vital sign is more effective for health care

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2. Pulse

3. PULSE
Pulse: The rhythmic dilation of an artery that results from
beating of the heart
Pulse represent stroke volume
Cardiac output:(CO) The amount of blood the heart pumps
through the circulatory system in a minute.
stroke volume(SV)The amount of blood ejected with each
cardiaccontraction
CO= HR*SV 70 BEAT* 65ML = 4.5 l/m

4. •For example, 65mL x70 beats per minute = 4.55 L per minute.
When an adult is resting, the heart pumps about 5 litersof
blood eachminute

5. Compliance of the arteries is their ability to expand and contract.
when a person's arteries loss their dispensability as can happen
in old age, greater pressure is required to pump the blood into the
arteries.
In a healthy person, the pulse reflects the heartbeat that is the
pulse rate is the same as the rate of ventricular contractions of the
heart however, in some type of in cardiovascular disease
heartbeat and pulserate can differ.
Pulse

6. PULSE
Peripheral pulse: pulse located away from heart e.gwrist and
foot
Apical pulse: located at the apex of the heart
Also called central pulse
Factor Affecting Pulse
1)Age 5) Medication
2)Sex 6) Hypovolemia
3)Exercise 7) Stress
4)Fever 8) Position
9) Pathology

7. PURPOSES
•To establish baseline data for subsequent
evaluation
• To identify whether the pulse rate is within
normal range
• To determine the pulse volume and whether
the pulse rhythm is regular
• To determine the equality of corresponding
peripheral pulses on each side of the body

8. Con…
• To monitor and assess changes in the client’s
health status
• To monitor clients at risk for pulse alterations
(e.g., those with a history of heart disease
or experiencing cardiac arrhythmias,
hemorrhage, acute pain, infusion of large
volumes of fluids, or fever)
• To evaluate blood perfusion to the extremities

9. PULSE SITE
1)Temporal
2)Carotid
3)Apical
4)Brachial
5)Radial
6)Femoral
7)Popliteal
8)Posterior Tibial
9)Dorsalis Pedis

16. PulseSites
Readilyaccessible
When radial pulse is notaccessible
Radial
Temporal
Carotid
Apical
During cardiac arrest/shock in adults
Determine circulation to the brain
Infants and children up to 3 years of age
Discrepancies with radial pulse
Monitor some medications

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PulseSites
Brachial
Bloodpressure
Cardiac arrest ininfants
Femoral
Cardiac arrest/shock
Circulation to a leg;
Circulation to lower leg
Circulation to the foot
Popliteal
Posterior
tibial
Dorsalis
pedis
Circulation to thefoot

18. FactorsAffecting the Pulse
Age: specific variation in pulse rates from birth to adulthood

19. FactorsAffecting the Pulse
Gender. After puberty, the average male's pulse rate is slightly
lower than the female's.
Exercise. The pulse rate normally increases with activity.
Fever: The pulse rate increases:
 inresponsetotheloweredbloodpressurethatresults
fromperipheralvasodilatationassociatedwithelevatedbody
temperature.
becauseoftheincreasedmetabolicrate.
Medication:Somemedicationsdecreasethepulserate,and
othersincreaseit.Forexample,cardiotonics(digitalis)
decreasetheheartrate,whereasepinephrineincreaseit.

20. FactorsAffecting the Pulse
Hypovolemia. Loss of blood from the vascular system normally
increases pulserate.
Stress.In response tostress,sympathetic nervous stimulation
increases the overall activity of the heart. Stress increases
the rate as well as the force of theheartbeat.
Position changes. When a person is sitting or standing, blood
usually pools in dependent vessels of thevenous
system.Pooling results in a transient decrease in the
venous blood return to the heart and subsequent
reduction in blood pressure and increase in heart rate.

21. FactorsAffecting the Pulse
Pathology: certain diseasessuchas some heart
conditions or those thatimpair oxygenation can alter
the resting pulse rate.

22. Assessing the Pulse
When assessing the pulse, the nurse collects the following data:
Rate, rhythm, volume, presence, absence
Tachycardia:Anexcessivelyfastheartrateover100BPMin
adultisreferredtoastachycardia.
Bradycardia:Aheartrateinanadultof60BPMorlessis
called.
pulse rhythm: is the pattern of the beats and the intervals
between the beats. Equal time elapses between beats of a normal
pulse. A pulse with an irregular rhythm is referred to as a
dysrhythmia or arrhythmia.

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24. Pulsevolume:
Alsocalledthepulsestrengthoramplitude,referstothe
forceofbloodwitheachbeat.
Theelasticityofthearterialwallreflectsitsexpansibility
oritsdeformities.Ahealthy,normalarteryfeelsstraight,
smooth,soft,pliable.
Pulsedeficit:Thedifferencebetweentheapicalandradialpulse
Pulsepressure:Thedifferencebetweensystolicanddiastolic
bloodpressure.

26. Assessing Pulse Rate
EQUIPMENT
• Watch with a second hand
• Stethoscope
• Alcohol swab
• Gloves

27. TAKING A RADIAL (WRIST) PULSE
1.Wash hands/hand hygiene.
2.Inform client of the site(s) where pulse will be measured.
3.Flex client’s elbow and place lower part of arm across chest.
4.Support client’s wrist by grasping outer aspect with thumb.
5.Place index and middle fingers on inner aspect of client’s wrist
over the radial artery, and apply light but firm pressure until
pulse is palpated.
6.Identify pulse rhythm.
7.Determine pulse volume.
8.Count pulse rate by using second hand on watch

28. TAKING AN APICAL PULSE
•Wash hands/hand hygiene.
•Raise client’s gown to expose sternum and left
side of chest.
•Cleanse earpiece and diaphragm of stethoscope
with an alcohol swab.
•Locate apex of heart
•Inform client that his or her heart will be listened
to. Instruct client to remain silent.

29. Con…
•With dominant hand, put earpiece of the stethoscope
in ears and grasp diaphragm of the stethoscope in the
palm of the hand for 5 to 10 seconds.
•Place diaphragm of stethoscope over the PMI and
auscultate for sounds S1 and S2 to hear lub-dub sound.
•Note regularity of rhythm.
•Start to count while looking at second hand of watch.
Count lub-dub sound as one beat
•Record by site the rate, rhythm, and, if applicable,
number of irregular beats.
•Wash hands/hand hygiene.

30. APICAL PULSERADIAL PULSE

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