Clinical Observations:

Respiration Assessment...

The respiratory system supplies the bodies tissues with suffient oxygen whilst removing waste Carbon-dioxide. It is important to asses respiratory rate on admission to ensure a baseline for that patient is set, as changes to respiration rate are the most sensitive and earliest indications of patient deterioration. Try to avoid telling the patient you are trying to take their repiation rate, as breathing should be involuntary so if the patient is aware what u are measuring they may alter their breathing rate. Taking the patients pulse may allow good distraction for the patient so u can take their resp rate at the same time as assessing their pulse. Respiration rate is calculated as the number of breathes per minute. 

Respiratory assesment can identify Bradypnoea ( slow, regular respiration <12 breaths/minute), Tachypnoea (rapid, regular >20 breaths/minute), prolonged expiration (expiration longer than inspiration), Cheyne-stokes respiration (slow, shallow breaths, gradually rapid, deep breaths, ten periods of apneoa between 12-20 seconds. A cycle may lasts 45 seconds to 3 minutes), Dyspnoea (diffcult, laboured, uncomfortable breathing), Orthopneoa (dyspnoea in the recumbent position) 


Oxygen saturation - measured using a pulse oximeter, it measures the saturation of haemoglobin in the arterial blood of the peripheries. Pulse oximetry should be used as part of a wider, holistic assessment.

Air or Oxygen...

Check whether te patient is using air or oxygen to breathe and oxygen will affect SpO2 readings.

Blood Pressure...

Blood pressure is the pressure in the ventricles against the arterial walls as the heart contracts (systole-top number) and pressure in the arteries when the heart relaxes (systole-bottom number). Blood pressure can be indirectly measured using a manual sphygmomanometer and stethescope or a digital sphygmomanometer. It is important to know how to take a manual blood pressure as digital is not always reliable and a digital version may not always be available. 

It is important to check blood pressure as part of holistic assessment as it can help to identify infection and sepsis if systolic is <90. Or if the patient is hypertensive/hypotensive. 

Taking Manual blood pressure:

1) Find pulse (brachial pulse site). Attach Blood Pressure (BP) cuff 2 fingers above the anticubital fossa, ensuring a width of two fingers under the cuff as if the cuff is too tight or lose it is likely to give an incorrect reading. 

2) Find brachial pulse and inflate the cuff unitl the pulse can no longer be felt.

3) Place stethoscope on brachial pulse site. Inflate the cuff to 20-30mmHg above where the pulse was lost in step 2. 

4) Gradually deflate the cuff by 2-3mmHg at a time - slowly. 

5) As soon as the pulse can be heard through the stethoscope this is the systolic reading (top number).

6) when the pulse can no longer be heard this is the diastolic reading (bottom number)

This gives the Blood Pressure, the top number - systolic, and the bottom number -diastolic. Ideal blood pressure is usually between 90/60mmHg and 120/80mmHg.


Pulse assessment aims…


No comments have yet been made