PULSE

PULSE

Pulse is the wave of expansion and recoil occurring in an artery is response to the pumping action of the heart

Pulse is the heart beat, conveniently felt at the wrist and at any point where an artery passes superficially over the bone

Pulse is defined ad checking rate, rhythm and volume of throbbing of an artery against abony prominence

Purpose

• To determine number of heart beats acquiring per minutes create
• To evaluate amplitude (strength) of pulse
• To assess the vascular status of limbs
• To assess response of heart to cardiac medications, activity, blood volume and gas exchange
• To asses heart ability to deliver blood to distant area of the body
• To obtain information about heart rhythm and patterns of beat

Normal Rate

• Newborn – 140 beats/minute
• Infant – 120 beats/minute
• 2-3 year – 100 beats/minute
• 5-10 year – 90 beats/minute
• Adults – 70-80 beats/minute (average 72 per minute)
• Old age – may be slower
• Extremely old age – may be more rapid

Sites of Taking Pulse

• Radial artery – in front of the wrist
• Brachial artery – above the elbow
• Carotid artery – sides of the neck
• Temporal artery – over the temporal bone
• Facial artery – above the lower jaw
• Femoral artery – in the groin
• Tibial artery – behind the medical Milhous
• Dorsalis pedis artery – on the foot

Factors Affect the Pulse

• Age: very old have slow pulse rate and children will have faster beat
• Sex: it is slower in men than in women
• Stature: it is slower in tall people than in short people
• Position: the pulse rate is slower than at rest or asleep than in standing position
• Emotions: anger or excitement increases the pulse rate temporarily
• Exercise: it is much faster during exercise

Common Sites for Checking Pulse

1. Radial

Location: inner aspect of the waist on thumb side

Reasons for use: easily accessible

• Temporal

Location: site superior (above) and lateral to (away from the midline) the eye

Reasons for use: it’s used when radial pulse is not accessible. Easily accessible pulse in children

• Carotid

Location: at the side of the trachea where the carotid artery runs between the trachea and the sternocleidomastoid muscle

Reasons for use: to assess cerebral perfusion

• Apical

Location: left side of the chest in the fourth, fifth or sixth intercostals space in the midclavicular line

Reasons for use: used to find out discrepancies with radial pulse

• Brachial

Location: medially in the antecubital space

Reasons for use: used to monitor blood pressure and assess for lower arm circulation

• Femoral

Location: below inguinal ligament, midway between symphysis pubis and anterosuperior iliac space

Reasons for use: to assess circulation to lower hip

• Popliteal

Location: medial or lateral to the popliteal fossa with knees slightly flexed

Reasons for use: used to determine circulation to the leg. To take blood pressure in the lower limb

• Posterior tibial

Location: on the medial surface of the ankle behind the medial malleolus

Reasons for use: to assess circulation to the foot

• Dorsalis pedis

Location: along dorsum of foot between extensor tendons of great and first toe

Reasons for use: to assess circulation to the foot

Ulnar pulse

Location: on the little finger side, outer aspect of the wrist

Reasons for use: to assess circulation to ulnar side of hand. To perform Allen’s test

Characteristics of Pulse

• Rate: number of beats/minute, corresponds with age (above 100 tachycardia, below 60 – bradycardia)
• Rhythm: it is the regularity of beats. The distance between beats (regular)
• Volume: it is the fullness of artery. It is the force of blood felt at each beat (full/large/small)
• Tension: it is the degree of compressibility (high/low)

Abnormal Pulse

• Rate: tachycardia: pulse rate more than 100 beats/minute. It commonly found in patients with fevers. Thyotoxicosis, organic heart diseases, nervous disorders and intake of drugs like belladorma and alcoholism cause tachycardia
• Bradycardia: pulse rate less than 60 beats per minute. Caused by opium poisoning heart muscle disorder, cerebral tumors and myxedema
• Abnormal rhythms are intermittent pulse, extra-systoles, atrial fibrillation, ventricular fibrillation, sinus arrhythmia
• Abnormal volume causes pulsus alternans, full bounding pulse and feeble pulse

Dicrotic pulse: there is a one heart and two arterial pulsations giving the sensation of a double beat, it is due to flabby weak arterial pulse

• Water hammer pulse or Corrigan’s pulse: it is a full volume pulse. This type of pulse found in aortic regurgitation. When the blood is forced into the artery, then leaks back into the ventricle due to the nonclosure of the aortic valve

General Instruction for Taking Pulse

• Count the pulse for one full minute. Especially when there is irregularity
• Observe rate, rhythm, volume and tension of pulse
• Pulse should not be taken immediately after exercise, in emotional stress or after a painful treatment
• Record pulse immediately
• Choose suitable site for taking pulse
• Nurse to be aware if patient is on any medication that can interfere with heart rate
• To check pulse after 10-15 minutes, after strenuous physical exercise
• Notify physician if pulse rate is below <60/mt or above >100/mt, normal and abnormal patterns (missing beats). Record in TPR record

Equipment

• Watch with second hand
• Red pen
• TPR sheet

Procedure

• Wash hands
• If supine, place client’s forearm across lower chest with wrist extended straight. If sitting, bend client’s elbow 90 degrees and support lower arm on chains or on nurse’s arm. Slightly extend wrist with palm down
• Place tips of the first two or middle three fingers of dominant hand over groove along radial or thumb side of client
• Lightly compress against radius obliterates pulse initially, and then releases pressure so pulse becomes easily palpable
• When pulse is easily palpable, look at watch’s second hand and begin to count rate: when sweep hand hits number on dial, start counting with zero, then one two and so on
• If pulse is regular count rate for 30 seconds and multiply total by 2
• If pulse is irregular count for full minute
• Assess regularity and frequency of any dysarrhythmia
• Determine strength of pulse. Note whether thrust of vessel against fingertips is bounding, strong weak or thread
• Assist client in returning to comfortable position

After Care

• Wash hands
• If pulse is assessed for first time establish as baseline
• Assess pulse again by having another nurse conduct measurement, if pulse character is abnormal or irregular
• Record characteristic of pulse in nursing progress sheet or vital sign flow sheet. Also record any accompanying signs and symptoms of pulse alternations
• Report abnormal findings to the nurse in charge or physician