After watching this presentation, you will be

able to:

2. Describe factors that affect pulse.

1. Cite the definition of pulse.

3. Identify the different pulse sites.

5. Demonstrate the appropriate and organized method of assessing pulse.

4. Explain the variations of pulse depending on different factors.

What is pulse???It is a wave of blood created by contraction of the left ventricle of the heart.In a healthy person, it reflects the heartbeat.It represents the stroke volume output or the amount of blood that enters the arteries with each ventricular contraction.It is expressed in beats per minute (BPM).

Factors Affecting the Pulse…Age. As age increases, the pulse rate

gradually decreases overall. See table z.2 below.

Gender. After puberty, the average male’s pulse rate is slightly lower than the female’s.Exercise. The pulse rate normally increases with activity.

Fever. During a fever, a person’s pulse rate increases due to increase metabolic rate.

Medications. Some medications decrease the pulse rate, and others

decrease it.Hypovolemia. Loss of blood from the

vascular system normally increases pulse rate.Stress. The sympathetic nervous system

responses to stress by increasing the rate as well as the force of the heartbeat.Position changes. When a person is sitting or standing, blood usually pools in dependent vessels of the venous system.Pathology. Certain diseases such as some heart conditions or those that impair oxygenation can alter the resting pulse rate.

TABLE Z.2 Variations in Pulse by Age

AGE PULSE AVERAGE (AND RANGES)

Newborn 130 (80 to 180)

1 year 120 (80 to 140)

5 to 8 years 100 (75 to 120)

10 years 70 (50 to 9)

Teen 75 (50 to 90)

Adult 80 (60 to 100)

Older adult 70 (60 to 100)

What are the different pulse sites???

1. Temporal. It is where the temporal artery passes over the temporal bone of the head. This site is superior and lateral to the eye.2. Carotid. It is at the side of the neck

where the carotid artery runs between the trachea and the sternocleidomastoid muscle.3. Apical. It is at the apex of the heart.It is located at the left side of the chest and at the fourth, fifth or sixth intercostal space. It is also referred to as the point of maximal impulse (PMI).

4. Brachial. It is at the inner aspect of the biceps muscle of the arm or medially in the antecubital space.

5. Radial. It is where the radial artery runs along the radial bone, on the thumb side of the inner aspect of

the wrist.

6. Femoral. It is where the femoral artery passes alongside the inguinal ligament.

7. Popliteal. It is where the popliteal artery passes behind the

knee.

8. Posterior tibial. It is on the medial surface of the ankle where the posterior

tibial artery passes behind the medial malleolus.

9. Pedal (dorsalis pedis). It is where the dorsalis pedis artery passes over bones of the foot.

TERMINOLOGIES:Cardiac Output-It is the volume of blood pumped into the arteries by the heart and equals the result of stroke volume (SV) times the heart rate (HR) per minute.Peripheral pulse

-It is a pulse located away from the heart, for example, in the foot or wrist.Pulse volume

-It is also called the pulse strength or amplitude. It refers to the force of blood with each beat.

Tachycardia

It is an excessively fast heart rate. Bradycardia- It is a heart rate in an adult of less than 60 BPM.Pulse rhythm

- It is the pattern of the beats and the intervals between the beats.

Dysrythmia or arrhythmia

- It is a pulse with an irregular rhythm.

Assessing the Pulse…

A pulse is commonly assessed in two ways:

1.Palpation or feeling

This is done by applying moderate pressure with the three middle fingers of the hand.

2. Auscultation or hearing

This is done by using Doppler ultrasound stethoscope (DUS).

ASSESSING A PERIPHERAL PULSE

To establish baseline data for subsequent evaluation. To identify whether the pulse rate is within normal range. To determine whether the pulse rhythm is regular and the pulse volume is appropriate. To monitor and assess changes in the client’s health status. To monitor clients at risk for pulse alterations To evaluate blood perfusion to extremities.

PURPOSES:

ASSESSMENTAssess Clinical signs of cardiovascular alterations such as dyspnea, fatigue, pallor, cyanosis, palpitations, syncope or impaired peripheral tissue perfusion. Factors that may alter pulse rate. Which site is most appropriate for assessment based on the purpose.

PLANNINGDelegation

Measurement of the client’s radial or brachial pulse can be delegated to UAP- or family members/ caregivers in nonhospital settings/.

Equipment

Watch with a second hand indicator

If using a DUS: transducer probe, stethoscope headset, transmission gel and tissue wipes

IMPLEMENTATIONPreparationIf using a DUS, check that the equipment is functioning normally.

Performance

A. Through palpation (of peripheral pulse)…1. Prior to performing the procedure, introduce self and verify the clients identity using agency protocol. Explain to the client what you are going to do, why it is necessary and how can he or she can cooperate. Discuss how the results will be used in planning further care or treatments.2. Perform hand hygiene and observe appropriate infection control procedures.

3. Provide for client privacy.

4. Select the pulse point. Normally, the radial pulse is taken, unless it cannot be exposed or circulation to another body area is to be assessed.

5. Assist the client to a comfortable resting position. When the radial pulse is assessed, with the palm facing downward, the client’s arm can rest alongside the body or the forearm can rest at a 90 degree angle across the chest. For the client who can sit, the forearm can rest across the thigh, with the palm of the hand facing downward or inward.6. Palpate and count the pulse. Place two or three middle finger-tips lightly and squarely over the pulse point. Rationale: Using the palm is contraindicated because a person’s thumb has a pulse that could be mistaken for the client’s pulse.7. Assess the pulse rhythm and volume.

8. Document the pulse rate, rhythm and volume and your actions in the client record. Also record pertinent related data such as variation in pulse rate compared to normal for the client and abnormal skin color and skin temperature in the nurse’s notes.

B. Through auscultation of the apical pulse…

1. Follow the procedure numbers 1-3 above.

2. Position the client in a comfortable supine position or in a sitting position. Expose the area of the chest over the apex of the heart.

3. Locate the apical impulse. This is the point over the apex of the heart where the apical pulse can be most clearly heard.

4. Auscultate and count heartbeats.

�Use antiseptic wipes to clean the earpieces and diaphragm of the stethoscope if their cleanliness is in doubt.Rationale: The diaphragm needs to be cleaned and disinfected if soiled with body substances.

�Warm the diaphragm (flat-disc ) of the stethoscopeby holding it in the palm of the hand for a moment. Rationale: The metal of the diaphragm is usually cold and can startle the client when placed immediately on the chest.

�Insert the earpieces of the stethoscope into your ears in the direction of the ear canals, or slightly forward, to facilitate hearing.

�Place the diaphragm of the stethoscope over the apical impulse and listen to the normal “lub-dub” heart sounds.

�Count the heartbeats for 60 seconds.

5. Assess the rhythm and strength of the heartbeat.

6. Assess the pulse site, rate, rhythm and volume and nursing actions in the client record. Also record pertinent related data such as variation in pulse rate compared to normal for the client and abnormal skin color and skin temperature.

�Tap your finger lightly on the diaphragm to be sure if it is the active side of the head.

EVALUATION

Compare the pulse rate to baseline data or normal range for age of client.

Relate pulse rate and volume to other vitals signs; pulse rhythm and volume to baseline data and health status.

If assessing peripheral pulses, evaluate equality, rate and volume in corresponding extremities.

Conduct appropriate follow-up such as notifying the primary care provider or giving medication.

Report to the primary care provider any abnormal findings.

..THE END..

“Mam aWw,tHis iS really iS it!!!”