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!!