I

The abnormal rhythm in the pulse is seen in the following conditions:

Arrhythmias: It is a technical term that indicates any variation from normal rhythm.

Intermittent pulse: It is one in which the beats are missed at regular intervals. In intermittent
pulse, there is a difference between the apical and the radial pulse. It is known as pulse
deficit.

Extra systoles: When the cardiac contractions occur prematurely, i.e. before they are
normally due in the cardiac cycle, it is called extra systolic pulse.

Atrial fibrillation: Rapid contractions of the atrium causing irregular contractions of the
ventricles in both rhythm and force.

Ventricular fibrillation: It is the rapid twitching of the ventricles. It is fatal. Sinus

arrhythmia: It is a condition in which the pulse rate is rapid during inspiration and slow
during expiration.

Dicrotic pulse: There is one heart beat and two arterial pulsations giving the sensation of a
double beat.

The abmormal volume of pulse will be seen in the following

Water hammer pulseJor Corrigan's pulse or collapsing pulse: It is a full volume pulse
but rapidly collapsing pulse occurring in aortic regurgitation or incompetence, where the
blood having been forced into the artery by the ventricular contraction, regurgitates back into
the ventricle, owing to the non closure of the aortie valve.

Bounding pulse: Signifies an increased stroke volume as seen in exercises, anxiety, anaemia,
hepatic failure, heart block and the water hammer pulse.

Pulses alternans: The rhythm is regular but the volume has an alternative strong and weak
character. This may be noticed in the left ventricular failure, heart block and digitalis toxicity.

Bigeminal pulse: It is accompanied by an irregular rhythm in which every other beat comes
early. The second or premature beat feels weak due to inadequate filling of the ventricles
between the two beats. It may be so weak that it fails to produce a palpable peripheral pulse
(pulse deficit). It is seen in myocardial infarction and digitalis toxicity.

Weak/ wiry/thready pulse: A small weak pulse that feels like a wire or thread on the
palpation of arteries. It signifies a decreased stroke volume and is seen in haemorrhagic shock
or loss of fluid from the body, e.g. diarrhoea and vomiting.

Paradoxical pulse: In this case the force or strength of the pulse wave varies, feeling weaker
when the client takes in a breath. During inspiration, less blood is returned to t-he loft side of
the heart, reduces the stroke volume and therefore decreases the strength of the pulse. This
may occur normally. but if pronounced this may indicate cardiac damage.
Abnormal Respirations: breaths per
minute.
24
. . d es irator)' rate over
Tachypnoea (Polypnoea): It 1s an increase r p ·nute
th pern11 ·
1 than 10 brea s
Bradypnoea: It is a decreased respiratory rate - ess . Cheyne-Stoke's
. d' as seen 111
. This may be peno ic
Apnoea: Total cessatlon of breath mg.
respiration.

Hyperpnoea: It is an increase in the depth of respiration.

Orthopnoea: The client can breathe only In an upright position.

. . d are made by the air passing
Stertorous respiration: It is a noisy breathmg. Snormg soun s
through the secretions as seen in acute alcoholism.

Stridor: A harsh, vibrating. shrill sound Is produced dunng · respira· (1on as seen in upper
airway obstruction, e,g. laryngitis and foreign body in the respiratory tract.
· h e atr
Rale (Rahl): An abnormal ratting or bubbling sound caused by the mucus mt · passages
as seen in the bronchitis or penumonia.

Wheeze: The high pitched, musical whistling sound that occurs with the partial obstruction
of the smaller bronchi and bronchioles as seen in asthma or emphysema.

Sigh: A very deep inspiration followed by a prolonged expiration. Frequent sighs are signs of
emotional tension.

Air hunger: A form of dyspnoea in which there are deep sighing respirations.

Cheyne Stoke's respiration: It consists of a series of respirations that gradually become

deeper and noisier until a climax is reached, when a pause occurs (apnoea) then the cycle is
repeated. An increase in the rate and depth of respiration alternates with a period of apnoea.

Dyspnoea: Difficult or laboured breathing.

When breathing is interfered with. it results in the incomplete exchange of gases and it may
lead to:

Cyanosis: Blueness or discolouration of the skin and membrane caused by lack of oxygen in
the tissues.

Anoxia (Hypoxia): It is the lack of oxygen in the tissues

Anoxaemia (Hypoxaemia): It is the lack of oxygen in the blood stream.

Asphyxia: It is a state of suffocation. This condition is produced by prolonged interference

with a sufficient supply of oxygen.

Kussmaul respiration: Respiration is abnormally deep but regular, rate is increased. It is

seen in diabetic ketoacidosis.
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l\\ot' s respiration: It is shallow breathing interrupted by irregular periods of apnoea, seen in

central nervous system disorders.
p
Abnormalities of Blood Pressure

Hypertension: is blood pressure that is above normal for a sustained period.

Primary/Essential Hypertension: is hypertension without a known cause.

Secondary Hypertension: is one which is associated with a known pathology.

Hypotension: is a condition of abnormally low blood pressure.

Orthostatic hypotension (Postural hypotension): is a low blood pressure associated with

weakness or fainting when rises to an erect position (either supine to sitting, supine to
standing or sitting to standing). It is the result of peripheral vasodilatation without a
compensatory rise in cardiac output.