Pulse

Question 1

What is the normal resting pulse for an adult?

Answer 1

60-100 beats per minute

Question 2

Radial pulse is a commonly used palpitation site. Name 7 more common pulse sites.

Answer 2

1. Carotid
2. Brachial
3. Femoral
4. Popliteal
5. Ulnar
6. Dorsalis pedis
7. Posterior tibial

Question 3

What is the most common cause of an irregular pulse?

Answer 3

Atrial fibrillation

Question 4

Describe the cardiovascular physiology that results in the feeling of a pulse

Answer 4

The alternative expansion and recoil of an artery that occurs with each beat of the left ventricle creating a pressure wave

Question 5

What factors can alter the pulse/heart rate?

Answer 5

Anxiety
Pain
Fever
Age
Sex
Exercise
Cardiac disease
Positioning (lying vs standing)
Certain medications such as beta blockers and digoxin

Question 6

Name two other methods that you may use to assess the heart rate in some clinical settings

Answer 6

1. Auscultating the apex beat with a stethoscope
2. Using an electronic device such as a pulse oximetry or ECG monitor

Question 7

Give three signs of poor circulation

Answer 7

1. Bluelish lips (cyanosis)
2. Skin pallor (skin colour)
3. Pale or blueish colouration of the nail beds

Question 8

If a nail bed takes longer than 2 seconds to flush red following a capillary refill test, what could this indicate?

Answer 8

Poor circulation/ vasoconstriction
Hypothermia

Question 9

How do you manually assess the radial pulse?

Answer 9

1. Explain the procedure to patient and gain consent;
2. Check patient has rested for 20 mins and ask them not to speak during the assessment;
3. Decontaminate hands;
4. Assess peripheral perfusion by noting the colour of the extremities and consider use of a capillary refill test;
5. Capillary refill test: press firmly in the nail bed for a minimum of 5 seconds until it goes white (blanches). Release the pressure and note how long it takes to flush red;
6. Prepare a reliable timer. Support the patient’s arm with a pillow;
7. Lightly compress the radial artery, by turning the limb palm side up and place fingertips along the base of the thumb, down from the fold of the wrist;
8. Assess the rhythm of the pulse;
9. Count the heart beat for 60 secs to obtain the rate per minute;
10. Accurately record the pulse rate and rhythm, and comment on pulse quality and any other factors that may have affected the reading;
11. Consider previous read joys and note any changes. Interpret the reading in relation to the patient, context, history and other assessment findings;
12. Decontaminate hands;
13. Explain the results to the patient in terms the patient can understand;
14. Report any abnormal findings to the appropriate person, according to local policy