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Anxiety can raise the pulse rate. If the patient’s pulse rate is higher than expected, reassess it at the end of the physical assessment when the patient is more relaxed.
If an irregular pulse is palpated, further assessment may be required.
The pulse is the palpable impulse of ventricular depolarization and blood flow. The force of the blood exiting the heart and aortic distention create a pulse wave that travels rapidly toward the extremities. When the pulse wave reaches a peripheral artery, a pulse can be felt by lightly palpating the artery against underlying bone or muscle. The number of pulsing sensations that occur in 1 minute is the pulse rate per minute.
Assessing the patient’s peripheral pulse offers valuable data for determining cardiovascular function. An abnormally slow, rapid, or irregular pulse may indicate the cardiovascular system’s decreased ability to deliver an adequate blood supply to the body.
The pulse can be assessed using any central or peripheral artery (Table 1), but the radial artery is the most commonly used (Figure 1). During cardiovascular collapse, the radial pulse may not be palpable because of decreased blood pressure and decreased perfusion to the distal arteries. In cases of suspected shock, a more central site (e.g., carotid artery) should be used for pulse evaluation. A central pulse will be the last pulse present during cardiovascular collapse.
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Rationale: The relaxed position of the lower arm and the extension of the wrist permit full exposure of the artery to palpation.
Rationale: Pulse assessment is more accurate when using moderate pressure. Too much pressure occludes the pulse, impairs blood flow, and may result in the health care team member counting the health care team member’s pulse rate.
Rationale: Strength reflects the volume of blood ejected against the arterial wall with each heart contraction. An accurate description of strength improves communication among health care team members.
Use this subjective scale as accurately as possible, especially if the presence or absence of pulses is a concern.
Rationale: Inefficient contraction of the heart fails to transmit a pulse wave, resulting in an irregular pulse. A full minute assessment helps ensure an accurate estimate of beats per minute.
American Heart Association (AHA). (n.d.). Bradycardia: Slow heart rate. Retrieved July 20, 2022, from https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/bradycardia--slow-heart-rate
Kusumoto, F.M. and others. (2018). 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. Retrieved July 20, 2022, from, https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628
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