Normal & Abnormal Pulse Rate
12+ years old
School-aged children (5–12 years old)
Preschoolers (3–5 years old)
Toddlers (1–3 years old)
Infants (< 1 year old)
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!
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.
Normal & Abnormal Pulse Rhythm
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.
Normal & Abnormal Pulse Amplitude
The pulse amplitude, or character, 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 hemorrhaging, 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.
Obtaining a Pulse
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.
- 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.
- Check for obvious pulsations.
- 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 for one full minute.
- While you count, notice the pulse amplitude on a subjective scale from 0-4.
- 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.
First, gather the supplies you'll need, including:
- a watch that measures seconds
- alcohol wipes
- a stethoscope
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 fifth and sixth ribs. That's usually just below the left nipple or under the breast.
- 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 pulse. 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.
- Take the stethoscope off the clients' chest, adjust the head of the bed, and assist them back into a suitable position. Finally, wipe the stethoscope clean and practice hand hygiene.
- a pulse rate above or below normal or a value specific for the client;
- an irregular pulse rhythm
- a weak, thready, or feeble pulse
- an usually strong, bound pulse
Remember to document:
- the date and time
- pulse rate, rhythm, and amplitude
- any observations you made while measuring the client's pulse