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.