Chapter 24: Clinical measurement

Activity 24.3: Palpation sites

The carotid pulse palpation site:

image of carotid palpation site

The femoral pulse palpation site: 

image of femoral palpation site

The positives and negatives of carotid and femoral palpation sites:

Site Positive Negative
Carotid
  • Easily accessible
  • Can normally be found even when the blood pressure is low
  • Not always easy to locate the pulse site
  • Caution is required in patients with carotid artery disease
  • Excessive palpation can cause vagal nerve stimulation causing the heart rate to slow
Femoral
  • Can normally be found even when the blood pressure is low
  • Can be difficult to access due to clothes and nappies.
  • Need to wear PPE as potential for exposure to bodily fluids
  • Need to expose the patient, so must ensure dignity

 

Activity 24.7: Patient's fluid balance

Pyrexia increase’s the body’s metabolic rate, causing vasodilation and activating the body’s sweat glands to try to lower the core temperature. All of these three elements will increase the need for additional fluids as there is a risk of dehydration.

Persistent diarrhoea and vomiting can cause the Gastro Intestinal (GI) tract to lose excessive amounts of fluid and electrolytes which can result in hypovolaemic shock.

Young children are more susceptible to dehydration due to larger body water content, renal immaturity, and inability to meet their own needs independently. Older children show signs of dehydration sooner than infants due to lower levels of Extracellular Fluid (ECF).

Activity 24.8: Fluid balance chart

  • The patients name is IVOR WELL
  • Ivor has he taken 1,200 mls orally during the 24 hours covered by the fluid balance chart?
  • Ivor’s urine output for the 24 hours covered by the fluid balance chart was 1,325 mls
  • Ivor is in positive fluid balance for the 24-hour period
  • This means that he has taken more fluid in than he has passed out

Activity 24.9: Billie

In this situation it would be appropriate to support Billie to take her own blood sugar level, just like she does at home.  This would also enable you to ensure that Billie has a good technique and is recording accurate blood sugar values.