PT 503L Lecture Notes - Lecture 4: Temporal Bone, Anatomical Terms Of Motion, Inguinal Ligament
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PT 503 Physical Therapy Processes I
Introduction to Cardiopulmonary Systems Screening:
Assessment of Vital signs
• Fulk, Susan B O'Sullivan, Thomas J Schmitz, G. Physical Rehabilitation. F. A. Davis
Company, 2013. [VitalSource Bookshelf].
• Washington, Sheryl Fairchild, Roberta O'Shea, R. Pierson and Fairchild's Principles &
Techniques of Patient Care. Elsevier Health Sciences (US). [VitalSource Bookshelf].
1. Provide the rationale for the need to measure, monitor, and record a patient’s
2. Locate and palpate a client’s arterial pulse at various sites.
3. Accurately measure and record a client’s pulse and heart rates, respiration rate,
blood pressure and gait speed
4. Describe the expected normal and abnormal changes in blood pressure, heart
rate, and respiration rate resulting from exercise and other factors.
5. Explain to a client or family member the significance of measuring and monitoring
Table 2.1 O’Sullivan et al., Physical Rehabilitation, 6th ed p.31
Pulse or Heart Rate (HR)
“Pulse” is a wave of blood in the artery created by contraction of the left ventricle during a
cardiac cycle (one complete cycle of cardiac muscle contraction and relaxation). Peripheral
pulses are those located in the periphery of the body that can be felt by palpating an artery
over a bony prominence or other firm surface. The apical pulse (not taught in this course!) is
a central pulse located at the apex of the heart that is monitored using a stethoscope
(O’Sullivan, p.52). Normal accepted range for the resting pulse is 60 to 100 beats/min in an
adult and 100 to 130 beats/min in the newborn.
Monitoring Pulse (Pearson et al, p. 52 - 57)
• Wash your hands, obtain a timepiece that measures seconds, and explain the procedure
to the client. Observe for signs of stress, anxiety or distress.
• Select an arterial site and firmly, but gently, place 2 or 3 fingertips over the artery.
Avoid using your thumb, as you may perceive your own pulse rather than that of the
client, and the thumb pad is less sensitive.
• Avoid excessive pressure as it may occlude the artery. An exception to light pressure is
when you attempt to palpate the popliteal artery. Firm, deep pressure may be required
to locate that artery and palpate its pulse.
• When determining resting heart rate for the first time:
a. Allow the client to rest supine or seated for approximately 5 minutes before
b. Measure the pulse rate for a full minute to reduce the potential for error and
• Mentally count each beat.
a. If you measure the rate for 10 seconds and multiply the value by 6 to get total
beats in one minute, the margin of error is ± 6 beats/minute.
b. If you measure the rate for 15 seconds and multiple by 4, the margin of error is ±
c. If you measure the rate for 30 seconds and multiple by 2, the margin of error is ±
• Record the results in beats/minute, indicate any variations in rhythm or volume, and
identify patient position and the location you used to palpate and measure the pulse.
a. Such as: “68 beats/min, regular, R brachial pulse, client supine.”
b. “86 beats/min, irregular (every 4th beat absent over 1 minute), L radial pulse,
c. Descriptive terms - Rhythm:
i. “Strong and Regular”: even beats, good force
ii. “Weak and regular”: even beats, poor force
iii. “Irregular”: both strong and weak beats occurring – may be regular or
d. Descriptive Terms – Depth
i. Absent – no pulse palpable
ii. Diminished – weak but palpable
iii. Strong - normal
iv. “Thready” (typically describes a rapid, feeble pulse difficult to palpate)
“Tachycardia” indicates a rapid HR (>100 beats/min)
“Bradycardia” indicates a slow HR (<60 beats/min)
Pulse Measurement Sites
• Temporal. Over the temporal bone, superior and lateral to the eye; or anterior and
adjacent to the ear.
• Carotid. Inferior to the angle of the mandible and anterior to the sternocleidomastoid
(SCM) muscle; fingers over the thyroid cartilage, between the trachea and medial
border of the SCM. Pressure should not be applied bilaterally or high on the neck to
avoid stimulation of the carotid sinus and a subsequent reflex drop in pulse rate.
• Brachial. Medial to the biceps in the antecubital fossa or on the medial aspect of the
midshaft of the humerus.
• Radial. At the wrist on the volar forearm medial to the stylus process of the radius.
• Abdominal. Above and to the left of the umbilicus, following the aorta downward
through the abdomen.
• Femoral. At the femoral triangle slightly lateral and anterior to the inguinal crease.
Inferior to the inguinal ligament, midway between the ASIS and the symphysis pubis;
typically monitored in supine.
• Popliteal. In the midline of the posterior knee crease between the tendons of the
hamstring muscles. Deep and at times difficult to palpate. Typically monitored in prone
with the knee flexed to relax the hamstrings.
• Dorsal pedal. Along the midline or slightly medial on the dorsum of the foot. Lateral to
the tendon of the extensor hallicus longus; ankle should be slightly plantar flexed.
• Posterior tibial. On the medial aspect of the foot inferior to the medial malleolus.
LAB ACTIVITY 1:
Locate and accurately record your lab
partner’s RADIAL pulse for 1 minute.
LAB ACTIVITY 2:
Locate EACH of the peripheral pulses on
your partner at the sites detailed in the