ASSESSING THE

PULSE
 Pulse

 is commonly assessed by palpation (feeling) or auscultation (hearing)

The middle three fingertips are used for palpating all pulse sites except the
apex of the heart.
 Factors Affecting the Pulse

• Age
• Sex
• Exercise
• Fever
• Medications
• Hypovolemia/dehydration
• Hypovolemia/dehydration
• Emotions/Stress
• Position
• Pathology
Nine sites for assessing pulse
1. Temporal
 where the temporal artery passes over the temporal bone of the head.
 The site is superior (above) and lateral to (away from the midline of) the eye.

2. Carotid
 at the side of the neck where the carotid artery runs
3. Apical
 at the apex of the heart.
In an adult, located : on the left side of the chest, about 8 cm (3 in.) to the left
of the sternum (breastbone) at the fifth intercostal space (area between the
ribs).
older adults: the apex may be further left if conditions are present that have
led to an enlarged heart.
 Before 4 years of age, the apex is left of the midclavicular line (MCL); between
4 and 6 years, it is at the MCL
 For a child 7 to 9 years of age, the apical pulse is located at the fourth or fifth
intercostal space.
4. Brachial
 at the inner aspect of the biceps muscle of the arm or medially in the
antecubital space.

5. Radial
where the radial artery runs along the radial bone
on the thumb side of the inner aspect of the wrist.
6. Femoral
 where the femoral artery passes alongside the inguinal ligament.

7. Popliteal
where the popliteal artery passes behind the knee.
8. Posterior tibial
 on the medial surface of the ankle where the posterior tibial artery passes
behind the medial malleolus.

9. Dorsalis pedis
where the dorsalis pedis artery passes over the bones of the foot, on an
imaginary line drawn from the middle of the ankle to the space between the
big and second toes.
 Assessing the Pulse
Definition of term:

Tachycardia
Excessively fast heart rate (over 100 bpm)

Bradycardia
 Heart rate of less than 60 bpm in adults

Pulse rhythm
 pattern of the beats and the intervals between the beats
between the beats.
Dysrhythmia / arrhythmia
 pulse with an irregular rhythm
Consists of random, irregular beats or predictable pattern of irregular beats

Pulse Volume
 also called pulse strength or amplitude
 force of blood with each beat.
Full or Bounding pulse
 forceful or full blood volume that is obliterated only with difficulty.

Weak/ thread / feeble pulse

 a pulse that is readily obliterated with pressure from the fingers
 PULSE

It is a rhythmical throbbing result from a wave of blood passing through an

artery as the heart contracts.

Equipment:
• Watch with second hand
• Paper and pen
• Stethoscope
 Normal Pulse Rate per minute:

New Born (0-1 month) 120-160 bpm

First Year (1-12 months) 100-140 bpm

Toddler 80-120 bpm

Adult Male 70-80 bpm

Adult Female 80-90 bpm

A. RADIAL PULSE : PROCEDURES

STEPS RATIONALE
1. Wash hands Deter spread of microorganisms
2. Explain the procedure Gain cooperation and makes patient at
ease
3. Have the patient rest his arm This position places radial artery on the
along side his body with the inner aspect of the patient’s wrist. The
wrist extended and the palm of nurse’s fingers rest conveniently on the
the hand downward, or place artery with thumb in a position to the
arm on top of the patient’s center aspect of the patient’s wrist.
upper abdomen
4. Place your 2nd, 3rd, and 4th fingers along the The finger tips which are sensitive to touch
radial artery and press gently against the will feel the pulsation of the patient’s radial
radius; rest the thumb on the back of the artery. If the thumb is used to palpate the
patient’s wrist. patient’s pulse, the nurse may feel her own
pulse.

5. Apply enough pressure so that the Moderate pressure allows the nurse to feel
patient’s pulsating artery can be felt the superficial radial artery expand and
distinctly. contract with each beat. Too much pressure
will obliterate the pulse, too little pressure
will be imperceptible

6. Using a watch with second hand, count the Sufficient time is necessary to detect
number of pulsation felt for one full minute. irregularities or other defect
7. If pulse rate is abnormal in any way, When the pulse is abnormal, longer counting
repeat the counting to determine accurately and palpitation are necessary to identify
the rate, the quality and volume. most accurately the unusual characteristics
of the pulse.
8. Record pulse rate on the jot down
notebook.
B. APICAL PULSE

If the peripheral pulse is irregular, weak or extremely rapid, causing it to be

difficult to assess accurately, the apical rate may be assessed.
Purposes:

• To obtain the heart rate of newborns, infants and young children (2-3 y.o)
• To obtain the heart rate of an adult who has irregular peripheral pulse.
• To determine whether the cardiac rate is within normal range and the rhythm
is regular.
• For a client known with cardiovascular, pulmonary and renal diseases.
• Commonly assessed prior to administering medications that affect heart rate
PROCEDURES:
STEPS RATIONALE
1. Wash hands and read chart. Deter spread of microorganism.
2. Explain the procedure To gain cooperation and understanding
from the client significant others
3. Position the patient on supine Have a clear visualization of the chest
over the apex of the heart.
4. Cleanse earpiece and diaphragm of Placing the diaphragm against the skin
the stethoscope using alcohol swab may startle the patient and
momentarily chest increase the heart
rate.
5. Warm the diaphragm of the Placing the diaphragm against the skin
stethoscope with your hand before may startle the patient and
applying it to the patient’s. momentarily and increase the heart
rate.
6. Raise patient’s gown to expose Allows access to patient’s chest for
sternum and left side of chest. proper placement

7. Place the diaphragm of the This gives the loudest and most
stethoscope over the apex of the heart, distinctive sound of the heart.
located at the fifth Intercostal space,
left midclavicular line. Then, insert the
earpiece in your ears.
8. Move the diaphragm to the site of An irregular pulse requires a full
the loudest beats. Count the beats for minute count for accurate assessment.
60 seconds and note their rhythm and A longer duration helps determine
volume. Also evaluate the intensity pulse rhythm and quality.
(loudness) of heart sound.

9. Record the apical pulse on the jot To make patient presentable and
down notebook comfortable.

10. Refer to head nurse or attending If there are irregularities and

physician if necessary. abnormalities that need to be reported
immediately.

10. Record it to patient chart For future references/comparison