Assessing The Pulse

Assessing the Pulse

A pulse is commonly assessed by palpation (feeling) or auscultation (hearing). Middle three fingertips are used for palpating all the pulse sites except apex of the heart. The pads on the most distal aspects of the finger are the most sensitive areas for detecting a pulse

Equipments:

A Stethoscope is used for assessing apical pulses.

The five major parts of the stethoscope are the earpieces, binaurals, tubing, bell chest piece, and diaphragm chest piece.

The plastic or rubber earpieces should fit snugly and comfortably in your ears. The binaurals should be angled and strong enough so the earpieces stay firmly in the ears without causing discomfort. The polyvinyl tubing is flexible and 30 to 40cm (12 to 18 inches) in length. Thick walled and moderately rigid tubing eliminates transmission of environmental noise and prevents the tubing from kinking which distorts sound wave transmission.

The chest piece consists of a bell and diaphragm that u rotate in position. The diaphragm is the circular, flat portion of the chest piece covered with a thin plastic disk. It transmits high pitched sounds created by the high-velocity movement of air and blood. Auscultate bowel, lung and heart sounds using the diaphragm. Always place the stethoscope directly on the skin because clothing obscures the sound.

The bell is a bowl shaped chest piece usually surrounded by a rubber ring. The bell transmits low pitched sounds created by the low-velocity movement of blood.

Auscultate heart and vascular sounds using the bell. Apply the bell lightly, resting the chest piece on the skin.

A Doppler ultrasound stethoscope (DUS) is used for pulses that are difficult to assess. DUS headset has earpieces similar to standard stethoscope earpieces, but it has a long cord attached to a volume — controlled audio unit and an ultrasound transducer. The DUS detects movement of red blood cells through a blood vessel.

Procedure/ Techniques/ assessment of Peripheral Pulses

Purposes

·         To establish baseline data for subsequent evaluation.

·         To identify whether the pulse rate is within normal range.

·         To determine whether the pulse rhythm is regular and the pulse volume is appropriate.

·         To determine the equality of corresponding peripheral pulses on each side of the body.

·         To monitor and assess changes in the clients health status

·         To monitor clients at risks for pulse alterations

·         To evaluate blood perfusion to the extremities

Assessment

·         Clinical signs of cardiovascular alterations such as dyspnea (difficult respirations), fatigue, pallor, cyanosis (bluish discoloration of skin and mucous membranes), palpitations, syncope (fainting).

·         Factors that may alter pulse rate (emotional status and activity level)

·         Which site is most appropriate for assessment based on the purpose

Equipment

·         Watch with a second hand or indicator

·         DUS/ Stethoscope

Procedure

Steps		Rationale
Introduce self and verify the clients identify Perform hand Hygiene
	Provide for client privacy
	Select the pulse point. Normally the radial pulse is taken, unless it is contraindicated
	Assist client in assuming a supine or sitting position. If supine ,place patient's forearm straight alongside body or across lower chest or upper abdomen with wrist extended straight ,if sitting, bend patient's elbow 90 degrees and support lower arm on chair or on your arm.		Relaxed position of lower arm and slight flexion of wrist promote exposure of artery to palpate without restriction.
	Palpate and count the pulse. Place two or three middle finger tips lightly and squarely over the pulse point		Using thumb is contraindicated because the nurse's thumb has a pulse that could be mistaken for client's pulse.)
	Count for 15 seconds and multiply by 4. Record the pulse in beats per minute on your worksheet. If the pulse is irregular count for a full minute. If an irregular pulse is found, also take the apical pulse
	Assess the pulse rhythm and volume •         Assess the pulse rhythm by noting the pattern of the intervals between the beats. A normal pulse has equal time periods between beats •         Assess the pulse volume. A normal pulse can be felt with moderate pressure, and the pressure is equal with each beat.
	Document the pulse rate, rhythm and volume.