Pulse -It can be felt in any artery near the surface of body as it passes over a bone.

 

   PULSE :

“ Pulse is the alternate expansion (Rise ) and recoil (fall) of the arteries produced by the wave  of blood forced  into them as the heart left ventricle contracts”.

   As the blood is pumped out into the arteries, it causes the arteries to expand.

·      Pulse is the palpable bounding of blood flow noted at various point of the body

·      Pulse wave is felt during the contraction or systole of the heart and recoil during the relaxation or the diastole of the heart.

·      Pulse is the wave of expansion and recoil occurring in an artery in response to the pumping action of the heart.

It can be felt in any artery near the surface of body as it passes over a bone.

·       When the left ventricle contracts, it force about 70ml of  blood into the aorta and into the arteries.

·      The pulse wave moves  15 time faster through the aorta and 100 time faster through the small arteries than the ejected volume of blood.

·      A pulse is normally palpated by applying   moderate pressure  with the three middle fingers of the hand.

·      The pads on the most distal aspects of the finger are the most sensitive areas of detecting a pulse.

·      The pulse is the palpable bounding of blood .it is an indicator of circulatory status.

 

Pulse  “Pulse may be define as the alternate expansion and contraction of an artery as the wave of blood is forced through it by the contraction of left ventricle “.

        

Common pulse sites:

1.      Temporal: Over temporal bone of  head ,above and lateral to eye.

2.      Carotid : Along medial edge of sternocleidomastoid muscle in neck.

3.      Apical: Fourth to fifth intercostal space at mid-clavicular line

4.      Brachial: groove between bicep and triceps muscles at antecubital fossa.

5.      Radial : Ulnar side of the forearm at wrist.

6.      Femoral :  Below inguinal ligament midway between symphysis pubis and anterior superior iliac spine.

7.      Popliteal:  Behind knee in popliteal fossa.

8.      Posterior tibia  :  Inner side of each ankle below medial malleolus.

9.      Dorsalis pedis  : A long top of foot , between extension tendon of great and first toe.

·         Any artery can be assessed for pulse rat, but the radial and carotid artery are easily palpated peripheral pulse sites.

·         When a client  condition suddenly worsens, the carotid site is the best for quickly finding a pulse.

·         The heart will continue delivering blood  through the carotid artery to the brain as long as possible.

·         When cardiac output declines significantly ,peripheral pulses weaken and are difficult to palpate .

 

Factor Influencing pulse Rate:

                               A pulse rate  varies according  to a number of factors. The nurse should consider reach  of          following  when assessing a client’s pule:

1.      Exercise :  short term exercise increases pulse rate while long term exercise reduces pulse rate.

2.      Fever and heat : These increase pulse rate.

3.      Age: Pulse rate varies according to age .

4.      Acute pain and anxiety : These increase pulse rate .

5.      Sever chronic pain : It reduce pulse rate .

6.      Medication :  some medication alter pulse rate e.g , Digitalis and atropine.

7.      Hyperthyroidism :   It increase pulse rate.

8.      Hemorrhage : Loss of blood increases pulse rate. 

9.      Postural changes:  lying down decreases pulse rate  while standing or sitting increases it

10.  Food : Ingestion of food increase pulse rate .

11.  Blood pressure : When blood pressure is low , pulse rate is increased.

12.  Sex : Female has a slightly increased pulse rate as compared to male.

13.  Physique : The short person with small body has slightly more rapid pulse than tall heavy individual .

14.  Mental & emotional disturbance :will increase pulse rate tempo-rarely.

15.  Disease Condition : Heart diseases thyroid disturbance and other infection have marked effect on pulse rate.

Pulse Rate : The number of pulsing sensation occurring in one minute is the pulse rate.

Cardiac output: The volume of blood pumped by the heart during one minute is the cardiac output.

Cardiac output =pulse rate x stroke  volume.

E .g: 70 beats per minute  x 70ml /beat =4.9/min

60beats per minute x 95ml/beat =5.1/min

  

In a normal  adult the heart normally pumps 5000ml of blood per minute

 use of a stethoscope :

when assessing the apical rate ,the nurse uses a stethoscope. The stethoscope consists of five major parts:

1.      Ear piece.

2.      Binaural

3.      Tubbing’s

4.      Bell chest piece and

5.      Diaphragm chest piece

·         The plastic or rubber ear piece should fir snugly and comfortably in the nurse ears

·         The binaural should be angled and strong enough so the ear piece stay firmly in the ears without causing discomfort

·         To ensure the best reception of sound, the ear pieces follow the contour of the ear canal pointing toward the face when the stethoscope is in the place 

 

Characteristics of the pulse :

  When assessing the pulse the nurse collecting following data :

The rate  :

·         The pulse rate expressed in beat per minute

·         An excessively fast heart rate e.g., over 100 beats per minute in an a adult is referred as a tachycardia .

·         A heart rate in an a adult of 60 beats per minute or less is called bradycardia

·         If a client as tachycardia or bradycardia , apical pulse should be assessed.   

                        The pulse rhythm :

·      It is the pattern of the beats and the intervals between the beats.

·      Equal time elapses between beats of a normal pules.

·      A pulse with an irregular rhythm is referred to as a dysrhythmia or arrhythmia .

