A 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. A stethoscope is used for assessing apical pulses and fetal heart tones. Increasingly, a Doppler Ultrasound Stethoscope (DUS) is being used for pulses that are difficult to assess. The DUS headset has earpieces similar to standard stethoscope earpieces, but it has a long cord attached to a volume-controlled audio unit and an ultrasound transducer. The DUS detects movement of red blood cells through a blood vessel. In contrast to the conventional stethoscope, it excludes environment sounds. I t cannot detect blood flow in deep vessels or in those underlying bone or in, such as the vessels in the abdomen, thorax, or skull. The DUS is battery operated, and batteries must be replaced about every 6 months.
The cardiac monitoring machine is another device for assessing the apical pulse. It indicates the rate on a screen or readout graph.
A pulse is normally palpated by applying moderate pressure with the three middle fingers of the hand. The pads on the most distal aspect of the finger are the most distal aspects of the finger are the most sensitive areas for detecting a pulse. With excessive pressure, one can obliterate a pulse, whereas with too little pressure, one may not be able to detect it. Before the nurse assesses the resting pulse, the client should assume a comfortable position. The nurse should also be aware of the following:
• Any medication that could affect the heart rate
• Whether the client has been physically active. If so, wait 10 to 15 minutes until the client has rested and the pulse has slowed to its usual rate.
• Any baseline data about the normal heart rate for the client. For example, a physically fit athlete may have a heart below 60 beats per minute.
• Whether the client should assume a particular position (eg, sitting). In some clients the rate changes in blood flow volume and autonomic nervous system activity.
When assessing the pulse, the nurse collects the following data: the rate, rhythm, volume, arterial wall elasticity, and presence or absence of bilateral equality. An excessively fast heart rate (eg, over 100 beats per minute in an adult) is referred to as tachycardia. A heart rate in an adult of 60 beats per minute or less is called bradycardia. If a client has either tachycardia or bradycardia, the apical pulse should be assessed.
The pulse rhythm is the pattern of the beats and the intervals between the beats. Equal time elapses between beats of a normal pulse. A pulse with an irregular rhythm iseferred to as a dysrhythmia or arrhythmia. It may consist or random, irregular beats. When a dysrhythmia is detected, the apical pulse should be assessed. An electrocardiogram (ECG or EKG) is necessary to define the dysrhythmia further.
Pulse volume, also called the pulse strength or amplitude, refers to the force of blood with each beat. Usually, the pulse volume is the same with each beat. It can range from absent to bounding. A normal pulse can be felt with moderate pressure of the fingers and can be obliterated with greater pressure. A forceful or full blood volume that is obliterated only with difficulty is called a full or bounding pulse. A pulse that is readily obliterated with pressure from the fingers is referred to as weak, feeble, or thready. A pulse volume is usually measured on a scale of 0 to 3.
The elasticity of the arterial wall reflects it expansion or its deformities. A healthy, normal artery feels straight, smooth, soft, and pliable. Elderly people often have inelastic arteries that feel twisted (tortuous) and irregular upon palpation. The elasticity of the arteries may not affect the pulse rate, rhythm, or volume, but it does reflect the status of the client’s vascular system.
When assessing a peripheral pulse to determine the adequacy of blood flow to a particular are of the body, the nurse should also assess the corresponding pulse on the other side of the body, the second assessment gives the nurse data with which to compare the pulses. For example, when assessing the blood flow to the right foot, the nurse assesses the right dorsalis pedis pulse and then the left dorsalis pedis pulse. If the client’s right and left pulses are the same, the client’s dosali pedis pulses are bilaterally equal.
PERIPHERAL PULSE ASSESSMENT
A peripheral pulse, usually the radial pulse, is assessed by palpation in all individuals except:
• Newborn and children up to 2 or 3 years. Apical pulses are assessed in these clients.
• Very obese or elderly client’s, whose radial pulse may be difficult to palpate. Doppler equipment may be use for some clients, whose radial pulse may be difficult to palpate. Doppler equipment may be use for some clients, or the apical pulse is assessed.
• Individuals with a heart disease, who require apical pulse assessment.
• Individuals in whom the circulation to a specific body part must be assessed; for example, following leg surgery, the pedal (dorsalis pedis) pulse is assessed.
APICAL PULSE ASSESSMENT
Assessment of the apical pulse is indicated for clients whose peripheral pulse is irregular as well as for clients with known cardiovascular, pulmonary, and renal disease. It is commonly assessed prior to administering medications that affect heart disease. The apical site is also used to assess the pulse for newborns, infants, and children up to 2 to 3 years old.
APICAL AND RADIAL PULSE ASSESSMENT
An apical-radial pulse may need to be assessed for clients with certain cardiovascular disorders. Normally, the apical and radial rates are identical. An apical pulse rate greater than a radial pulse rate can indicate that the thrust of the blood from heart is too feeble for the wave to be felt at the peripheral pulse site, or it can indicate that vascular disease is preventing impulses from being transmitted. Any discrepancy between the two pulse rates needs to be reported promptly. In no instance is the radial pulse greater than the apical pulse.
An apical-radial pulse can be taken by two nurses or one nurse, although the two-nurse technique may be more accurate.
Procedure in Assessing an Apical-radial Pulse
