FAR EASTERN UNIVERSITY

Institute of Nursing

FUNDAMENTALS OF NURSING

Module: ASSESSING PULSE

Introduction:
The measurement of a person’s physiological observations or vital sign is a core nursing function and
key to the recognition of patient deterioration. Vital signs provide important information about the
condition of a person’s vital organ. Vital signs that are within normal limits reflect a person’s
physiological well-being whereas abnormal vital signs maybe an early warning of clinical deterioration.

Learning Outcomes

At the end of this module, the student will be able to;

1. List the vital signs most commonly measures.
2. Discuss the rationale, knowledge and skills require for assessing pulse.
3. Describe factors affecting that may affect the accurate measurement of pulse.
4. Identify the variation that may occur in normal pulse across the lifespan.
5. Verbalize the steps used in assessing pulse.
6. Identify and explain the procedures for using, caring for, and storing the various sites of pulse.
7. Demonstrate appropriate documentation and reporting of pulse rate.
Topic Outline:
1. Definition of Pulse
2. Purpose of assessing peripheral pulse
3. Factors affecting Pulse rate
4. Types of Pulse
5. Different Pulse points
6. Rhythm
7. Pulse volume
8. Different terminologies
9. Nursing Interventions

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 PULSE
➢ a wave of blood created by contraction of the left ventricle of the heart.
➢ pulse wave represents the stroke volume output or the amount of blood that enters the
arteries with each ventricular contraction.
➢ compliance of the arteries is their ability to contract and expand
➢ rate of pulse is expressed in beats per minute (BPM)
➢ You can check a person's pulse by putting 2 fingers: index (first finger) and middle
fingers. Do not use your thumb, because it has its own pulse that you may feel
PURPOSES OF ASSESSING PERIPHERAL PULSE
1. To gain information about the general health and well-being of the person
2. To gain a basic cardiovascular assessment of the person.
3. To monitor the person’s health condition during and or following investigation/
operations.
4. To use as a basis for assessing any improvement or deterioration in the person’s
condition.
5. To compare and identify any changes to baseline observations following therapeutic
procedures, prescribed medications or emergency situations.
6. To determine the baseline observation of the person.

FACTORS AFFECTING PULSE RATE

1. Age- as the age increases, the pulse rate gradually decreases overall for specific variations
in pulse rates from birth to adulthood.
2. Gender- after puberty, the average pulse rate of a male is slightly lower than that of a
female.
3. Pyrexia- the pulse rate increases (a) in response to the lowered blood pressure that results
from peripheral vasodilatation associated with elevated body temperature, and (b)
because of the increased metabolic rate
4. Medication- some medications decrease the pulse rate and others increase it.
5. Hypovolemia- loss of blood from the vascular system normally increase pulse. In adults,
the loss of circulating volume results in an adjustment of the rate to increase blood
pressure as the body compensates for the lost blood volume. Adults can usually lose up to
10% of their normal circulating volume without adverse effect.
6. Stress- in response to stress, sympathetic nervous stimulation increases overall activity of
the heart. Stress increases the rate as well as the force of the heartbeat. Fear and anxiety
as well as the perception of severe pain stimulate the sympathetic system.
7. Position changes- when a person is sitting or standing, blood usually pools in dependent
vessels of the venous system. Pooling results in a transient decrease in the venous blood
return to the heart and a subsequent reduction in blood pressure and increase in heart rate.
8. Pathology- certain diseases such as some heart conditions or those that impair
oxygenation can alter the resting pulse rate.

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 VARIATION IN PULSE BY AGE

TWO TYPES OF PULSE

1. Peripheral pulse- is a pulse located away from the heart, for example, in the foot or
wrist.
2. Apical- pulse is a central pulse; that is, it is located at the apex of the heart. It is also
referred to as the point of maximal impulse (PMI).

PULSE POINTS

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 PERIPHERAL PULSE POINTS
1. Temporal- where the temporal artery passes over the temporal bone of the head. The site
is superior (above) and lateral to (away from the midline of) the eye. (located in the front
of the ear)

2. Carotid – at the side of the neck where the carotid artery runs between the trachea and
the stemocleidomastoid muscle. (located beside the larynx)

3. Brachial- at the inner aspect of the biceps muscle of the arm or medially in the
antecubital space. (hallow, in front of the elbow)

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 4. Radial- where the radial artery runs along the radial bone, on the thumb side of the inner
aspect of the wrist.

5. Femoral- Located halfway between the anterior superior iliac spine and the symphysis
pubis, below the inguinal ligament.

6. Popliteal- where the popliteal artery passes behind the knee.

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 7. Dorsalis pedis – located on the dorsum of the foot with the foot plantar flexed. Palpate
for this pulse halfway between the middle of the pt.’s ankle and the space between the
great toe and the second toe.

8. Posterior tibial- on the medial surface of the ankle where the posterior tibial artery
passes behind the medial malleolus.

9. Apical pulse- is measured by listening over the apex of the heart on the left side of the
chest, using a stethoscope. The apex is usually found at the 5th intercostal space just
inside the midclavicular line. Apical pulse is indicated for people whose peripheral pulse
is irregular or unavailable as well as for people with known cardiovascular, pulmonary
and renal diseases. It is commonly assessed prior to administering of medication that
affect the heart rate (e.g. digoxin). Use to assess the pulse for newborn, infants and
children up to 2-3 years old.

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 PURPOSES OF ASSESSING APICAL PULSE
1. To obtain the heart rate of newborn, infants and children 2-3 years-old or of an adult
with an irregular peripheral pulse.
2. To establish baseline data for subsequent evaluation.
3. To determine whether the cardiac rate is within normal range and the rhythm is regular.
4. To monitor people with cardiac, pulmonary or renal disease and those receiving
medications to improve heart action.

REASON FOR USING A SPECIFIC PULSE SITE

*When assessing the pulse, the nurse collects the following data: the rate, rhythm, volume, amplitude
and presence or absence of bilateral equality.

• Pulse rhythm- is the pattern of beat and interval between the beats.
• Dysrhythmia or arrhythmia- a pulse with an irregular rhythm. It may consist of random irregular
beats or a predictable pattern of irregular beats. (apical, ECG)
• Full bounding- a forceful or full blood volume that is obliterated only with difficulty.
• Elasticity of arterial wall- reflects its expansibility or its deformities.
• Absence of bilateral equality indicates cardiovascular disorder.
• Pulse volume- also called 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.

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
 PULSE VOLUME

TERMINOLOGIES
• Bradycardia- rate of less than 60 bpm
• Tachycardia- rate of more than 100 bpm
• Bounding/ full- strong pulse
• Thread/ weak- diminished strength

PULSE: Lifespan Consideration

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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM
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PREPARED BY: VILMA S. VASQUEZ MAN, RN, RM