Nurses Are Masters at the Fine Art of Caring

Vital Signs: How to Take a Pulse

There are five vital signs. The pulse or heart rate is just one of them. It can tell a lot about the health status of the patient.

A pulse is created as blood is pushed along through the arteries. The artery contracts and relaxes periodically to rhythmically force the blood along its way circulating throughout the body. This coincides with the contraction and relaxation of the heart as it pumps the blood through the arteries and veins. Therefore the pulse rate is also known as the heart rate.
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Radial Pulse
The radial pulse is taken over the radial artery in the wrist. The index and middle finger are used for this. You should not use a thumb as the thumb has a pulse as well and could give false readings. Feel for any irregularities, and if you note them be sure to listen with your stethoscope as well and document in your charting. Continuing hold the fingers in place to count respirations without the patient knowing and becoming anxious or changing the breathing pattern.

Don't Use Your Thumb
Press your index and middle finger into the groove along the inside of the wrist. You may need to move your fingers up or down the arm a few centimeters until you find the best spot to feel your pulse. You may have to press a little harder if you don't feel it. But don't press so hard that you obliterate the pulse. apicalpulss
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Apical Pulse

The apical pulse is taken using a stethoscope placed over the heart and listening to the heart beating for one minute while counting the beats. Listen for any irregularity in the beats such as skipped beats, or a pulse that speeds up and slows down. Record this in your documentation. If this is a new sign, you should notify the MD. If the patient experiences any other symptoms such as a shortness of breath or complaints of chest pain, this needs to be noted and reported as well.

Other Arteries You can Palpate for a Pulse
Your pulse may also be felt along the carotid artery in the side of you neck just below your jaw; and in such places as in your groin, behind your knee, on top of your foot just below the ankle joint as well as just above your big toe. Most of these are a little more difficult to locate for the lay person.

Relax and Count
Once you find your pulse in your wrist, relax and take a few deep breaths. Rest your hands comfortably on your abdomen on chest and using a watch or clock with a second hand, begin counting the beats (throbbing). You need to count for at least 15 seconds. For a more accurate pulse rate you should count for a whole minute.

Multiply to Get the Rate
If you counted for 15 seconds, you'll multiply the number of beats you counted by 4 to determine the pulse or heart rate. Pulse rate is recorded as the number of beats in one minute. So if you counted 15 beats, the pulse rate would be 15 X 4 = 60 beats/minute. If you counted 18 beats the pulse rate would be 18 X 4 = 72 beats/minute.

The Resting Pulse Rate
The normal resting pulse rate for an adult will range from 60 to 100 beats/minute. If you have just climbed a set of stairs, run a mile, or been performing other activities, you would expect your heart rate/pulse to be faster.

Reasons For a Fast Pulse
If not due to recent activity, a rapid pulse rate may be due to such things as a fever. If the person is anemic or dehydrated (hypovolemic) the pulse rate would also be faster. A rapid pulse can also be due to drugs such as caffeine, nicotine, cocaine, or theophylline.

Slow Heart Rates
Athletes may have slow heart rates. Patients taking drugs such as beta-blockers, or calcium channel blockers may also have slow heart rates. During sleep or deep relaxation, the pulse rate will slow as well.

Report Abnormalities
Abnormalities in heart rate or pulse should be reported to the physician. These can include a pulse over 100 beats/minute or less than 60; especially if accompanied by other symptoms such as (but not limited to) fever, chest pain, shortness of breath, dizziness, weakness especially on one side of the body. does not collect, nor use your data.

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