PULSE

Vital signs

Vital signs are the important part of assessment of the patient as these provide the baseline data about the condition and functioning of the patient’s body. 

Vital signs include-

  • Temperature,
  • Pulse,
  • Respiration
  • Blood pressure

Pulse-

The American Heart Association states the normal resting adult human heart rate is 60–100 bpm.Tachycardia is a high heart rate, defined as above 100 bpm at rest. Bradycardia is a low heart rate, defined as below 60 bpm at rest.

Definition 

  • The pulse is a wave of blood created by alternate expansion and recoil of elastic arteries after each contraction of the left ventricle of the heart.
  • Throbbing caused by the regular contraction and expansion of an artery as the blood passes through it, which is usually felt by finger in radial artery at the wrist.
  • A rhythmical throbbing of the arteries as blood is propelled through them, typically as felt in the wrists or neck.
  •  Is the rate of heart beats. Pulse is actually called heart rate, which is the number of time heart beats each minutes.
  •  Pulse is defined as “the pressure of the blood pushing against the wall of an artery as the heart beats and rests.”

Sites of Taking Pulse -

  • Temporal - It is where the temporal artery located between the upper, lateral part of the eye and upper medial part of the ear.
  • Carotid - At the side of the neck, at the carotid triangle. Located between the anterior and below the angle of mandible.
  • Apical-At the apex of the heart. In adult this is located on the left side of the chest. In children 7 to 9 years old, the apical pulse is located between the 4th and 5th intercostal space.
  • Brachial - At the anterior part of the arm in children and at the anticubital space in adult.
  • Radial - Located at the wrist (anterior part), along with the thumb. It is where the radial artery is located.
  • Femoral - At the inguinal ligament, the femoral artery is located.
  • Popliteal - At the popliteal region, located at the back of the knee.
  • Posterior Tibial - At the medical aspect of the ankle, it is where the posterior tibial artery is located.
  • Dorsalis Pedis - Where the dorsal is pedis artery passes over the bones of the foot, at the space between the big toe and the 2nd toe.

Characteristics of pulse

The characteristics of a pulse involves -

  • Rate- Number of beats per minute.The pulse rate can be used to check overall heart health and fitness level.
  • Rhythm -Pattern or regularity of the beats. The length of time between beats should be same. 
  • Volume - Amount of blood pumped with each beat.The degree of expansion displayed by artery during diastolic and systolic state is called volume.
  • Arterial wall elasticity - The artery wall should feel soft and flexible under the fingers.
  • Equality-Comparing pulses and different places gives valuable clinical information.
  • Force-Also known as compressibility of pulse. It is a rough measure of systolic blood pressure.
  • Tension-It corresponds to diastolic blood pressure. A low tension pulse (pulsus mollis), the vessel is soft or impalpable between beats. In high tension pulse (pulsus durus), vessels feel rigid even between pulse beats.

Factors affecting pulse

  • Age-As age increases, the pulse rate gradually decreases overall.
  • Sex- After puberty, the average male’s pulse rate is slightly lower than the female’s.
  • Exercise- Pulse rate increases with activity.
  • Fever/ Temperature - Pulse rate increases with elevated body temperature because of the increased metabolic rate.
  • Medications- Some medications decrease the pulse rate, and some increase it.
  • Hypovolemia/Dehydration- Loss of blood from the vascular system increases the pulse rate.
  • Pain /Stress- Pain & Stress increases the rate as well as the force of the heartbeat.
  • Eating- Eating food and beverage cause change in blood flow thus heart rate is  increase  after eating 
  • Position-When the person is upright, the heart rate is usually faster than when lying down.
  • Obesity- Overweight and obese person have higher metabolic rate thus pulse rate also gets faster. 
  • Heart diseases 

Alterations in Pulse

  • Tachycardia- Tachycardia is the heart rate above 100 beats/min.
  • Bradycardia- Bradycardia is the resting heart rate below 60 beats/min in an adult.
  • Dysrhythmia- It is the abnormal rhythm of heartbeat.
  • Absent pulse- No pulsation is felt despite extreme pressure.
  • Intermittent pulse- It is the pulse in which there is occasionally missed beat due to premature atrial or ventricular contraction.
  • Sinus arrhythmia- It is a condition in which the pulse rate is rapid during inspiration and slow duringexpiration.
  • Thready pulse- Pulsation is not easily felt, and slight pressure causes it to disappear.
  • Weak pulse- It is stronger than thready pulse and light pressure causes it to disappear.
  • Bounding pulse- It is a strong pulse that does not disappear with moderate pressure. It is due to forceful heartbeat.
  • Pulsus alternans- It is an arterial pulse with alternate strong and weak beats.
  • Bigeminal pulse- It is a type of pulse in which every other beat comes early. The second beat feels weak due to inadequate filling of ventricles between the two beats.
  • Paradoxical pulse-The strength of pulse wave varies feeling weaker during inspiration.

General Instructions For Taking Pulse-

  • Choose the most appropriate site for taking pulse.
  • Pulse should not be taken immediately after exercise.
  • Encourage the client to relax.
  • Do not use the thumb for counting pulse.
  • Count the pulse for one minute.
  • Do not apply the force or pressure over the arteries.
  • Note the rate, rhythm and volume.
  • Record the pulse immediately and accurately.

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