Teaching How to Take a Pulse (Home Health Care) - CE/NCPD

The content in Clinical Skills is evidence based and intended to be a guide to clinical practice. Always follow your organization’s practice.

The intended learners for this teaching skill are the patient, family, and caregivers.

ALERT

Caution the learner against vigorously massaging the neck while locating the carotid pulse. Stimulating the carotid sinus stimulates the vagus nerve and leads to reflex slowing of the heart rate.

Simultaneously occluding both carotid arteries decreases blood to the brain and causes fainting.

OVERVIEW

A variety of illnesses (e.g., cardiac, kidney, and vascular diseases) place patients at risk for wide pulse variations. Patients who know how to measure the pulse and recognize when the pulse rate is outside the acceptable range or the rhythm is irregular benefit from earlier medical attention and intervention. Among patients who should know how to measure the pulse are those with heart disease and those involved in cardiac rehabilitation programs. In addition, healthy patients who exercise should learn how their own body responds to exercise and be able to determine appropriate exercise plans based on their pulse before, during, and after exercise.

Learners should be taught how to recognize signs and symptoms that indicate the need for pulse measurement and how to measure their pulse regularly, record these measurements, and interpret readings that are outside the normal values (Table 1).

Signs and symptoms that indicate the need for pulse measurement include:

• Palpitations
• Shortness of breath
• Fainting
• Chest discomfort
• Dizziness
• Weakness or fatigue

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Encourage questions and answer them as they arise.

PROCEDURE

1. Determine if the learner has health literacy needs or requires tools or assistance to effectively communicate. Be sure these needs can be met without compromising safety.
2. Review the learner’s previous experience and knowledge of taking a pulse and understanding of the care to be given.
3. Review the patient’s medication list for those that may affect the pulse.
4. Explain what a pulse rate means, which specific medical issues affect pulse readings, and why an awareness of variations is important to the patient’s well-being.
5. Teach the learner the normal pulse ranges and the signs, symptoms, and common causes of high and low readings.
6. Describe the symptoms that indicate the need for pulse measurement.
7. Teach the learner the signs and symptoms of medications that affect pulse rate (e.g., tachycardia). Explain which medications should be held and which medications may affect pulse rate and give instructions on when to seek additional care.
8. Evaluate the learner’s visual acuity and ability to see the second hand on a clock or watch.
9. Evaluate the learner’s ability to feel the pulse.
10. If the patient has been active or smoking, have the learner wait before taking the pulse.
11. Stress the importance of a quiet, comfortable environment for measuring a pulse.
12. Discuss with the learner the best sites for taking a pulse (i.e., radial and carotid sites).
13. Demonstrate and discuss the steps for palpating a pulse.
    1. Locate the artery on the wrist or neck.
    2. Use two or three fingertips for palpation.
    3. Lightly compress the artery.
    4. Palpate the pulse for strength.
    5. Count the pulse.
    6. Calculate the pulse rate.
14. Teach the learner to use gentle pressure; emphasize that the learner should not press hard over the pulse site.^{undefined#ref2">2}

    Rationale: Pressing too hard over the pulse site may occlude the artery.

15. Teach the learner how to use a watch or clock that counts seconds.
16. Teach the learner to count the pulse.
    1. If the pulse is regular, count for 30 seconds and multiply the count by two.¹
    2. If the pulse is irregular, count for a full 60 seconds.¹

       Rationale: A full 60-second count increases accuracy.¹

17. Discuss the patient’s target pulse ranges, the purposes of monitoring, and the times to take measurements (e.g., before and after taking heart medications; before, during, and after exercise).
18. Explain when the learner should report abnormal readings to the practitioner.
19. Have the learner demonstrate taking a pulse (Figure 1).

    Rationale: Using the teach-back method confirms understanding.

20. Have the learner describe the reason for pulse monitoring and any related medications (e.g., antiarrhythmics) or treatment (e.g., diet and exercise).³
21. Give the learner printed instructions with a written, pictorial, or video guide that demonstrates the procedure, if possible.
22. Help the learner start a logbook to record the pulse and the time it was measured.
    1. Have the learner record pulse-affecting medications have been taken as prescribed.
    2. Have the learner share the written record with the practitioner.

EXPECTED OUTCOMES

• Learner demonstrates accurate measurement of pulse.
• Learner states the importance of measuring pulse and best time for measurement.

UNEXPECTED OUTCOMES

• Learner is unable to demonstrate accurate measurement of pulse.
• Learner is unable to state the importance of measuring pulse and best time for measurement.

DOCUMENTATION

• Teaching methods used
• Evidence of learning (e.g., return demonstration; repeating back instructions, steps, safety protocols, and information)

OLDER ADULT CONSIDERATIONS

• Musculoskeletal changes, such as arthritis or other joint conditions, may impair an older adult patient’s ability to position the limb comfortably or perform the fine motor skills required to measure the pulse.

REFERENCES

1. Ball, J.W. and others (Eds.). (2023). Chapter 6: Vital signs and pain assessment. In Seidel’s guide to physical examination: An interprofessional approach (10th ed., pp. 79-92). St. Louis: Elsevier.
2. Pietsch, T. (2025). Chapter 42: Home care teaching. In A.G. Perry and others (Eds.), Clinical nursing skills & techniques (11th ed., pp. 1222-1263). St. Louis: Elsevier.
3. Yen, P.H., Leasure, A.R. (2019). Use and effectiveness of the teach-back method in patient education and health outcomes. Federal Practitioner, 36(6), 284-289.

Clinical Review: Marlene L. Bokholdt, MS, RN, CPEN, TCRN

Published: October 2024