Pulse
2. Pulse rate
Pulse: Expansion of an artery with each hart beat.
Pulse is a wave of blood created by contraction of the left ventricle of the heart.
The heart is a pulsate pump and the blood enters the arteries with each
heartbeat, causing pulse waves.
Pulse is actually called heart rate which is the number of times the heart beats
each minute.
The beat of the heart felt at an artery as a wave of blood passes through the
artery.
A pulse is felt every time the heart beats.
More easily felt in arteries that come close to the skin and can be gently pressed
against a bone.
The pulse should be the same in all pulse sites on the body.
The pulse is an indication of how the cardiovascular system is meeting the
body’s needs.
Factor affecting pulse rate
• Age, • Illness,
• Gender, • Injury,
• Exercise, • Heat, and
• Fever, • Pain.
• Medication,
• Emotions,
• Position change,
Measuring techniques / places of assessing
I. Palpation (Peripheral Pulse): II. Auscultation (Apical Pulse):
Carotid artery, stethoscope(over heart).
Brachial artery,
Radial artery,
Femoral artery,
Popliteal artery,
Dorsalis pedis artery,
Posterior tibial artery, etc.
Characteristics of Pulse
1. Pulse quality refers to the ‘‘feel’’ of the pulse, its rhythm and forcefulness.
– Normal
– Strong (fever),
– Weak (shock/heart failure).
Characteristics of Pulse(cont.)
2. Pulse rate is an indirect measurement of cardiac output obtained by counting
the number of apical or peripheral pulse waves over a pulse point.
A normal pulse rate for adults is between 60 and 100 beats per minute.
Resting pulse rates
Ages Pulses per minutes
Neonate 80 - 180
Infant 80 - 160
1 - 2 years 80 - 130
2 - 6 years 80 - 120
6 -12 years 70 - 110
12 years & older 60 - 100
Athletes 40 - 60
Characteristics of Pulse(cont.)
3. Pulse rhythm is the regularity of the heartbeat.
It describes how evenly the heart is beating:
– Regular (the beats are evenly spaced).
– Irregular (the beats are not evenly spaced).
– Dysrhythmia (arrhythmia) is an irregular rhythm caused by an early, late, or
missed heartbeat.
Characteristics of Pulse(cont.)
4. Pulse volume is a measurement of the strength or amplitude of force exerted
by the ejected blood against the arterial wall with each contraction.
– - It is described as normal (full, easily palpable).
– - Weak (thready and usually rapid), or
– - Strong (bounding).
Pulse volume scale
Scale Description
0 Absent pulse.
1 Weak and thready pulse.
2 Normal pulse.
3 Bounding pulse.
Abnormal pulse rate
Bradycardia is a heart rate less than 60 beats per minute in an adult.
Tachycardia is a heart rate in excess of 100 beats per minute in an adult.
Factors may slow the pulse
Rest,
Increasing age,
People with thin body size,
Some medications,
Thyroid gland disturbances, and
Heart block.
Factors contribute to increase pulse
Pain,
Fever,
Stress, exercise,
Bleeding,
Decrease in blood pressure,
Some medications as (adrenalin, aminophylline), and
Shock.
How to check pulse rate
Pre procedure
Greet and explain procedure to the patient,
Provide privacy and perform hand hygiene,
Select pulse point and position patient appropriately,
Place 2 or 3 fingers tips lightly and squarely over the pulse site,
Palpate and count pulsation for 1 minutes.
Inform patient findings.
Post procedure
Perform hand hygiene.
Inform Senior and specialist any abnormal results,
Document reading.
Radial pulse
Most common site used for taking a pulse,
Can be taken without disturbing or exposing the person,
Place the first two or three fingers of one hand against the
radial artery,
The radial artery is on the inner aspect of forearm on thumb
side of wrist,
Do not use your thumb to take a person’s pulse,
Use gentle pressure,
Count the pulse for 60 seconds.
Carotid pulse
Bilateral, under lower jaw in neck along medial edge of sternocleidomastoid muscle.
Used routinely for infants and during shock or cardiac arrest when other peripheral pulses are
too weak to palpate; also used to assess cranial circulation.
Brachial pulse
Inner aspect between groove of biceps and triceps muscle at antecubital fossa.
Used in cardiac arrest for infants, to assess lower arm circulation, and to auscultate blood
pressure.
Femoral pulse
In groin, below inguinal ligament (midpoint between symphysis pubis and antero_superior iliac
spine).
Used to assess circulation to legs and during cardiac arrest.
Popliteal pulse
Behind knee, at center in popliteal fossa.
Used to assess circulation to legs and to auscultate leg blood
pressure.
Posterior tibial pulse
Inner aspect of ankle between Achilles tendon and tibia (below medial malleolus).
Used to assess circulation to feet.
Dorsalis pedis pulse
Over instep, midpoint between extension tendons of great and second toe.
Used to assess circulation to feet.
Temporal pulse
Over temporal bone,
superior and lateral to
eye.
Used routinely for
infants and when
radial is inaccessible.
Using a stethoscope
Always clean the earpieces of the stethoscope
with alcohol before and after use,
Warm the diaphragm in your hand before
placing it on the person,
Hold the diaphragm in place over the artery,
Do not let the tubing strike against anything
while the stethoscope is being used.
Apical pulse
Taken with a stethoscope,
Counted by placing the stethoscope over the
heart(Left mid clavicular line at fourth to fifth
intercostal space),
counted for one full minute,
The heart beat normally sounds like a lub-dub. Each
lub-dub is counted as one heartbeat,
Do not count the lub as one heartbeat and the dub as
another.
Apical pulse assessment
Apical pulse represents the actual beating of the heart.
The apical pulse is taken for patients whose peripheral pulse is irregular as well
as for patients with known cardiovascular, pulmonary, and renal diseases.
It is commonly assessed prior to administering medications that effect heart.
The apical pulse is also used to assess the pulse for newborns, infants, and
children up to 2-3 years old.
Also used in very obese or elderly person.
Apical - Radial Pulse
The apical and radial pulse rates should be equal,
Sometimes the heart beat is not strong enough to
create a pulse in the radial artery,
This would cause the radial pulse to be less than the
apical pulse,
One person counts the apical while the other person
counts the radial,
The difference in pulses is called the pulse deficit.
signifies that the pumping action of the heart is faulty.
