artery is much below heart level, blood pressure appears falsely

high. Patient’s own effort to support the arm may raise BP.

- Retaking BPo If you need to take the BP again, switch to the R arm or wait about 1 min to

retake it in the L arm.

- Why is it important to estimate systolic pressure?o So you don’t miss what’s called an ausculatory gap, which is indicative of

atherosclerosis or arterial stiffness.

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o The gap happens when you hear sound, then silence, then sound again. Sometimes when taking BP you can completely miss the top of the systolic pressure if you do not test first by taking the radial pulse while inflating the cuff.

Finding Pulses: o Rule #1 while taking pulses, never use your thumb. Your thumb has a large enough

artery in it that you may feel it while attempting to take the patient’s pulse. Only use digits 2-4.

o Pulses important for physical exam: temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis

1) Temporala. Located just in front of the ear, just above or below the zygomatic

arch.2) Carotid

a. Find the submandibular glands. Allow finger to slide directly inferior to the gland on to the neck.

b. Only palpate one carotid at a time.3) Brachial

a. Flex the patient’s elbow slightly and palpate for the artery just medial to the biceps tendon at the antecubital crease. It can also be felt higher in the arm in the groove between the biceps and triceps muscle.

4) Radiala. Locate the styloid process of the radius. On the palmar side of the

forearm, place your fingers medial to the styloid process. Press down slightly to find the radial pulse.

5) Femorala. Press deeply below the inguinal ligament and about midway between

the ASIS and the pubic symphysis6) Popliteal

a. Have the patient’s knee somewhat flexed and the leg relaxed. Place the fingertips of both hands so that they just meet in the midline behind the knee and press them deeply into the popliteal fossa. Often difficult to feel, as it is deeper and feels more diffuse.

7) Posterior tibiala. Use your R hand to examine the L ankle. Use your L hand to examine

the R ankle.b. Curve your fingers behind and slightly below the medial malleolus of

the ankle.8) Dorsalis pedis

a. Feel the dorsum of the foot just lateral to the extensor tendon of the great toe. If you cannot feel it, try moving your fingers laterally.

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Heart Sounds

Diaphragm (large end) better for high pitched sounds o Use throughout the precordium (over the heart)o Press firmlyo Hear S1 and S2

S1 = first sound, louder at apex, beginning of systole S2 = louder at base, end of systole

Bell (small end) more sensitive to low pitched soundso Use bell at the apex, then move medially along the lower sternal bordero Light pressure, otherwise it functions as a diaphragm

Mitral valve soundsheard over heart apex(in 5th intercostal space)in line with middle ofclavicle

Pulmonary valvesounds heard in 2ndintercostal space at leftsternal margin

Aortic valve sounds heard in 2nd intercostal space atright sternal margin

Tricuspid valve sounds typically heard in right sternal margin of 5th intercostal space Figure 18.19

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Name the three layers of a blood vessel wall, most external to internal, and their function:Name of Layer Function

Which layer has the most smooth muscle?

What is a vasovasorum? Where is it found?

Which artery type is the most important for maintaining blood pressure?

Name the 3 types of capillaries, their function, and where they are found:Name Function Location

Name 5 important facts about veins that differentiate them from arteries.1.2.3.4.5.

What is a collateral channel? Why is it important?

What force/factor is the most important in creating blood pressure (it is also inversely proportional to it)?

What is the most important factor in creating resistance in the arteries?

Ventricular contraction creates systolic/diastolic pressure (circle the correct choice).

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Ventricular relaxation creates systolic/diastolic pressure (circle the correct choice).Short term BP control:

Where are baroreceptors located?

What activates baroreceptors?

Describe the effect of baroreceptors:If baroreceptors are stimulated, what happens to BP?

If baroreceptors are inhibited, what happens to BP?

Chemoreceptors:What molecule are they most sensitive to?

When this molecule increases, what happens to BP?

Hormonal control:Angiotensin II does what 2 things to increase BP?

Long term BP control is managed by what organ? How?

Exchange of nutrients at capillaries:

How do lipid-soluble molecules move across the capillaries?

How do water-soluble molecules move across capillary membranes?

How do large molecules move across capillary membranes?

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