1. Nurse Assistant in a LTC Facility
PULSE
Nurse Assistant in a LTC Facility

2. PULSE
Definition- Beat of the heart felt at an artery as a wave of blood passes through the artery
Pulse can be felt every time the heart beats
Feel throbbing of the arteries caused by the contraction of the heart
More easily felt in arteries that lie close to the skin et can be pressed against a bone

3. Factors that Elevate Pulse
Exercise
Stimulant drugs
Excitement
Fever
Shock
Nervous tension
Strong emotion (anger, fear)
Pain

4. Factors that Lower Pulse
Resting or Sleep
Clinical Depression
Certain drugs (depressant drugs, digitalis)
Heart disease
Coma

5. Pulse Rate Elderly adult between 50-100 beats per minute
Count for 1 FULL MINUTE
Number of the beats per minute
Vary with individuals depending on age, sex et body size
Elderly adult between beats per minute
Adults: wide range beats per minute
Children over 7: beats per minute
Children from 1-7: bpm
Infants: bpm

6. PULSE Rhythm: Regular or Irregular
Noted along with rate
Regularity of the pulse, or the spacing of the beats
Regular or Irregular
Regular Rhythm- Pulse is felt in a pattern with the same time interval occurring between beats
Irregular- Note when beats are unevenly spaced or beats are skipped

7. PULSE Force or Volume Noted along with rate et rhythm
Described the strength or intensity of the pulse
Strong- easy to find
Weak or Thready - hard to find (hemorrhage or going into shock, erratic, weak, fast, irregular)
Bounding- bounces back at you like a scary movie

8. Sites for Taking Pulse
Figure 8.8 – Sites for Taking a Pulse

9. Major Pulse Sites of the Body
Temporal: side of the forehead
Carotid: side of the neck, used for CPR
*May stop circulation to the brain
Brachial: bend of the elbow, used for BP
Apical: Left side of chest slightly below nipple, must use stethoscope, most accurate, lubb dubb
Radial: underside of the wrist near residents thumb
*Most common site for measuring pulse

10. Major Pulse Sites of the Body
Femoral: inner aspect of upper thigh
* 1st aide to check circulation
Popliteal: behind knee
* to check circulation
Pedal Pulse
*Dorsalis Pedis: top of foot arch, to check circulation
Posterior Tibal: on the tibia bone, to check for circulation

11. Basic Principles for Taking a RADIAL PULSE
Position arm comfortably, palm of hand positioned down
Tips of two or three of your fingers to locate pulse -thumb side of wrist
Count pulse for one full minute
Note rate, rhythm, et volume of pulse
Do NOT take pulse with your thumb, it has a pulse of its own
Take patients pulse et respirations together. Keep pulse number in mind when counting respirations

12. Basic Principles for Taking a APICAL PULSE
Reason Dr. Order
Pt has irregular heartbeat
Hardening of the arteries
Weak or rapid radial pulse!!
Infant or child rapid radial pulse, difficult to feel

13. Basic Principles for Taking a APICAL PULSE
Most accurate
Listen to actual heartbeat, LEFT of chest, slightly below left nipple
Stethoscope
Amplifies sound
Ear piece, tubing, bell, diaphragm
Ear pieces bent forward when placed in ears, snug not painful
Clean ear pieces, bell, diaphragm cleansed with disinfectant
Privacy
Count for 1 FULL MINUTE- so arrhythmias can be detected
Note rate, rhythm et volume

14. Basic Principles in Taking an Apical Pulse
Heart Sounds
Two separate sounds are heard while listening to the heartbeat
Lubb Dubb counts as one heartbeat
Sounds are caused by the closing of heart valves as blood flows the chambers of the heart
Report abnormal sounds immediately

15. Pulse Deficit
Number of pulse beats counted at wrist or other pulse sites is less than those counted in the same period of time at the heart
Atrial Fibrillation (atria of heart quivers)
Heart is weak et does not pump enough blood to produce pulse
Tachycardia- . There is not enough time for the heart to fill with blood. Heart does not produce a pulse each time

16. Method of Measuring Pulse Deficit
One person measures apical pulse with stethoscope
Second person measures radial pulse at same exact time
Subtract radial pulse from apical pulse= Pulse Deficit
If one person takes apical pulse et immediately take radial pulse this will Not be accurate

17. PULSE Record All Information Include rate, rhythm, et volume
Example: Date, time, P82 strong et regular, your signature et title

18. Terms Pulse rate- number of pulse beats per minute
Bradycardia- slow pulse rate, usually under 60 bpm
Tachycardia- rapid pulse rate, usually over 100bpm