Download Pulse Assessing radial pulse rate Assessing the rhythm, strength

Pulse
Assessing radial pulse rate
Assessing the rhythm, strength, and rate of a patient’s peripheral pulse provides valuable
information about the cardiovascular system. The rhythm of the pulse is usually regular,
reflecting the time interval between each heartbeat. The strength of the pulse correlates with
the volume of blood being ejected against the arterial walls with each contraction of the heart.
Pulse strength is usually described as absent, weak, diminished, strong, or bounding. If blood
volume decreases, the pulse is often weak and difficult to palpate. If blood volume increases,
the pulse is often bounding and easy to palpate.
Although peripheral pulses are palpable at a variety of body sites, the radial pulse is the easiest
to access and is therefore the most frequently checked peripheral pulse. Assessment of other
peripheral sites, such as the carotid or femoral pulses, is not usually part of routine vital-sign
measurement. Clinicians typically access these sites when performing a complete physical
examination. When they cannot palpate peripheral pulses, they use a Doppler ultrasound
stethoscope to confirm the presence or absence of the pulse.
A normal adult pulse rate ranges from 60 to 100 beats per minute. It is usually slightly faster in
women and more rapid in infants and children. In addition to gender and age, exercise,
medications, decreased oxygen saturation, blood loss, and body temperature can all influence a
patient’s pulse rate. When assessing pulse, it is important to find out what a normal rate is for
that particular patient.
A pulse rate slower than 60 beats per minute is called bradycardia. Conditions such as
decreased thyroid activity, hyperkalemia, an irregular cardiac rhythm, and increased
intracranial pressure can all slow the heart rate. Many athletes who do a lot of cardiovascular
conditioning have pulse rates in the 50s and experience no problems.
A pulse rate faster than 100 beats per minute is called tachycardia. Conditions such as
congestive heart failure (CHF), hemorrhage, shock, dehydration, and anemia can all speed up
the heart rate. Patients who have tachycardia might experience dyspnea, fatigue, chest pain,
palpitations, and edema.
An abnormally irregular, weak, slow, or rapid pulse, especially if sustained, might mean that the
heart cannot function properly and requires further evaluation.
1. The radial pulse is easy to find and is the most frequently checked peripheral pulse.
2. To check the radial pulse with the patient supine, position the patient's arm along the
side of the body or across the upper abdomen with the patient's wrist relaxed. Apply
light pressure with the pads of the fingers in the groove along the radial or thumb side
of the patient's inner wrist.
3. Be careful not to apply too much pressure, as this can impair blood flow.
4. If the pulse is regular, count for 15 seconds, then multiply that number by 4. You can
also count for 30 seconds, and then multiply by 2. If the pulse is irregular, count for 1 full
minute.
Palpate a patient's pulse to determine circulation distal to the pulse site and for rhythm,
quality, and strength. Is it normal, weak or thready, full or bounding, or absent?
Perform hand hygiene before and after patient care and document your findings on the
appropriate flow sheet or record.
Assessing apical pulse rate
Evaluating the apical pulse is the most reliable noninvasive way to assess cardiac function. Each
pulsation you hear is a combination of two sounds, S1 and S2. S1 is the sound you hear when
the tricuspid and mitral valves close at the end of ventricular filling and just before systolic
contraction begins. S2 is the sound you hear when the pulmonic and aortic valves close at the
end of systolic contraction.
When determining an apical pulse, it is important to use anatomical landmarks for correct
placement of the stethoscope over the apex of the heart so that you can hear the heart sounds
clearly. If the apical rate is regular, you can usually determine an accurate rate in 30 seconds.
When the apical pulse is irregular, it is best to count for at least 1 minute to obtain an accurate
rate.