ASSESSMENT OF PULSE

PULSE ASSESSMENT

• Pulse assessment is the detection of a patient's pulse.
• 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.
• Assessing the pulse is a common procedure and an important aspect of many nursing interventions
• It should always be done with care and reassessed as needed.
• Assessment should always be taken seriously, with any deviations from the normal should be reported and pulse rate, rhythm and strength must always be documented.
• Pulses indicate numerous patient characteristics like the degree of relaxation of heart, regularity of cardiac contractions and sufficiency of cardiac output.

Sites for taking Pulse

• Carotid
• Brachial
• Radial
• Ulnar
• Femoral
• Popliteal
• Posterior Tibial
• Dorsalis Pedis

Location of Pulse

Upper Limbs:

• Axillary pulse: located inferiorly of the lateral wall of the axilla
• Brachial pulse: located on the inside of the upper arm near the elbow.
• Radial pulse: located on the lateral of the wrist (radial artery).
• Ulnar pulse: located on the medial of the wrist (ulnar artery).

Head & Neck:

• Carotid pulse: located in the neck (carotid artery). The carotid artery should be palpated gently and while the patient is sitting or lying down. A person's two carotid arteries should not be palpated at the same time. Doing so may limit the flow of blood to the cerebrum, possibly leading to fainting or brain ischemia. It can be felt between the anterior border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage.
• Facial pulse: located on the mandible (lower jawbone) on a line with the corners of the mouth (facial artery).
• Temporal pulse: located on the temple directly in front of the ear (superficial temporal artery).

Lower Limbs:

• Femoral pulse: Located in the inner thigh, at the mid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine at the groins (femoral artery).
• Popliteal pulse: Above the knee in the popliteal fossa, found by holding the bent knee. The patient bends the knee at approximately 124°, and the health care provider holds it in both hands to find the popliteal artery in the pit behind the knee (Popliteal artery).
• Dorsalis pedis pulse: Located on top of the foot, immediately lateral to the extensor of hallucis longus (dorsalis pedis artery).
• Tibialis posterior pulse: Located on the medial side of the ankle, 2 cm inferior and 2 cm posterior to the medial malleolus (posterior tibial artery).

Equipment Needed:

• Clock

Technique of taking pulse:

• 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 and count the pulse for one full minute.
• Document the Results in the Vital Signs Chart

After Care:

• Make the patient comfortable and reassure 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 communicated to the attending physician.

Special Considerations:

• As there may be no prior knowledge of the patient's previous pulse recordings for comparison, it is important 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.
• Refrain from consuming tobacco, caffeinated drinks, and alcohol 30 minutes prior to the procedure. But these precautions cannot be taken in an emergency situation.