![]() Always count the apical pulse for 1 full minute.Rate: count the pulse rate for 30 seconds and multiply by 2 if the pulse rate is regular, OR 1 full minute if the pulse rate is irregular.When you assess a pulse point you will be assessing: As a nurse you will be assessing many of these pulse points regularly, while others you will only assess at certain times. Friedrich's sign: exaggerated "x" wave or diastolic collapse of the neck veins from constrictive pericarditis.We will review 9 common pulse points on the human body.Kussmaul's sign: neck veins rise in inspiration rather than fall-often a sign of pericardial tamponade or right heart failure (acute right ventricular myocardial infarction).You will also hear the murmur of tricuspid regurgitation-a pansystolic murmur that increases on inspiration.Tricuspid regurgitation, if significant, will be accompanied by a pulsatile liver (feel over the lower costal margin).The ventricle contracts and if the tricuspid valve does not close well, a jet of blood shoots into the right atrium.Tricuspid regurgitation is the most common cause (Lancisi sign).No atrial contraction, common to atrial fibrillation.Premature atrial/junctional/ventricular beats.It occurs when an atrium contracts against a closed tricuspid valve during AV dissociation. Large positive venous pulse during "a" wave.Resistance to right atrial emptying, may occur at or beyond the tricuspid valve."Y" descent: ventricular filling (tricuspid opens) ![]() "V" wave: atrial venous filling (occurs at same of time of ventricular contraction) "C" wave: ventricular contraction (tricuspid bulges). "A" wave: atrial contraction (ABSENT in atrial fibrillation)
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