Presentation titleSUB TITLE HERE

How to Measure a

PulseVital Signs in the

Ambulatory Setting:An Evidence-Based Approach

Cecelia L. CrawfordRN, MSN

Pulse Measurement – An Overview

• Equipment for accurate pulse measurement Watch or clock with second hand or digital second counter Stethoscope for apical pulse (optional) Pen or pencil Flowsheet, chart, or medical record Clean hands and fingers!

• Waited 5 minutes if patient was active• Patient in a comfortable & relaxed position• Enough time to count the pulse

Terminal Digit Preference• Some people may show a preference for

certain numbers in pulse readings* Zeros, even numbers, odd numbers

• Be aware you might “like” some numbers more than others!

(*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)

Pulse – It’s All About The Numbers!

Pulse Procedure

1. Wash hands & put on gloves, if appropriate

2. Provide privacy

3. Assist patient to a comfortable & relaxed position

Pulse Procedure - Radial

4. Do NOT use your thumb Thumbs have a pulse, which can be

mistaken for a patient’s pulse

5. Place fingertips of first 2 or middle 3 fingers over the radial pulse area

Thumb side of patient’s forearm at the wrist

6. Lightly press your fingertips on the pulse area

Pulse Procedure - Brachial

4. Used for infants and small children

5. Place fingertips of first 2 or middle 3 fingers over the brachial pulse area Inside of the elbow

6. Lightly press your fingertips on the pulse area

Pulse Procedure7. Begin to count rate when pulse is felt regularly

8. Count for 60 sec

9. Count for 30 sec and multiply X2 Shorter time counts = inaccurate data

Pulse Procedure•If pulse irregular or skipping, count for 60 sec

Pulse Procedure – Apical (Optional)

Listen to the heart with a stethoscope to count the pulse if:

Pulse is difficult to feel or count Pulse is very fast or very slow

Pulse Procedure – Machine Taken• Automated BP machines can take pulse

readings• Accurate with strong, normal pulses• Inaccurate with:

Very fast or very slow pulses Weak, skipping or irregular pulses Arm movement or agitation

• When in doubt – count it yourself!

Pulse Procedure

10. Inform the RN or MD if pulse is:

Difficult to feel or count Very fast or very slow Irregular or skipping An Apical pulse

Normal Pulse Rates

Babies to age 1: 100–160

Children ages 1 to 10: 60–140

Children age 10+ & Adults: 60–100

Well-conditioned Athletes: 40–60

Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

Pulse Procedure

11. Discuss pulse rate with patient or parent

12. Remove gloves & wash hands

Pulse Procedure

13. Document the Results Flowsheet, clinic record, or clinic chart

14. Communicate the Results RN MD

Pulse Measurement in the Clinic

• YOU can make the difference:

Welcoming presence Decrease any anxieties

& fears Reassure patients &

family Accurate vital signs