Pulse

It is the bounding of blood flow in an artery that is palpable at various points on the body.
The pulse is caused by the stroke volume ejection and distension of the walls of the aorta, which
creates a pulse wave as it travels rapidly toward the distal ends of the arteries. As the pulse wave
reaches a superficial peripheral artery and travels over an underlying bone or muscle, the pulse
can be palpated by applying gentle pressure over a pulse point (a specific area where the
peripheral pulses can be palpated). The figure shows the location of pulse points throughout the
body.
As nurses, we are obligated to know how to get a patient’s pulse to know and asses its
regulation, we need also to further comprehend the concept of perfusion, know the normal ranges,
and factors that affect the pulse rate. We need to asses and know the pulse rate to identify the
client’s status if he/she needs advance monitoring.

Pulse Sites
Nurses assess the pulse at the apex of the
heart (apical pulse) or at a place where an artery
can be pressed by the fingers against a bone
(peripheral pulses). Peripheral sites are shown in
the figure.
The choice of pulse site depends on the reason for
assessing the pulse and/or the accessibility of a
site. To measure a peripheral pulse, you would, for
example, use the:

■ Radial artery for routine assessment of vital

signs. This is the most commonly used site
because it is easily found and readily accessible.
■ Brachial artery when performing
cardiopulmonary resuscitation of infants.
■ Carotid artery when performing CPR of inpatient
adults and for assessing circulation to the brain.
Note: Palpate only one side of the neck at a time to avoid interrupting circulation to the head.
Palpate lightly so that you don’t occlude the artery; and don’t massage the area because that can
decrease the heart rate and blood pressure.

■ Temporal artery—when assessing circulation to the head or when other sites are not easily
accessible.
■ Dorsalis pedis (also called pedal pulse) and posterior tibial arteries for assessing peripheral
circulation.
■ Femoral artery to determine circulation to the legs, in cases of cardiac arrest, and for children.
■ Popliteal artery for assessing circulation to the lower leg.

Pulse Rate
To assess the pulse rate, count the number of beats per minute while palpating or
auscultating. Begin the count with one, rather than zero. For normal, healthy adults, you can
determine the rate of a regular heart rhythm by counting the pulse for 15 seconds and multiplying
the result by 4. Research is conflicting, but some studies indicate that a 30-second count is more
accurate. If the pulse is irregular or slow, always count for 1 full minute.
Rates below 60 beats/min are known as bradycardia (brady = slow, cardia = heart). Rates over
100 beats/min are known as tachycardia (tachy = rapid, cardia = heart).
Pulse Rhythm
Rhythm is the intervals between heartbeats that makes the pattern of the pulse. When the
intervals between beats vary enough to be noticeable, the rhythm is abnormal (dysrhythmia).
Abnormal rhythms may be single beats that occur too early or too late, or a group of irregular
beats that form a pattern. When assessing an irregular pulse, it is important to determine whether
the beat is regularly irregular (an irregular rhythm that forms a pattern) or irregularly irregular (an
unpredictable rhythm). To make this distinction, you must count the rate for one full minute. An
irregular heart rhythm can be very serious and may require additional assessment by
electrocardiogram (ECG), a procedure that traces the electrical pattern of the heart.

Pulse Quality
You will be able to asses the quality of the pulse by figuring out its volume and bilateral
equality (both sides) of the pulses. The amount of force produces through the body determines
the pulse volume. Normally, the pulse volume for each beat is the same. The following terminology
refers to the characteristics of the pulse volume; the numbers are assigned on a scale of 0 to 3.

0—Absent: Pulse cannot be felt.

1—Weak or thready: Pulse is barely felt and can be
easily obliterated by pressing with the fingers.
2—Normal quality: Pulse is easily palpated, not weak
or bounding.
3—Bounding or full: Pulse is easily felt with little pressure; not easily obliterated.

The equality of the blood flow through your body is what we called bilateral equality. It id
useful to figure out or determine if the blood flow is enough. Assess bilateral equality by comparing
the pulses on both sides of the body for equal volume. If both the pulses on each side feels the
same, they are said to be equal in strength bilaterally. Unequal bilateral happens when one pulse
is stronger than the other pulse.

If a peripheral pulse is absent or weak, it may be because the circulation is compromised

in that extremity. If this is the case, then pallor or cyanosis may be present. Pallor refers to the
paleness of skin in one area when compared to another part of the body. Cyanosis is a bluish or
grayish discoloration of the skin resulting from deficient oxygen in the blood.
Factors That Influence The Pulse Rate

■ Developmental level. Newborns have a rapid pulse rate. The rate stabilizes in childhood and
gradually slows through old age.
■ Gender. Adult men have a slower pulse rate than adult women,
■ Exercise. Physical activities normally increases pulse rate. Athletes on the other side who are
well conditioned have a lower heart rate.
■ Food. Ingestion of food causes a slight increase in pulse rate for several hours.
■ Stress. Stress triggers the fight-or-flight sympathetic nervous system response, which increases
both pulse rate and strength of the heart contractions (stroke volume).
■ Fever. The pulse rate tends to increase about 10 beats/ min for each degree Fahrenheit of
temperature elevation. The reasons are that (1) the metabolic rate increases and (2) the body
attempts to compensate for the decrease in blood pressure produced by the peripheral
vasodilation that occurs with fever.
■ Disease. Diseases, such as heart disease, hyperthy- roidism, respiratory diseases, and
infections, are generally associated with increased pulse rates. Hypothyroidism is associated with
decreased pulse rates.
■ Blood loss. Small blood loss is generally well tolerated and produces only a temporary increase
in pulse rate. Theoretically, a large blood loss stimulates the sympathetic nervous system,
bringing about an increase in pulse rate to compensate for the decreased blood volume.
■ Position changes. Standing and sitting positions cause a temporary increase in pulse rate and
decrease in blood pressure as a result of blood pooling in the veins of the feet and legs. This
decreases blood return to the heart, decreasing blood pressure and subsequently increasing
heart rate.
■ Medications. Stimulant drugs (e.g., epinephrine) increase pulse rate. Cardiotonics (e.g.,
digitalis) and opioids (e.g., narcotic analgesics) or sedative drugs decrease pulse rate.

References:

Wilkinson, J. M., Treas, L. S., Barnett, K., & Smith, M. H. (2015). Fundamentals of Nursing (3rd ed., Vol.
1). F.A. Davis Company.
DeLaune, S. C., & Ladner, P. K. (2003). Fundamentals of Nursing: Standards & Practice (4th ed.). Albany,
NY: Delmar Thomson Learning.