1. PULSE Stephanie Oliver, DNP, RN

2. It is an indicator of circulatory status The normal pulse varies according to age  Infants 100-160  Preschoolers 80-110  School age 70-100  Adolescent 60-90  Adult 60-100 The pulse is a palpable bounding of blood flow noted at various points on the body (pressure of the blood pushing against the walls of an ARTERY ).

3. PULSE POINTS Temporal Carotid Apical Brachial Radial Ulnar Femoral Popliteal Posterior Tibial Dorsalis Pedis

4. PULSE CHARACTER Rate  Number of beats per minute (60-100) Rhythm  Interval between contractions of ventricles (regular, irregular) Strength  Volume of blood ejected against the arterial wall graded as strong, weak, thready, bounding Equality  Are pulses the same on both sides of the body

5. COUNTING THE PULSE Radial is most logical spot: pt sitting or lying down two fingers over radial pulse compress gently determine strength note sweep hand on watch determine start number begin count regular pulse,, count 30 sec multiply by 2 **irregular pulse…count for full minute

6. APICAL PULSE (PMI) Point of maximal impulse is located midline fifth intercostal space midclavicular line

7. COUNTING THE APICAL PULSE Use on infants, patients with heart failure, abnormally fast heartbeat, some meds require the apical pulse to be checked before administering When pulse is irregular it may be necessary to determine the pulse-deficit:  This requires two nurses  One to count the radial pulse one to count the apical pulse (pulse at apex of heart)  This is done at the same time  Subtract the radial pulse from the apical (example: radial = 96, apical =100, pulse deficit = 4)  If radial pulse is higher than the apical pulse, do the assessment again, it is not possible