1. Pulse
Stephanie Oliver, DNP, RN

2. It is an indicator of circulatory status
The normal pulse varies according to age
Infants
Toddlers
Preschoolers
School age
Adolescent
Adult
The pulse is a palpable bounding of blood flow noted at various points on the body.

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

4. 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

5. 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

6. 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

7. 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

8. 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

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