Pulse assessment is the detection of a patient's pulse.
Purpose
Pulse assessment is performed to establish a baseline on a patient's admission (from which to compare any significant changes), and to detect any abnormalities from the healthy state.
Precautions
As there may be no prior knowledge of the patient's previous pulse recordings for comparison, it is important for the nurse or other health professional to know the range of normal values that apply to patients of different ages. Any known medical and surgical history or abnormal readings of any of the vital signs, as well as details
of any current medication the patient is taking, should be obtained. Exertion, such as climbing stairs, may affect the results. Therefore the patient should have rested prior to having their pulse taken, and refrained from consuming tobacco, caffeinated drinks, and alcohol 30 minutes prior to the procedure. Of course, these precautions cannot be taken in an emergency situation.
Description
The pulse is checked as one indicator of abnormalities of the heart by observing the rate, rhythm, and the strength and tension of the beat against the arterial wall. The pulse may be recorded hourly to every four hours, or p.r.n. (when required), based on the patient's condition. For example, the pulse may be recorded postoperatively every 15 minutes in the recovery room.
Preparation
The equipment required for pulse assessment is a watch with a sweep second hand or a digital readout. The pulse may be read where a surface artery runs over a bone, e.g. the radial artery (in the forearm), carotid artery (in the neck), temporal artery (at the temple), popliteal artery (at the back of the knee), or dorsalis pedal artery (at the instep). The radial artery in the wrist is the option used most often. The physician may choose such sites as the carotid artery pulse if atrial or ventricular problems are suspected.
To take the radial pulse, the patient should be sitting or lying comfortably, so that the readings are taken in similar positions each time and that there is little excitement to affect the results. The patient's forearm should not be raised to a level higher than the heart, as this position will change the reading. The nurse should place the index, middle, and ring fingers over the radial artery, which is located above the wrist on the anterior surface of the thumb side of the wrist. Apply gentle pressure to avoid obstructing the patient's blood flow. The rate, rhythm, strength and tension of the pulse should be noted. Using a watch, the pulsations that are felt where the artery rests against the bone are counted for half a minute, and the result doubled to give the beats per minute. However, any irregularities noted within the 30-second count means that the pulse should be recorded for one full minute to avoid any discrepancies.
Aftercare
The nurse should make the patient comfortable and reassure him or her that recording the pulse is part of normal health checks and that it is necessary to ensure the patient's health is being correctly monitored. Any abnormalities in the pulse must be reported in the nurse's notes and relayed to the attending physician.
Results
The average heart rate for older children and adults can range from 50 to 90 beats per minute (bpm). This is an average; rates vary between males and females, with age, and with the patient's health and level of fitness. It is not abnormal for athletes to display a low pulse rate.
The pulse is an indicator of the health of the heart and the arterial circulation. Such factors as anxiety, medication, or pulmonary disease may also cause the heart rate to be faster or slower.
Pulse pressure may become raised due to arteriosclerosis, as the heart has to pump harder to promote the flow of blood around the body. This high-pressure pulse is called a bounding pulse, and may also be caused by such conditions as fever, pregnancy, or thyrotoxicosis. It may also be an indicator that pulmonary disease is present.
Other conditions that can be detected in part by pulse assessment include tachycardia (a heartbeat that is too fast) and bradycardia (a heartbeat that is too slow). The nurse would also be able to detect missed heart beats and pulsus alternans (alternating strong and weak beats).
The pulse is recorded and compared with normal ranges for the patient's age, gender, and medical condition, and a decision is made regarding the interpretation of the results as to whether any further action should be taken.
Health care team roles
Patients may ask questions about specific concerns they have regarding pulse recordings or a particular disease. Nurses should have a thorough knowledge of what pulse irregularities indicate to enable them to answer the patient's questions, or provide counseling on the prevention of illness and injuries, or direct the person to their doctor. Further tests may be performed to evaluate the heart and diagnose abnormalities.
Arteriosclerosis—Hardening and thickening of the walls of the arteries, causing loss of elasticity. It may also include calcium deposits in the arteries.
Bradycardia—A slow heartbeat or pulse below 60 bpm in an adult.
p.r.n.—pro re nata, when required.
Pulsus alternans—Alternating weak and strong beats of the pulse.
Tachycardia—A rapid heartbeat or pulse above 100 bpm in an adult.
Thyrotoxicosis—Hyperthyroidism.
BOOKS
Guyton, Arthur C., John E. Hall, Textbook of Medical Physiology, 9th edition. Philadelphia: W. B. Saunders Publishing, 1996, p. 173.
Nettina, Sandra M. The Lippincott Manual of Nursing Practice, 6th edition. Lippincott-Raven Publishers, 1996, p. 249.
Tierney, Lawrence M., Stephen J. McPhee, Maxine A. Papadakis, Current Medical Diagnosis and Treatment 2000, 39th edition. New York: Lange Medical Books/McGraw-Hill Publishing, 2000, p. 353.
ORGANIZATIONS
American Nurses Association. 600 Maryland Avenue SW, Suite 100 West, Washington, DC 20024. (202) 651-7000.
