Assessing Pulse and Blood Flow

Pulse

• Pulse is a wave of blood created by the contraction of the left ventricle.
• Pulse reflects the heart beat and is regulated by the autonomic nervous system.
• Stroke volume and the compliance of the arterial wall are two important factors influencing pulse rate.
• Pulse rate is expressed in beats per minute (BPM).

Pulse Assessment

• Pulse is assessed for rate (60-100bpm), rhythm (regularity or irregularity), volume, and elasticity of the arterial wall.
• Pulse is commonly assessed by palpation (feeling) and auscultation (hearing using a stethoscope).
• Pulse can be assessed at different locations, including:
  • Carotid: side of the neck below the tube of the ear
  • Temporal: temporal bone area
  • Apical: apex of the heart (routinely used for infants and children < 3 yrs)
  • Brachial: inner aspect of the biceps muscle of the arm or medially in the antecubital space (elbow crease)
  • Radial: on the thumb side of the inner aspect of the wrist
  • Femoral: along the inguinal ligament (used for infants and children)
  • Popliteal: behind the knee
  • Posterior tibial: on the medial surface of the ankle
  • Pedal (Dorsal Pedis): palpated by feeling the dorsum (upper surface) of the foot

Pulse Rate

• Normal pulse rate is 66-60 beats per minute.
• Adult pulse rate > 66 BPM is called tachycardia.
• Adult pulse rate < 66 BPM is called bradycardia.

Pulse Rhythm

• Pulse rhythm is the pattern and interval between the beats.
• Dysrhythmia is characterized by random, irregular beats.

Pulse Volume

• Pulse volume is the force of blood with each beat.
• A normal pulse can be felt with moderate pressure of the fingers.
• A full or bounding pulse has a forceful or full blood volume.

Elasticity of Arterial Wall

• Elasticity of arterial wall is reflected in the healthy, normal artery feeling straight, smooth, soft, and easily bent.
• It reflects the status of the client's vascular system.

Respiration Rate

• Respiration rate (RR) is the act of breathing and includes the intake of oxygen and removal of carbon dioxide.
• Ventilation is another word that refers to the movement of air in and out of the lung.
• Hyperventilation is a very deep, rapid respiration.
• Hypoventilation is a very shallow respiration.

Respiration Assessment

• Respiration rate is assessed by watching the movement of the chest or abdomen.
• Rate, rhythm, depth, and special characteristics of respiration are assessed.
• Rate is described in rate per minute (RPM) and is measured for a full minute if regular, or for 36 seconds if irregular.
• Healthy adult RR is 26-05 per minute.
• As the age decreases, the respiratory rate increases.
• Eupnea is a normal breathing rate and depth.
• Bradypnea is slow respiration.
• Tachypnea is fast breathing.
• Apnea is temporary cessation of breathing.