ASSESSING PULSE DEFICI' Pulse doficit-the difference betweon the apical and peripheral pulse rates— can signal an arrhythmia. You'll need to monitor this deficit if your patient's pulse rhythm Is irregular. DON’T © Don't assess the apical pulse first, then the radial pulse (or vice versa). For accuracy, you and a co-worker should assess both pulses simultaneously. ‘© Dont place a cold stethoscope on the patient's skin. It may startle him and momentarily increase his heart rate, po ‘¢ Help the patient to a comfortable position, Remove any clothing covering his chest—you need to place the stethoscope directly on his skin for an accurate reading, ¢ Warm the stethoscope diaphragm and place it over the apex of the patient's heart. © Ask the co-worker who's assisting you to palpate the radial pulse with her fingertips while you auscultate the © Indicate to your co-worker when to start counting the pulse rate. Count for 1 minute unless the radial pulse is ‘weak, as it may be in an elderly patient. In that case, count for another minute to ensure a more accurate as- sessment. ‘© Subtract the radial pulse rate from the apical pulse rate to determine the pulse deficit. Document the pulse deficit by indicating the rate at each site —for example, “A/R pulse: 120/112.” Because a pulse deficit may result from an arrhythmia (such as atrial fibrillation, atrial flutter, pre ‘mature ventricular contractions, and some heart blocks), the patient may need an ECG as well pulse Elina A. McConnal, RN, PRD, author of Ginigel De's end Doni, on independent nurse-constent in Madison, Wis Nunsina93, NovempeR Boa Neaann