How to measure resting heart rate and blood pressure A comprehensive physical assessment includes the measurement of resting heart rate and blood pressure. No special preparatory measures are usually needed to measure heart rate or blood pressure, but doing the following can ensure the most accurate measurement (Mayo Clinic, 2022): ● Have the client sit upright and relax in a chair for 5 minutes before the test. ● Ensure that the client does not smoke, exercise, or use caffeine 30 minutes before the test. Such activities can increase blood pressure and heart rate. ● Have clients wear a short-sleeved shirt so that the blood pressure cuff can be more easily placed on the arm. ● Be aware of medications that client may take that may affect blood pressure. Heart rate can be measured through several means, including pulse palpation or stethoscope auscultation on the wrist (radial artery), the neck (jugular artery), or the ankle (brachial artery) (Mayo Clinic, 2022). A heart rate monitor can also be used. A blood pressure test measures Respiratory system changes The respiratory system includes the thoracic cage (which encompasses the ribs, thoracic vertebrae, and intercostal muscles), lungs, and diaphragm. It is theorized that, as in the cardiovascular system, a lifetime of cellular stress and damage leads to changes in the lung’s tissue as well as in the thoracic cage and diaphragm, resulting in decreased function of the respiratory system with aging. At a cellular level, there are numerous changes in the lung tissue, or parenchyma, including a decrease in the elastic tissue within the lungs that results in a decrease in the elastic recoil of the lungs as well as a premature closure of small airways during normal breathing. This results in air trapping and an inability to completely empty the lungs (Sharma & Goodwin, 2006). At the same time, cellular changes in the thoracic cage result in an increased stiffness of the intercostal muscles and calcification of the costal cartilages, resulting in decreased ability of the lungs to expand. Osteoporosis and a lifetime of poor posture may also contribute to the development or worsening of kyphotic posture due to reduced height of the thoracic vertebrae and a collapse of the thoracic intervertebral discs (Chester & Rudolph, 2011). As a result of the structural changes in the thoracic cage and an increase in kyphotic posture, there is a loss of chest wall compliance, or the ability of the chest to expand with inhalation.
the pressure in the arteries as the blood pumps. It is ideal to have the client sit upright in a chair with both feet on the floor. For blood pressure of the arm the arm should rest comfortably at heart level. Wrap the blood pressure cuff around the top part of the arm, with the bottom of the cuff just above the elbow. Ensure that the blood pressure cuff fits, that it is not too large or too small. If using an automated cuff, follow the written directions. If taking a manual measurement of blood pressure, place the stethoscope over the brachial artery to listen to blood flow. Using the small hand pump, inflate the cuff pressure until you can no longer hear the arterial blood flow through the brachial artery. Open the valve on the hand pump slowly, deflate the handcuff until you hear a heartbeat, note the systolic pressure reading, continue to deflate until you no longer hear the arterial flow, and note the diastolic pressure. Blood pressure cuffs can also be used for wrist (radial) and ankle (brachial) pressure assessment, which are described on the Mayo Clinic website (2022). The decreased chest wall compliance results in an increased amount of work necessary to bring in a normal volume of air. The increase in kyphotic posture additionally places the diaphragm at a mechanical disadvantage and reduces its efficiency of contraction (Chester & Rudolph, 2011), which, when combined with the decreased strength of the diaphragm that occurs with aging, results in further decreases in the efficiency of breathing (Sharma & Goodwin, 2006). The combination of a loss of elastic recoil in the lungs with a decrease in chest wall compliance, along with functional changes in the ability of the diaphragm to efficiently contract, result in increased work to breathe and decreases physiologic reserve for the respiratory system. Similar to the cardiovascular system, at rest there may be minimal changes in older adults, as they are able to compensate and adapt. One such example of adaptation is seen in the increased respiratory rate that many older adults experience (Cester & Rudolph, 2011). However, with a stressful systemic event, such as surgery or illness, many older adults may be unable to compensate and will experience declines in respiratory function (Chester & Rudolph, 2011). Expiratory volume This is the volume of air that can be exhaled forcibly after exhalation of normal tidal volume. The normal adult value is 700–1200 mL. Expiratory reserve volume (ERV) is reduced with obesity and ascites, as well as following upper abdominal surgery (Physiopedia, 2022). Respiratory rate To assess your own respiratory rate: 1. Sit down and try to relax. It's best to take your respiratory rate while sitting up in a chair or in bed. 2. Measure your breathing rate by counting the number of times your chest or abdomen rises over the course of one minute. 3. Record this number. (Mayo Clinic, 2022) among various systems. For example, the release of the hormone insulin from the pancreas results in an increased uptake of glucose in most cells of the body. Aging is associated with numerous changes in the release and
Measurement of inspiratory and expiratory volume and respiratory rate Tidal volume
This is the amount of air that can be inhaled or exhaled during one respiratory cycle. The normal adult value is 10% of vital capacity, which is approximately 300–500 mL
(Physiopedia, 2022). Inspiratory volume
This is the amount of air that can be forcibly inhaled after a normal tidal volume. Inspiratory reserve volume (IRV) is usually kept in reserve and is used during deep breathing. The normal adult value is 1,900–3,300mL (Physiopedia, 2022).
Endocrine system changes The endocrine system is responsible for regulating the body’s metabolism through the release of hormones that act as signals to cells throughout the body. These chemical messengers act to coordinate a whole-body response
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