·      It may consists of random, irregular beats it as predictable pattern of irregular beats .

·      When a dysrhythmia is detected, apical pulse should be assessed.

 

 

The pulse volume :

·      It is also called as pulse strength or amplitude ,refers to the force of blood with each beat.

·      Usually 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 of full blood volume that is obliterated with difficult is called a full bounding pulse .

Tension :

·     It indicates the amount of resistance the artery gives when the figure is pressing against it .

·    the amount of tension present is due to the pressure of the blood in the arteries . tension of pulse is usually expressed as high or low  .

·    A pulse of high tension is soft to touch and artery is difficult to compress where the walls of the arteries are relaxed.

   

 Assessing radial and apical pulse:

 

Radial pulse :

(a)   Radial pulse:

1.      Explain the procedure to the patient to gain confidence and cooperation .

2.      Prepare the needed articles like pen, pencil and seconds wrist watch, TPR chart .

3.      Wash hands.

4.      Assist client to assume a supine or sitting position .

5.      If supine, place clients forearm straight alongside or across lower chest or upper abdomen with wrist . extended straight. If sitting bend clients elbow 90degrees and support lower arm on chair or on nurse’s arm .slightly flex the wrist with palm down.

6.      Place tips of first two fingers of hand over groove along radial or thumb side of client’s inner wrist.

7.      Lightly compress against radius ,obliterate pulse initially ,and then relax pressure so pulse becomes easily palpable.

8.      Determine strength of pulse. Not whether thrust of vessel against fingertips is bounding ,strong weak or ready.

9.      After pulse can be felt regularly ,look at watch’s second  hand and begin to count rate ;when sweep hand hits number on dial, start counting with zero ,then one, to three and so on.

10.  If the pulse is regular ,count rate for 30 second and multiply total by 2.

11.  IF the pulse is irregular, count rate for 60 seconds. Assess frequency and pattern of irregularity.

12.  Pulse should  not be checked immediately after exercise, in emotional stress or during and after painful treatment.

13.  Do not use thumb for counting the pulse, because there is a pulse in the thumb which the nurse uses the fingertips of the first, second and third finger for counting the pulse.

14.  After checking the pulse note the rate ,rhythm, volume and tension of the pulse .

15.  Record immediately before forget ting

(b)   Apical Pulse  :

1.      Assist  client to supine position. Move aside bed linen and  gown to expose sternum and left side of chest.

2.      Locate anatomical landmarks to identify the point of maximal impulse (PMI),also called the apical impulse. Heart is located behind and  to left sternum with base at top and apex at bottom . find angle of louis just below suprasternal notch between sternal body and manubrium can be felt as a bony prominence . slip fingers don each side of angle to find second intercostal space(ICS). Carefully move finger don left side of sternum to fifth ICS and laterally to the left midclavicular line (MCL) .A light tap felt within an PMI is reflected from the apex of the heart .

3.      Place diaphragm of stethoscope in palm of hand for 5 to 10sec.

4.      Place diaphragm of stethoscope over PMI at the fifth ICS at left MCL, and auscultate for normal S1 and S2 heart sounds (hear “lub-dub).

5.      When S1 and S2 are heard with regularity ,use watch’s second hand hits number on dial ,start counting with zero ,then one, two and so on.

6.      If apical rate is regular or client is receiving  cardiovascular medication ,count for 1 minute or 60 seconds.

7.      If apical rate is regular ,count for 30 seconds and multiply by 2.

8.      Note regularity of any dysrhythmia

9.      Replace client’s  gown and bed linen .

10.  Assist in returning to comfortable position .

11.  Clean ear pieces and diaphragm of the stethoscope with alcohol swab as needed.

12.  Record the reading immediately before forgetting .

 

 Normal Pulse  Rate :

           Normal pulse rate for the healthy adult is 70-80 beats per minute. Pulse rate for an infants   varies from 130-140 beats per minute. The pulse rate for women is usually slightly higher normal pulse rate for the healthy adult is 70-80 beats per minute. The pulse rate for women is usually slightly more rapid than that of men .in old age ,the normal pulse rate is decreased  to 60-70 beats per minute.

         

Pulse rate before birth	140-150 per minute
Pulse rate at birth	130-140 per minute
Pulse rate 1st year	115-130per minute
Pulse rate 2nd year	100-115 per minute
Pulse rate 3rd year	90-100per minute
Pulse rate 4-8 year	86-90 per minute
Pulse rate 8-15 year	80-86 per minute
Pulse rate in old age	60-70per minute .

 

     Abnormalities of pulse  :

·      Bradycardia : pulse rate below 60/minute.

·      Tachycardia : pulse rate above 140/minute.

·      Arrhythmia:  A variation from normal rhythm.

·      Irregular pulse :  It is one whose rhythm is not the same for succeeding beats or whose pulsation varies in force.

·      Extra systole : it is an extra beta.

·      Water hammer pulse or Corrigan’s pulse: it is very forceful beat with the artery falling away very quickly .

·      Collapsing Pulse : one which is feeble in touch and ,then ,subsides abruptly.

·      Dicrotic pulse:  It is one which has two marked expansion in one beat of artery . it is seen in thyroid patients.