Why we should check a pulse

-

Evidence base

Checking the pulse has been a diagnostic tool for millennia, and is noted in ancient Chinese, Egyptian, Greek and Roman medical texts. A great deal of practical experience has accumulated since then. However, it is not a topic that has had extensive clinical trials, so the evidence base is mainly the result of taught experiential learning.
There have been studies of the accuracy of timing the heart rate for 15 seconds, 30 seconds or one minute. A 15-second check may be sufficient for a patient who is well and where the heart rate appears to be within the normal range (Hwu et al 2000). A longer check is recommended to ensure accuracy in unwell patients, or where bradycardia, tachycardia or irregularity is detected (Hollerbach and Sneed 1990, Sneed and Hollerbach 1992).
learningpoints

Learning points

  1. Always explain the reason for checking the radial pulse and gain verbal consent from the patient. Resting pulse can be checked after the patient recovers from exertion or emotional imbalance.
  2. To locate the radial pulse, press firmly a few centimetres back from the tip of the base of the thumb, around a third of the way across the wrist, using the first and second fingers of your hand.
  3. To calculate the heart rate, count the number of beats that occur in one minute. Alternatively, beats could be counted for 30 seconds and then doubled, or counted for 15 seconds and quadrupled. Follow the organisation’s policy for reporting abnormal findings and taking action.
  4. The carotid and brachial arteries give the best information on the volume and character of the pulse. The character of the pulse could be a normal up and down stroke, or the pulse might be prolonged, collapsing or jerky. The volume of the pulse is not a direct measure of the stroke volume, but informs you whether the pulse is normal, weak or abnormally strong.
Disclaimer: please note that information provided by RCNi Learning is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed at the bedside by a nurse educator or mentor. It is the nurse’s responsibility to ensure their practice remains up to date and reflects the latest evidence.

Useful resources

References

Douglas G, Nicol F, Robertson C (Eds) (2013) Macleod’s Clinical Examination. 13th edition. Churchill Livingston/Elsevier, Oxford.
Hollerbach AD, Sneed NV (1990) Accuracy of radial pulse assessment by length of counting interval. Heart and Lung. 19, 3, 258-264. MEDLINE
Hwu YJ, Coates VE, Lin FY (2000) A study of the effectiveness of different measuring times and counting methods of human radial pulse rates. Journal of Clinical Nursing. 9, 1, 146-152. MEDLINE •CROSSREF
Levick JR (2010) An Introduction to Cardiovascular Physiology. Fifth edition. Hodder Arnold, London.
Sneed NV, Hollerbach AD (1992) Accuracy of heart rate assessment in atrial fibrillation. Heart and Lung. 21, 5, 427-433. MEDLINE


Comentários

Enviar um comentário

Mensagens populares deste blogue

Hemorrhoids (Piles) — Symptoms and Treatment

-
Imagem
Hemorrhoids cushions are normal structures of the lower rectum.  They are very vascular and pathology develops when that vasculature becomes engorged (especially the veins). Itching and pain are common symptoms of hemorrhoid pathology. Hemorrhoids are classified on their origin relative to the dentate line: external (below the dentate line), internal (above the dentate line), and prolapsed internal hemorrhoids. Most hemorrhoids are treated with dietary modification (increase fiber) and stool softeners, but occasionally surgery is required. Table of Contents Definition of Hemorrhoids Epidemiology of Hemorrhoids Etiology of Hemorrhoids Pathology and Pathophysiology of Hemorrhoids Symptoms of Hemorrhoids Diagnosis of Hemorrhoids Differential Diagnoses of Hemorrhoids Therapy of Hemorrhoids Progression and Prognosis of Hemorrhoids Review Questions References Image : “Types of hemorrhoids” by WikipedianProlific and Mikae...
Ler mais

12 Cranial Nerves — Functions and Mnemonics

-
Imagem
Crania l nerves emerge directly via the spinal cord from the bony skull because they supply cranial structures or fulfill specific functions. During medical studies, cranial nerves are an essential element of the subjects of the brain and the nervous system. In the following, you will find a concise overview of the classification, the functions and the course of the 12 cranial nerves. Table of Contents Classification of Cranial Nerves List of Cranial Nerves Cranial nerve I: Olfactory Nerve Cranial nerve II: Optic Nerve Cranial Nerve III: Oculomotor Nerve Cranial Nerve IV: Trochlear Nerve Cranial Nerve V: Trigeminal Nerve Cranial Nerve VI: Abducent Nerve Cranial Nerve VII: Facial Nerve Cranial Nerve VIII: Vestibulocochlear Nerve Cranial Nerve IX: Glossopharyngeal Nerve Cranial Nerve X: Vagus Nerve Cranial Nerve XI: Accessory Nerve Cranial Nerve XII: Hypoglossal Nerve Overview of the 12 cranial nerves Review Questions References Image : “Cranial Nerves” by Br...
Ler mais

Nerve Tissue: Brain

-
Imagem
In LECTURIO :) - Table of Contents Introduction to the Brain The Cerebrum The Cerebellum The Meninges The Spinal Cord References Image :  “Skull and brain normal human diagram”  by Patrick J. Lynch. License:  CC BY 2.5 Introduction to the Brain The brain is the central organ of the human nervous system along with the spinal cord. It is made up of: The cerebrum Diencephalon, consisting of thalamus, hypothalamus and pituitary gland The cerebellum The brainstem- consisting of midbrain, pons and medulla Image :  “Introduction to Brain Structures”  by BruceBlaus. License:  CC BY 3.0 The organ weighs about 1400 grams on average in an adult. It is housed and protected by the skull bones which include the: Parietal Frontal Occipital Ethmoid Sphenoid bone The bones of the face Image :  “Cranial sutures shown from the top of the head”  by Xxjamesxx. License:  CC BY-SA 3.0 At birth, the paired an...
Ler mais