The number of heart beats per minute

It is the rhythmic expansion and contraction of the arteries which are measured to indicate how fast the heart beats per minute.

Each expansion and contraction is measured as one pulse beat.

Vital Signs ~PULSE

We feel a pulse where the artery crosses over a bone near the skin surface.

Pulse is an easy, painless way to measure the circulatory function.

Measuring a pulse

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Bradycardia –slow pulse for the patients age and condition

Tachycardia – fast pulse for the patients age and condition

TERMS TO KNOW:

Arrythmia – irregular heart beat

TERMS TO KNOW…

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Radial Pulse – pulse located at the base of the thumb and wrist.

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Apical Pulse-pulse located at the apex (bottom tip) of the heart.

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Before birth…

At birth…

First year of life…

Childhood years…

Adult years…

140 – 160 bpm

130 – 140 bpm

115 – 130 bpm

80 – 115 bpm

50 – 80 bpm

PULSE RATES

Palpate – to feel with fingered hand

We feel (palpate) for 3 qualities:1. Rate – the number of beats per minute

a. 30 seconds x 2 = bpm

b. Rate is described as:* Normal* Fast (Tachycardia)* Slow (Bradycardia)

ASSESSMENT WITH PALPATION OF PULSE

2. Rhythm – regularity of the heart beat

Rhythm is described as:* Regular, steady* Irregular, skipped beats* Extra beats* Cyclic irregularity

*** If irregular pulse noted you need to take an apical pulse for 60 seconds ( one full minute).

3. Force – strength of heart beat

Force is described as:* Average, normal* Weak, thready* Strong, Bounding

Exercise Age Emotional

excitement Hemorrhage Fever Drugs

TACHYCARDIA-what causes it?

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Drugs

BRADYCARDIA –what causes it?

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Apical pulse – always done for 1 full minute with a stethoscope.

AUSCULTATE – to listen with a stethoscope

* Infants / toddlers *Radial pulse is

irregular * Tachycardia

(>100 bpm) Physicals Pre-op

* Always done for these reasons!

When is an apical pulse taken?

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Use the diaphragm of the stethoscope

Place the diaphragm on the left side of the patients chest, 1 – 1 ½ inches below the nipple

Stethoscope placement for apical pulse

1. Heart disease 2. Arterial disease 3. Anxiety 4. Weight

Factors that affect the rate, rhythm and force of the pulse:

Incorrect technique

Incorrect location

Incorrect calculation

Causes of incorrect pulse measurement:

A. 30 second method – done for patient with normal pulse characteristics during radial pulse method.

B. 60 second or 1 minute method- 1. Patient whose radial pulse has

any variation in the normal characteristics 2. All apical pulse measurements

Calculation of Pulse Rate:

Tachycardia

Irregular rhythm

Weak force

Examples of pulse variations:

Rate – any pulse outside of the normal range for age of the patient

Rhythm – any irregularity noted

Force – any pulse that is weak or bounding

Report these variations immediately!

A. Equipment:1. Watch with second hand2. Patient assignment sheet3. Pen or Pencil

B. Procedure:1. Wash hands2. Identify the patient by checking the ID band3. Tell the patient what you will be doing4. Have the patient assume a comfortable position.

Measuring the Radial Pulse

5. Support the patients’ hand and arm

6. Find the patients’ radial pulse by placing the tips of your index and middle fingers on the inner surface of the patients’ wrist at the base of his/her thumb

Radial Pulse Procedure:

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CAUTION: DO NOT use your thumb – it has it’s own pulse. You may be counting your own pulse instead of the patients.

Radial Pulse

Press lightly so you feel the pulsation.

CAUTION: by pressing TOO HARD, you may obliterate the pulse and will NOT be able to feel it!

Radial Pulse

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Feeling the pulse, notice the rate, rhythm and force

Look at the position of the 2nd hand of your watch.

Start to count the pulse beats (what you are feeling) until the 2nd hand reaches 30 second or 1 minute mark.

Radial Pulse Procedure

Variations will make it necessary for you to extend the counting method from 30 seconds to 1 full minute.

Examples of variations are:◦ Fast rate◦ Slow rate◦ Irregular rhythm◦ Extra beats ◦ Skipping beats◦ Weak force◦ Bounding force

Note: Any variations encountered while feeling the pulse

A. Equipment1. Stethoscope2. Antiseptic Wipes3. Watch with a 2nd hand4. Patient assignment sheet5. Pen or pencil

Measuring the Apical Pulse

B. Procedure1. Wash hands2. Identify the patient by checking the ID band3. Explain to the patient what you are doing4. Clean the stethoscope earplugs and diaphragm with the antiseptic wipes5. Warm the diaphragm by holding it tightly for a few seconds6. Uncover the left side of the patients chest

Caution: Avoid overexposing the patient.

Apical Pulse Procedure

7. Place the diaphragm over the apex of the heart.8.Put the earplugs in your ears.9. Listen for the heart sounds, noting all three characteristics.

Apical Pulse Procedure

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10. Count the heart sounds for 1 full minute.11. Record the findings on your patient assignment sheet.12. Cover and make the patient comfortable

13. Lower the bed to a position of safety14. Raise the side-rails if indicated15. Place the call light within easy reach of the

patient16. Clean the earplugs and diaphragm with

the antiseptic wipes17. Replace the equipment18. Wash your hands

Apical Pulse Procedure

19. Report the apical pulse rate and any variations of rhythm and force

20. Record the pulse on the TPR sheet

Documentation

We are ALL ready to take Pulses!!