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If the carotid site is chosen for pulse measurement, caution the patient against vigorously massaging the neck while locating the pulse and against attempting to locate both arteries at the same time. Stimulating the carotid sinus stimulates the vagus nerve and leads to reflex slowing of the heart rate. In addition, simultaneously occluding both carotid arteries decreases blood to the brain and causes fainting.
A variety of illnesses (e.g., cardiac, kidney, or vascular diseases) place patients at risk for wide pulse variations. Patients who know how to measure pulse and recognize when the pulse rate is outside acceptable ranges or is not a regular rhythm benefit from earlier medical attention and intervention. Among patients who should know how to measure pulse are those with heart disease and those involved in cardiac rehabilitation programs. In addition, patients who exercise should learn how their bodies respond to exercise and should be able to determine appropriate exercise plans based on the pulse before, during, and after exercise.
Pulse measurement helps the nurse establish baseline data about the patient and analyze trends related to medications, exercise, or a rehabilitation program. To facilitate gathering this essential information about a patient who is at home, the nurse should teach the patient to recognize signs and symptoms that indicate a need for pulse measurement. The nurse should also teach the patient to measure the pulse regularly, record the measurements, and interpret readings that are outside of individualized normal values (goal heart rate).
Signs and symptoms that indicate the need to perform pulse measurement include:
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Rationale: The effects of nicotine on the heart rate decline as soon as 20 minutes after smoking.4
Rationale: In most cases, the radial pulse is recommended and is the easiest to palpate. The carotid pulse may be used as an alternative site, but care must be taken to not palpate for long periods of time to avoid impinging on blood flow to the brain or causing a vagal reflex, leading to decreased pulse rate.
Rationale: The thumb has a pulse that may interfere with counting the pulse.
Rationale: Pressing too hard over the pulse site may occlude the artery.
Rationale: The patient must be able to determine when measurements should be taken and when values are not within desired ranges.
Rationale: Printed and audiovisual references promote confidence for independent performance.
Rationale: Keeping an organized record of pulse readings and medications empowers the patient and provides accurate information to the practitioner.2
American Heart Association (AHA). (2015). All about heart rate (pulse). Retrieved July 18, 2022, from https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse (classic reference)*
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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