1.  The number of heart beats per minute  It is the rhythmic expansion and contraction of the arteries which are measured to indicate how fast the heart beats per minute.  Each expansion and contraction is measured as one pulse beat.

2.  We feel a pulse where the artery crosses over a bone near the skin surface.  Pulse is an easy, painless way to measure the circulatory function. http://www.smart-heart-living.com/images/pulse-wrist.jpg

3.  Bradycardia – slow pulse for the patients age and condition  Tachycardia – fast pulse for the patients age and condition

4.  Arrythmia – irregular heart beat http://www.smartnow.com/content/ecg.jpg

5.  Radial Pulse – pulse located at the base of the thumb and wrist. http://i.ehow.com/images/a04/rs/7r/normal-pulse-rate-men-800X800.jpg

6.  Apical Pulse- pulse located at the apex (bottom tip) of the heart. http://static.howstuffworks.com/gif/sound-of-heartbeat3.jpg

7.  Before birth…  At birth…  First year of life…  Childhood years…  Adult years…  140 – 160 bpm  130 – 140 bpm  115 – 130 bpm  80 – 115 bpm  50 – 80 bpm

9. Palpate – to feel with fingered hand We feel (palpate) for 3 qualities: 1. Rate – the number of beats per minute a. 30 seconds x 2 = bpm b. Rate is described as: * Normal * Fast (Tachycardia) * Slow (Bradycardia)

10. 2. Rhythm – regularity of the heart beat Rhythm is described as: * Regular, steady * Irregular, skipped beats * Extra beats * Cyclic irregularity *** If irregular pulse noted you need to take an apical pulse for 60 seconds ( one full minute).

11. 3.Force – strength of heart beat Force is described as: * Average, normal * Weak, thready * Strong, Bounding

12.  Exercise  Age  Emotional excitement  Hemorrhage  Fever  Drugs http://www.soc.ucsb.edu/sexinfo/images/05-08-exercise.jpg

13.  Drugs http://newzar.files.wordpress.com/2009/01/prescription-drugs.jpg

14. Apical pulse – always done for 1 full minute with a stethoscope.

15.  * Infants / toddlers  *Radial pulse is irregular  * Tachycardia (>100 bpm)  Physicals  Pre-op * Always done for these reasons! http://i.ehow.com/images/a05/f6/4i/listen-baby_s-heartbeat-800X800.jpg

16.  Use the diaphragm of the stethoscope  Place the diaphragm on the left side of the patients chest, 1 – 1 ½ inches below the nipple

17. 1. Heart disease 2. Arterial disease 3. Anxiety 4. Weight

18.  Incorrect technique  Incorrect location  Incorrect calculation

19. A. 30 second method – done for patient with normal pulse characteristics during radial pulse method. B. 60 second or 1 minute method- 1. Patient whose radial pulse has any variation in the normal characteristics 2. All apical pulse measurements

20.  Tachycardia  Irregular rhythm  Weak force

21.  Rate – any pulse outside of the normal range for age of the patient  Rhythm – any irregularity noted  Force – any pulse that is weak or bounding

22. A. Equipment: 1. Watch with second hand 2. Patient assignment sheet 3. Pen or Pencil B. Procedure: 1. Wash hands 2. Identify the patient by checking the ID band 3. Tell the patient what you will be doing 4. Have the patient assume a comfortable position.

23. 5. Support the patients’ hand and arm 6. Find the patients’ radial pulse by placing the tips of your index and middle fingers on the inner surface of the patients’ wrist at the base of his/her thumb http://www.acefitness.org/calculators/images/radial-pulse.jpg

24.  CAUTION: DO NOT use your thumb – it has it’s own pulse. You may be counting your own pulse instead of the patients.

25.  Press lightly so you feel the pulsation.  CAUTION: by pressing TOO HARD, you may obliterate the pulse and will NOT be able to feel it! http://www.medtrng.com/Fm21_11/21110004.gif

26.  Feeling the pulse, notice the rate, rhythm and force  Look at the position of the 2 nd hand of your watch.  Start to count the pulse beats (what you are feeling) until the 2 nd hand reaches 30 second or 1 minute mark.

27.  Variations will make it necessary for you to extend the counting method from 30 seconds to 1 full minute.  Examples of variations are: ◦ Fast rate ◦ Slow rate ◦ Irregular rhythm ◦ Extra beats ◦ Skipping beats ◦ Weak force ◦ Bounding force

28. A. Equipment 1. Stethoscope 2. Antiseptic Wipes 3. Watch with a 2 nd hand 4. Patient assignment sheet 5. Pen or pencil

29. B. Procedure 1. Wash hands 2. Identify the patient by checking the ID band 3. Explain to the patient what you are doing 4. Clean the stethoscope earplugs and diaphragm with the antiseptic wipes 5. Warm the diaphragm by holding it tightly for a few seconds 6. Uncover the left side of the patients chest Caution: Avoid overexposing the patient.

30. 7. Place the diaphragm over the apex of the heart. 8.Put the earplugs in your ears. 9. Listen for the heart sounds, noting all three characteristics. http://todaysseniorsnetwork.com/Elderly%20Woman%20in%20Hospital%20Bed.jpg

31. 10. Count the heart sounds for 1 full minute. 11. Record the findings on your patient assignment sheet. 12. Cover and make the patient comfortable

32. 13. Lower the bed to a position of safety 14. Raise the side-rails if indicated 15. Place the call light within easy reach of the patient 16. Clean the earplugs and diaphragm with the antiseptic wipes 17. Replace the equipment 18. Wash your hands

33. 19. Report the apical pulse rate and any variations of rhythm and force 20. Record the pulse on the TPR sheet