Cardiovascular: Pulse (for nursing assistant training)

With every heartbeat, the heart creates a wave, or pulse, that’s sent to arteries all over the body in order to deliver oxygenated blood to our organs and tissues.

As a nursing assistant, you need to be able to obtain a pulse and determine its characteristics, including the pulse rate, rhythm, and amplitude, or character.

Okay, you can calculate the pulse rate by counting the number of pulses in one minute. This is actually equal to the heart rate, or the number of times the heart beats per minute.

Normal pulse rate varies among different age groups. So, for those 12 years of age or older, it’s typically between 60 and 100.

For school-aged children between 5 and 12 years old, it’s 75 to 110. For preschoolers from 3 to 5, it’s 80 to 120, while for toddlers from 1 to 3, have a normal pulse rate of 80 to 130.

Finally, infants under 1 year of age normally have the fastest pulse rate, which ranges from 120 to 160 beats per minute.

Besides age, the pulse rate can also be influenced by many factors, including physical activity; body temperature; emotions, like anger, fear, or stress; medications; or even the weather!

So, tachycardia is when the pulse rate is faster than normal, and this can occur in response to strenuous exercise, fever, pain, anxiety, or specific medications.

In contrast, bradycardia means that the pulse rate is too slow and can be due to heart problems or various medications.Another important characteristic is the pulse rhythm, which is normally regular, meaning that the intervals between the beats are equal.

In an irregular rhythm, also known as arrhythmia, the beats do not follow an even tempo and some of them might even be skipped.

Arrhythmia can be a result of heart problems or a complication of a heart attack or heart surgery. It can also be caused by problems with the balance of electrolytes, such as potassium, in the blood.Then, there’s the pulse amplitude, or character, which refers to how strong, forceful, or full the pulse is.

A weak, thready, or feeble pulse is typically considered an emergency and could be an indication of low blood pressure, like when a client is bleeding, as well as a serious heart problem or a blockage of a blood vessel.

In contrast, a bounding pulse refers to a pulse that’s stronger than normal and could be caused by an abnormally forceful heartbeat.

Alright, so, the pulse can be easily felt as a thumping sensation in arteries that are located near the skin’s surface. This includes the radial, carotid, brachial, femoral, popliteal, posterior tibial, and dorsalis pedis arteries.

Before taking a client's pulse, check with the care plan and the nurse to find out when and how often the pulse should be measured, what site to use, and if the nurse has any concerns about the client you should know about.

You can then gather the supplies you’ll need, including a watch. Remember to also practice hand hygiene.

Now, the radial pulse is one of the most easily accessible pulse locations. Start by assisting the client into a comfortable position.

If the client is lying supine, place their arm alongside their body. Then, place the middle two or three fingers on the front of the wrist, just under the thumb.

That’s where you’ll be able to feel the radial artery. Make sure to not use your thumb because you can get confused with your own pulse.

In an emergency or if the radial artery is not easily accessible, the carotid pulse can be obtained. First, check for obvious pulsations.

Then, using your middle two or three fingers, gently palpate the left, then right artery between the larynx and the anterior border of the sternocleidomastoid muscle.

Do not palpate both arteries at once and don’t apply excessive pressure because that would reduce blood flow to the brain.

In both cases, make sure to press firmly to obliterate the pulse and then apply a little less pressure until you can clearly feel it.

Count the first beat you feel as zero. The second beat is one, the third beat is two, and so on.

Count the pulse according to your facility policy. So, for example, if the rhythm is regular, you can count how many beats occur in 30 seconds and multiply by two to get the heart rate.

If the rhythm isn’t regular, you may count the number of beats in a full minute. A full minute of beats needs to be counted in children younger than 12 years old, too.

While you count, notice the pulse amplitude on a subjective scale from 0 to 4. Now, check the other side to assess for symmetry.

Both sides should be equal, which means both are receiving the same blood flow. When you’re done, remember to practice hand hygiene.Now, if one of these pulses seems too weak or irregular or if you're dealing with an infant or a client with heart disease or the client is taking certain medications that affect the heart, the most reliable and accurate way to measure the pulse is to obtain an apical pulse.

That’s the pulse that's felt right over the heart. So first gather the supplies you’ll need, including a watch, alcohol wipes, and a stethoscope.

This consists of a chest piece, which is the part that receives the sound and is placed against the client’s skin. This typically includes a diaphragm, which is the large, flatter side, and a bell, which is smaller, concave, and has a hole in it.

The sound then travels through the tubing, which is connected to the earpieces. So, once again, start by practicing hand hygiene.

If tolerated by the client, lift the head of the bed and assist the client to a sitting position. Adjust the client's clothing and use your fingers to identify anatomical landmarks that will help you locate the apical pulse.

Find the apical pulse at the apex of the heart on the left side of the chest between the 5th and 6th ribs. That’s usually just below the left nipple in biological males or under the breast in biological females.

Then use the alcohol wipes to clean the different parts of your stethoscope, including the earpieces, the diaphragm, and the bell.

After that, put the earpieces in your ears. Gently tap on your diaphragm.

If you don't hear the tap, turn the chest piece at the tubing. Once you hear the tap, place your stethoscope against the client's apical impulse.

You should now hear something that sounds like lub dub, lub dub, lub dub, which repeats over and over again. Each lub dub is a heartbeat.

Begin counting the heartbeats for one minute. Once you're done, take the stethoscope off the client's chest, adjust the head of the bed, and assist them back to a suitable position.

Finally, wipe the stethoscope clean and practice hand hygiene. Normally, every time the heart beats, there is a pulse, so the apical pulse matches the one measured in the arteries.

Sometimes, though, the heart beats irregularly, too quickly or weakly, to send enough blood to the arteries, which is the reason why some heartbeats might be heard with a stethoscope placed on the apex but not felt as a pulse in the arteries.

This can be checked by having one healthcare worker assess the apical pulse with a stethoscope and another one measure the radial pulse at the same time for one minute.

To find the pulse deficit, subtract the radial pulse from the apical pulse. Okay, when measuring a client’s pulse, there are a few things you should report to the nurse right away, such as a pulse rate above or below normal or a value specific for the client; an irregular pulse rhythm; a weak, thready, or feeble pulse; or an unusually strong, bounding pulse.

Let the nurse know if you find it hard to obtain a pulse. Finally, remember to document the date; time; pulse rate, rhythm, and amplitude; and any observations you made while measuring the client's pulse.##SummaryAll right, as a quick recap...

The pulse represents the vibration felt with each heartbeat over arteries near the surface of the body. It’s characterized by a pulse rate, which is the number of pulses per minute; a pulse rhythm, which can be regular or irregular; and a pulse amplitude, which reflects the strength or fullness of the pulse.

It is typically obtained by feeling the radial or the carotid artery. An apical pulse can be taken if these sites are not available or the client is an infant, has a heart condition, or takes medications that affect the heart.

This is done by measuring the number of heartbeats heard with a stethoscope over the apex of the heart. A pulse deficit is the difference between the apical and the radial pulse.

This can be due to heart conditions, causing the heart to beat irregularly: too quickly or weakly. Remember to report any unusual signs or symptoms to the nurse and document the pulse rate, rhythm, and amplitude along with your observations.