{"id":1796,"date":"2024-09-26T18:33:06","date_gmt":"2024-09-26T22:33:06","guid":{"rendered":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/chapter\/pulse-2\/"},"modified":"2024-10-02T18:00:53","modified_gmt":"2024-10-02T22:00:53","slug":"pulse","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/hcalabtheoryandpractice\/chapter\/pulse\/","title":{"raw":"9.7 Pulse","rendered":"9.7 Pulse"},"content":{"raw":"

What Is Pulse?<\/h1>\r\nPulse refers to a pressure wave that expands and recoils the artery when the heart contracts\/beats. It is palpated at many points throughout the body. The most common locations to accurately measure pulse as part of vital sign measurement include [pb_glossary id=\"1060\"]radial[\/pb_glossary], [pb_glossary id=\"1061\"]brachial[\/pb_glossary], [pb_glossary id=\"1062\"]carotid[\/pb_glossary], and [pb_glossary id=\"1381\"]apical pulse[\/pb_glossary]\u00a0as shown in Figure 9.7.1 The techniques vary according to the location, as detailed later.\r\n\r\n[caption id=\"attachment_1795\" align=\"aligncenter\" width=\"500\"]\"\" Figure 9.7.1<\/strong> Radial, brachial, carotid, and apical pulse (Illustration credit: Hilary Tang)[\/caption]\r\n\r\nThe heart pumps a volume of blood per contraction into the [pb_glossary id=\"1064\"]aorta[\/pb_glossary]. This volume is referred to as stroke volume. Age is one factor that influences stroke volume, which ranges from 5\u201380 mL from newborns to older adults.\r\n\r\nPulse is measured in beats per minute, and the normal adult pulse rate (heart rate) at rest is 60\u2013100 beats per minute. Newborn resting heart rates range from 100\u2013175 beats per minute (bpm). Heart rate gradually decreases until young adulthood and then gradually increases again with age. A pregnant person's heart rate is slightly higher than the pre-pregnant value (about 15 beats). See Table 9.7.1 for normal heart rate ranges based on age.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Table 9.7.1 Heart Rate Ranges<\/caption>\r\n
Age<\/th>\r\nHeart rate (beats per minute)<\/th>\r\n<\/tr>\r\n
Newborn to one month<\/td>\r\n100\u2013175<\/td>\r\n<\/tr>\r\n
One month to two years<\/td>\r\n90\u2013160<\/td>\r\n<\/tr>\r\n
Age 2\u20136 years<\/td>\r\n70\u2013150<\/td>\r\n<\/tr>\r\n
Age 7\u201311 years<\/td>\r\n60\u2013130<\/td>\r\n<\/tr>\r\n
Age 12\u201318 years<\/td>\r\n50\u2013110<\/td>\r\n<\/tr>\r\n
Adult and older adult<\/td>\r\n60\u2013100<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n\r\nPoints to Consider<\/strong>\r\n\r\nThe ranges noted in Table 9.7.1 are generous. It is important to remember that the role of the Health Care Assistant is to take the pulse measurement and record and report. The nurse will consider each client and situation to determine whether the heart rate is normal. For example, heart rate is considered in the context of a client\u2019s baseline heart rate. The nurse also considers the client\u2019s health and illness state and determinants such as rest\/sleep, awake\/active, and presence of pain. You can expect higher pulse values when a client is in a stressed state such as when crying or in pain; this is particularly important in the newborn. It is best to measure the vital signs when the client is in a resting state. If you obtain a pulse when the client is not in a resting state, document the circumstances (e.g., stress, crying, or pain) and retake the measurements as needed.\r\n\r\n<\/div>\r\n

Why Is Pulse Measured?<\/h1>\r\nHealth care providers measure pulse because it provides information about a client\u2019s state of health and influences diagnostic reasoning and clinical decision-making.\r\n

Tachycardia<\/h2>\r\nTachycardia refers to an elevated heart rate, typically above 100 bpm for an adult. Developmental considerations are important to consider, such as higher resting pulse rates in infants and children. For adults, tachycardia is not normal in a resting state but may be detected in pregnant people or individuals experiencing extreme stress. Tachycardia can be benign, such as when the sympathetic nervous system is activated with exercise and stress. Caffeine intake and nicotine can also elevate the heart rate. Tachycardia is also correlated with fever, anemia, hypoxia, hyperthyroidism, hypersecretion of catecholamines, some cardiomyopathies, some disorders of the valves, and acute exposure to radiation.\r\n

Bradycardia<\/h2>\r\nBradycardia is a condition in which the resting heart rate drops below 60 bpm in adults. In newborns, a resting heart rate below 100 bpm is considered bradycardia. However, a sleeping neonate\u2019s pulse may be as low as 90 bpm. People who are physically fit (e.g., trained athletes) typically have lower heart rates. If the client is not exhibiting other symptoms, such as weakness, fatigue, dizziness, fainting, chest discomfort, palpitations, or respiratory distress, bradycardia is generally not considered clinically significant. However, if any of these symptoms are present, this may indicate that the heart is not providing sufficient oxygenated blood to the tissues. Bradycardia can be related to an electrical issue of the heart, ischemia, metabolic disorders, pathologies of the endocrine system, electrolyte imbalances, neurological disorders, prescription medications, and prolonged bedrest, among other conditions. Bradycardia is also related to some medications, such as beta blockers and digoxin.\r\n

What Pulse Qualities Are Observed?<\/h1>\r\nThe pulse rhythm, rate, force, and equality are observed when palpating pulses.\r\n

Pulse Rhythm<\/h2>\r\nThe normal\u00a0pulse rhythm is regular, meaning that the frequency of the pulsation felt by your fingers follows an even tempo with equal intervals between pulsations. If you compare this to music, it involves a constant beat that does not speed up or slow down, but stays at the same tempo. Thus, the interval between pulsations is the same. However, sinus arrhythmia is a common condition in children, adolescents, and young adults. Sinus arrhythmia involves an irregular pulse rhythm in which the pulse rate varies with the respiratory cycle: the heart rate increases at inspiration and decreases back to normal upon expiration. The underlying physiology of sinus arrhythmia is that the heart rate increases to compensate for the decreased stroke volume from the heart\u2019s left side upon inspiration.\r\n

Pulse Rate<\/h2>\r\nThe\u00a0pulse rate is counted by starting at one, which correlates with the first beat felt by your fingers. Count for 30 seconds if the rhythm is regular (even tempo) and multiply by two to report in beats per minute. Count for one minute if the rhythm is irregular. In children, pulse is counted for one minute considering that irregularities in rhythm are common.\r\n

Pulse Force<\/h2>\r\nThe\u00a0pulse force is the strength of the pulsation felt when palpating the pulse. For example, when you feel a client\u2019s pulse against your fingers, is it gentle? Can you barely feel it? Alternatively, is the pulsation very forceful and bounding into your fingertips? The force is important to observe because it reflects the volume of blood, the heart\u2019s functioning and cardiac output, and the [pb_glossary id=\"1046\"]arteries[\/pb_glossary]\u2019 elastic properties. Remember, stroke volume refers to the volume of blood pumped with each contraction of the heart (i.e., each heart beat). Thus, pulse force provides an idea of how hard the heart has to work to pump blood out of the heart and through the circulatory system.\r\n

Pulse force is recorded using a four-point scale:<\/p>\r\n\r\n