L2.2: Vital Signs - Pulse

• Pulse

  • It is the movement of blood during the contraction of the heart’s left ventricle.
  • It is a throbbing sensation below the skin.
  • It may be palpated over the peripheral artery or auscultated over the apex of the heart.
  • It may be the distention or pulsation of arteries.
  • A wave can be felt when direct pressure is applied at certain points/pulse sites of the body.
• Pulse Sites

  • Temporal
  • Carotid
  • Apical
  • Brachial
  • Radial
  • Femoral
  • Popliteal
  • Posterior Tibial
  • Dorsalis Pedis/Pedal
• Pulse Sites

  • Temporal
  • Superior and lateral to the eye.
  • Indication of Use:
  • When the radial pulse is not accessible.
• Pulse Sites

  • Carotid
  • Side of the neck between the trachea and sternocleidomastoid muscle.
  • Indication of Use:
  • During cardiac arrest/shock in adults.
  • To determine circulation of blood to the brain
• Pulse Sites

  • Apical
  • Apex of the heart
  • Routinely used for infants and children up to 3-years-old
  • Indication of Use:
  • To determine discrepancies with radial pulse.
  • In conjunction with some medications.
• Pulse Sites

  • Apical
  • Locations:
  • Adult: 5th Intercostal Space Left Midclavicular Line
  • Infant (less than 4-years-old): 4th Intercostal Space Left Midclavicular Line
  • 4 to 6 years old: 5th Intercostal Space Left Midclavicular Line
  • 7 to 9 years old: 4th or 5th Intercostal Space Left Midclavicular Line
• Pulse Sites

  • Brachial
  • Inner aspect of the biceps muscle of the arm or medially in the antecubital space.
  • Indication of Use:
  • To measure blood pressure.
  • During cardiac arrest for infants.
• Pulse Sites

  • Radial
  • Thumb side of the inner aspect of the wrist.
  • Readily accessible and routinely used.
• Pulse Sites

  • Femoral
  • Inguinal Region
  • Indication of Use:
  • In cases of cardiac arrest or shock.
  • To determine circulation in the legs.
• Pulse Sites

  • Popliteal
  • Behind the knees.
  • Can be easily palpated with client’s knee flexed slightly.
  • Indication of Use:
  • To determine circulation to the lower leg.
  • To measure high blood pressure.
• Pulse Sites

  • Posterior Tibial
  • Medial surface of the ankle.
  • Indication of Use:
  • To measure circulation of the foot.
• Pulse Sites

  • Dorsalis Pedis/Pedal
  • Dorsum of the Foot
  • Indication of Use:
  • To determine circulation to the foot.
• Peripheral Pulse

  • Collective term for pulse sites.
  • Distant from the heart.
  • Pulse located in the periphery (usually limbs).
• Assessing a Peripheral Pulse (1-6)

  • Wash hands.
  • Introduce self.
  • Explain the purpose and procedure to the client.
  • Prepare the client.
  • Provide privacy.
  • Select the pulse site.
• Assessing a Peripheral Pulse (7-8)

  • Assist the client in a comfortable resting position, either in a lying or sitting position.
  • If the client is made to lie down, their arm rests alongside the body, palm down; or the forearm can rest at a 90-degree angle across teh chest with palm facing downward.
  • For clients who can sit, the forearm can rest across the thigh with the palm of the hand facing downward.
  • Palpate and Count the pulse.
  • Place two (2) or more middle fingertips lightly and squarely over the pulse site. Never use the thumb, because it has a pulse on its own.
• Assessing a Peripheral Pulse (9-10)

  • Assess the pulse quality (rhythm) and volume
  • Note the pattern of the intervals between the beats. Normally, it should have equal time periods between the beats.
  • Normally a pulse volume can be felt with moderate pressure and pressure is equal with each beat. A forceful pulse volume is full; an easily obliterated pulse is weak.
  • Document and Report pertinent data.
• Positions of Fingers in Assessing Various Pulses

  • Carotid pulse

  
• Positions of Fingers in Assessing Various Pulses

  • Radial pulse

  
• Positions of Fingers in Assessing Various Pulses

  • Posterior tibial pulse

  
• Positions of Fingers in Assessing Various Pulses

  • Brachial pulse

  
• Positions of Fingers in Assessing Various Pulses

  • Femoral pulse

  
• Positions of Fingers in Assessing Various Pulses

  • Dorsalis pedis pulse

  
• Positions of Fingers in Assessing Various Pulses

  • Popliteal pulse

  
• Pulse Rate

  • Number of pulse beats in one full minute.
  • Corresponds to the rate of the heartbeat.
  • Unit: Beats Per Minute (BPM)
  • Normal range in adult and adolescence at rest: 60-100 bpm
  • It increases and decreases in response to a variety of physiologic mechanisms
• Pulse Alterations

  • Tachycardia
  • Bradycardia
  • Palpation
• Pulse Alterations

  • Tachycardia
  • Tachy → Fast / Rapid, Cardia → Heart
  • Rapid Pulse Rate
  • > 100 bpm at rest
  • It tends to overwork the heart and may not oxygenate cells adequately.
  • Monitored closely and results are reported and recorded.
• Pulse Alterations

  • Bradycardia
  • Brady → Slow / Delayed, Cardia → Heart
  • <100 bpm
  • Less common than tachycardia
  • Needs prompt reporting and continued monitoring
• Pulse Alterations

  • Palpation
  • Awareness of one’s own heart contraction and can accompany tachycardia.
  • Feelings or sensations that your heart is pounding or racing.
• Pulse Rhythm and Regularity

  • Pattern by which the heart beats are spaces, normally regular with each beat.
  • Rhythm is regular, beats are felt by the finger at a regular interval and are of equal force.
• Pulse Rhythm and Regularity Alterations

  • Dysrhythmia or Arrhythmia
  • Bigeminal
• Pulse Rhythm and Regularity Alterations

  • Dysrhythmia or Arrhythmia
  • Irregular Pattern of Irregular Rhythm of Heartbeats.
  • Apical pulse should be assessed.
  • Should be reported promptly.
• Pulse Rhythm and Regularity Alterations

  • Bigeminal
  • Pulse as occasional premature beats.
  • Results in a shorter interval between beats followed by a longer interval.
• Pulse Volume and Amplitude

  • reflects the strength of left ventricular contraction.
  • Quality of pulsation felt usually is related to the amount of blood pumped with each heartbeat, or the force of heart contraction.
  • Normally strong when it can be felt with mild pressure over the artery.
• Types of Pulse Volume

  • Absent Pulse
  • Thready Pulse
  • Weak Pulse
  • Normal Pulse
  • Bounding Pulse
• Types of Pulse Volume

  • Absent Pulse
  • No pulsation is felt despite of extreme pressure.
• Types of Pulse Volume

  • Thready Pulse
  • Pulsation is not easily felt.
  • Slight pressure causes it to disappear.
• Types of Pulse Volume

  • Weak Pulse
  • Pulse is stronger than thready.
  • Light pressure causes it to disappear.
• Types of Pulse Volume

  • Normal Pulse
  • Pulsation is felt easily.
  • Moderate pressure causes it to disappear.
• Types of Pulse Volume

  • Bounding Pulse
  • Pulsation is strong and does not disappear with moderate pressure.
• Normal Heart Rates

  • Less than 1 month: 120-160 BPM
  • 1-12 months: 80-140 BPM
  • 12 months to 2 years: 80-130 BPM
  • 2 to 6 years: 75-120 BPM
  • 6 to 12 years: 75-110 BPM
  • More than 12 years: 60-110 BPM