Measuring Heart Rate

As the heart pumps blood to the body, the blood causes a pressure wave against the arterial walls called a pulse, which correlates with the heart rate, or the number of heart beats per minute. As the nurse, you’ll measure your patient’s pulse and evaluate its characteristics including rate, rhythm, and amplitude.

Pulse Measurement The pulse can be felt in the superficial arteries close to the skin, including the radial, carotid, brachial, femoral, popliteal, posterior tibial, and dorsalis pedis. The radial artery is the most common site because it’s easy to access. To locate the radial pulse, place the flat part of your middle two or three fingers on the anterior of the patient’s wrist, just under the thumb. Then, to feel the pulse, you’ll use your fingers to firmly palpate the artery, being careful not to obliterate it.

Now, if your patient’s pulse is abnormal, or if they have heart disease or are taking medications that affect their pulse, count an apical pulse, or the pulse that’s heard right over the heart using your stethoscope. To measure the apical pulse, place your stethoscope at the apex, or lowest portion, of the heart on the left side of the chest between the 5th and 6th ribs. You should hear something that sounds like ‘lub-dub’ which repeats over and over again. Each ‘lub-dub’ is one heartbeat and should be counted for one full minute.

Now, when measuring a pulse, you also need to determine its characteristics, including the rhythm, rate, and amplitude. The rhythm is the measurement of the intervals between heart beats. If these intervals are equal, the rhythm is considered regular. On the other hand, if the intervals are unequal, the rhythm is considered irregular, and is known as an arrhythmia. To determine the rate when the rhythm is regular, count the pulsations for thirty seconds, and then multiply that number by two to calculate the beats per minute. If the rhythm is irregular, you’ll count for a full minute.

Amplitude refers to how strong, forceful, or full the pulse feels. A pulse can be graded on a scale of 0 to 4+, where 4+ is a bounding pulse against your fingertips; 3+ is a strong, full, pulse, 2+ is considered normal; 1+ is diminished and is often described as weak and thready. Lastly, a pulse that’s absent or not palpable is graded as 0.