Pulse Stephanie Oliver, DNP, RN

It is an indicator of circulatory status The normal pulse varies according to age Infants 120-160 Toddlers 90-140 Preschoolers 80-110 School age 75-100 Adolescent 60-90 Adult 60-100 The pulse is a palpable bounding of blood flow noted at various points on the body.

Pulse points Temporal Carotid Apical Brachial Radial Ulnar Popliteal Posterior tibial Dorsalis

Assessment of the pulse character Rate Number of beats per minute Rhythm Interval between contractions of ventricles Strength Volume of blood ejected against the arterial wall graded as strong, weak, thready, bounding Equality Are pulses the same on both sides of the body

Questions to answer: What conditions could affect pulses at various parts of the body? What conditions affect the rate, strength, equality of the pulse Discuss how exercise, temperature, emotions, drugs, hemorrhage, postural changes, pulmonary conditions

Counting the pulse Radial is most logical spot, assess need for data type Radial pt sitting or lying down two fingers over radial pulse compress gently determine strength note sweep hand on watch determine start number begin count regular pulse,, count 30 sec multiply by 2 irregular pulse…count for full minute

Counting the apical pulse When pulse is irregular it may be necessary to determine the pulse-deficit This requires two nurses One to count the radial pulse one to count the apical pulse (pulse at apex of heart) This is done at the same time

Pulse deficit Nurse one determines the PMI, and listens to the heart beat at this point on the chest wall Nurse two locates the radial pulse at the wrist Nurse one determines start number on watch and calls start Both nurses then count the pulse at their respective site After counting for a full minute nurse one calls time the difference between the two pulse is the pulse deficit

pmi The point of maximal impulse is located midline fifth intercostal space midclavicular line