Assessment of pulse

PULSE

The pulse is the palpable bounding of blood flow noted at various points of body. pulse is an indicator of circulatory status.

Circulation is the means by which cells receive nutrients and oxygen and remove waste products of metabolism. For cells to function normally, there must be a continuous blood flow and an appropriate volume and distribution of blood to cells that need nutrients.

Blood flows through the body in a continuous circuit. Electrical impulses originating from the sinoatrial (SA) node travel through heart muscle to stimulate Cardiac contraction.

When, about 60 to 70 ml of blood enters aorta during each ventricular contraction the wall of aorta distends creating a pulse wave.

This pulse wave travels rapidly toward the distal ends of arteries. When the pulse wave reaches a peripheral artery, it can be felt by palpating the artery lightly against underlying bone or muscle.

The pulse is the palpable bounding of the blood flow in the peripheral artery. The pulse rate is the number of pulsing sensation occurring in one minute.

Assessment of pulse

Any artery can be assessed for pulse rate, but the radial and carotid arteries are easily palpated.

Peripheral pulse site.

Pulse site

Site    Location

Temporal : over temporal bone of head,

          above and lateral to eye.

Carotid       : along medial edge of

          sternocleido mastoid muscle in

          neck

Apical         : Fourth and fifth intercastal

          space at left elavicular line.

Radial : Radial or thumb side of forearm

          at wrist

Ulnar : Ulnar side of fore arm at wrist.

When assessing the heart rate, the nurse uses the stethoscope.

Character of the pulse

Assessment of radial pulse includes measurement of the rate, rhythm, strength and quality.

RATE

Pulse rate is counted for minute when the patient is in a sitting, standing and lying position.

Normal heart rate:

Age   Heart rate

Infant          120 - 160 / min

Toddlers     90      - 140 / min

Pre schooler         80      - 110 / min

School going        75      - 100 / min

Adolescents          60      - 90 / min

Adult 60      - 100 / min

Factors influencing pulse rate

1.     Exercise : Short term exercise increases pulse rate. An athlete, who participates in long - term exercise will have lower pulse rate at rest.

2.     Temperature : Fever and heat increases pulse rate. Hypothermic decreases pulse rate.

3.     Emotion : Pain and anxiety increase pulse rate.

4.     Drugs : Epinephrine increases pulse rate.

5.     Digoxin decreases pulse rate.

6.     Hemorrhage : blood loss increases pulse rate

7.     Postural changes : In standing or sitting positions, pulse rate increases. In lying down position, the pulse rate decreases.

8.     Pulmonary condition : Causes poor oxygenation and decreased pulse rate.

Purposes of Monitoring Pulse

1.     To test the health and efficiency of heart

2.     To test the elasticity and the health of arteries.

3.     To get an approximately idea of how much blood is being pumped into the artery system.

4.     To estimate the change in the needs of the body circulation.

5.     To understand the general condition of the body, recovery, or death

6.     To give emergency treatment if necessary

General Instructions

The pulse may be felt over any large artery that is close to the surface of the body and has a boney structure or other solid surface beneath. Common arteries used for counting the pulse rate are

a.     Radial

b.     Facial

c.      Temporal

d.     Dorsalis Pedis

e.      Carotid

f.       Femoral

g.     Tibial

h.     Popliteal

Equipments

1.     Watch

2.     Chart and Pen

Procedure

1.     Keep the patient in a comfortable position

2.     Hold the wrist firmly, place first three fingers over the artery, press it to make the pulsation distinct.

3.     Count the pulse for one minute

4.     Note rhythm , volume and any other abnormalities

5.     Record your observation

Common abnormalities in pulse rate

a.     Tachycardia is an abnormally elevated heart rate above 100 beats per minute in adults.

b.     Bradycardica is a slow rate, below 60 beats per minute in adults.

Rhythm

Normally a regular interval occurs between each pulse.

Abnormal rhythm :

When there is irregular interval or a missed beat that condition is abnormal rhythm. When dysarrhythmic occurs repetitively, it threatens the hearts ability to provide adequate cardiac output.

Strength:

The strength of a pulse reflects two volume of blood ejected against the arterial wall with each heart contraction. Normally the pulse strength remains same. Pulse strength may be graded as strong, weak, thready or bounding.

Equality

Normally the pulse in one extremity is equal in strength and rate. In some disease condition it may be unequal. Eg. clot formation, injury to blood vessels cervical rib syndrome. The carotid pulse should never be measured simultaneously because excessive pressure may occlude the blood supply to the brain.