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• A pulse occurs when the heart's left ventricle contracts and sends blood into the arteries.
• This process creates a pulse wave that can be palpated by a nurse.
• A person's heartbeat adjusts throughout the day based on the body's circulatory needs.
• Pulse is typically palpated using moderate pressure with the three middle fingers.
• The most sensitive areas for detecting a pulse are the pads of the fingers.

Pulse Measurement: Objectives

• To monitor the patient's condition
• To detect any abnormalities in pulse characteristics
• To obtain baseline data during patient admission
• To detect arrhythmia, inadequate circulation, or changes in patient condition
• To estimate medication dosage

Pulse Sites

• Temporal
• Carotid
• Apical
• Radial
• Femoral
• Brachial
• Popliteal
• Dorsalis Pedis (Pedal)
• Posterior Tibial

How to Measure Pulse

• Pulse is measured in beats per minute.
• Normal pulse ranges from 60-100 bpm.
• Readings between 90-100 bpm is high normal.
• A pulse faster than 100 bpm is Tachycardia.
• A pulse slower than 60 bpm is Bradycardia.

Pulse Quality/Characteristics

• Rhythm: Can be regular or irregular
• Rate: Should be within normal limits
• Strength: Can be strong, bounding, or thready

Factors Affecting Pulse Rate

• Increased by activity, pain, and fever.
• Increased by significant blood loss.
• Increased by emotions like anger, fear, agitation, or excitement.
• Decreased during sleep.
• Affected by some medications.
• Decreased by conditions such as depression.

Equipment for Measuring Pulse

• Watch with a second hand
• Stethoscope (for apical pulse)
• Alcohol swab
• Gloves (PPE as needed)

Steps to Measure Radial Pulse

• Identify the purpose of measuring radial pulse.
• Determine the order of the primary caregiver for measuring the radial pulse.
• Gather supplies: watch with a second hand, pen, and paper.
• Perform hand hygiene and observe infection control protocols.
• Prepare supplies.
• Knock, greet, verify person's identity, and establish rapport.
• Explain the procedure to the patient.
• Adjust equipment for body mechanics, ensuring bed is at a comfortable height and wheels are locked.
• Correctly position the person. In bed: Fowler's or supine position with arm supported. In a chair: feet flat on the floor with arm supported.
• Gently press first, second, and third fingers over the radial artery.
• Note the rhythm and force of the pulse.
• After the second hand reaches "12", count the pulse for one full minute.
• Adjust equipment for safety. Lower the bed, ensure wheels are locked, and call light is accessible.
• Clean up the working area and perform hand hygiene.
• Record the person’s name, the time, plus the pulse rate, rhythm, and force.

Measuring Pulse: Attitude

• Maintain professionalism
• Establish rapport with the person
• Preserve the person's dignity
• Provide privacy
• Provide comfort and safety

Normal Pulse Rate

• Adults and children over 10 years: 60-100 beats/min
• Children between 1 and 10 years: 70-130 beats/min
• Infants between 1 and 11 months: 80-120 beats/min
• Newborns between 1 and 30 days: 100-150 beats/min
• Well-trained athletes may have a resting pulse rate between 40-60 beats/min.

Observations Requiring Action

• Report the following to the nurse:
• Pulse rate less than 60 bpm (bradycardia) or greater than 100 bpm (tachycardia)
• Irregular pulse
• Weak (thready) or bounding pulse

Apical Pulse

• Placement of a stethoscope over the apex of the heart allows counting each pulse beat by listening, rather than feeling.
• The apical pulse is evaluated when the person has a very weak or irregular pulse that is difficult to detect at the radial artery, and when the person has certain heart conditions.
• This method is used for infants and young children.
• Place the stethoscope's diaphragm over the apex at the fifth intercostal space and auscultate for normal heart sounds ("lub-dub").
• Locate the apical impulse (apex) at the fifth intercostal space at the left midclavicular line.

Ensuring Accurate Pulse Evaluation

• Check for factors that could increase pulse rate before beginning.
• Give the person time to rest and relax before checking if they have been physically active, undergone a painful procedure, or are emotionally upset.
• Make sure the person's arm is resting comfortably when taking a radial pulse.
• Don’t place your thumb over the person's radial artery/the diaphragm of the stethoscope with your thumb (when taking an apical pulse), as your own pulse might cause confusion.

Introduction to respiration

• Process of breathing, including intake of oxygen and expulsion of carbon dioxide
• Is vital to life.
• The process of respiration consists of:
  • Inhalation or inspiration: Intake of air into the lungs.
  • Exhalation or expiration: Breathing out or expelling gases from the lungs to the atmosphere.
• Respiration is the act of breathing air into the lungs (inhalation) and exhaling air out of the lungs (exhalation).
• One inhalation plus one exhalation equals one respiration.
• A complex process that involves the intake of oxygen and the output of carbon dioxide

Purposes of Respiratory Assessment

• Collect baseline data for comparison and follow-up
• Monitor abnormalities of respirations.
• Monitor respirations before or after administration of medications that affect respirations.
• Detect some diseases.

Factors affecting respiratory Rate

• Factors that increase pulse rate also increase respiratory rate, for example, exercise, fever, pain, significant blood loss, and emotions.
• Factors that decrease pulse rate also decrease respiratory rate, for example, sleep, medications, and certain conditions, such as depression.
• In adults, the normal respiratory rate is between 15 and 20 breaths/min.
• In infants and children, the normal respiratory rate is faster.

Characteristics of Respirations

• The respiratory rate:
  • The number of respirations that occur in 1 minute.
  • Determined by counting the number of chest rises (inhalation) and falls (exhalation).
  • One breath is equal to one inhalation plus one exhalation
• The respiratory rhythm:
  • Regularity of breathing.
  • Normal breathing has evenly spaced breaths.
• The respiratory depth:
  • May be described as deep or shallow.
  • Normal breathing seems quiet, effortless, and evenly spaced.
  • Both sides of the chest rise and fall equally.

Observations Requiring Action

• Difficult, irregular, or noisy breathing is reported.
• Abnormal breathing: a respiratory of rate greater than 20 breaths/min or less than 15 breaths/min
• Dyspnea (DOF): The medical term for breathing that is difficult or requires a lot of effort
• A respiratory rhythm that is irregular.
• Respirations that are shallow or deep.
• Respirations that are strained or difficult (dyspnea).
• Respirations that do not cause both sides of the chest to rise and fall equally,

Ensuring Accurate evaluation of Respirations:

• Respiration can be controlled and can be interrupted normal pattern of breathing, by holding our breath.
• Evaluate respirations without the person knowing it.
• Evaluate a person's respirations right after evaluating her pulse.
• Keep your fingers on the person's wrist to make for a more accurate reading.
• Count the number of breaths for a full minute, counting one rise and one fall of the chest for each respiration.

Knowledge of Person's Respiratory Rate

• Identify the purpose/s of measuring the respiratory rate of the person.
• Determines the order of the primary caregiver for measuring the person's respiratory rate.
• Identify needed supplies such as watch with a second hand, pen and paper.

Skill of Measuring Person's Respiratory Rate

• Perform hand hygiene and observes other appropriate infection control protocols.
• Gathers and prepares the needed supplies for the procedure
• Knocks, greets the person, verifies person's identity base on hospital policy, and establishes rapport with the person.
• Adjusts equipment for body mechanics and safety and raises the bed to a comfortable working height. Make sure the wheels on the bed are locked.
• Holds the person's wrist as if taking a radial pulse.
• Looks at your watch. When the second hand reaches the “12”and you see the person's chest rise, begins counting the respirations. Remembers that one respiration equals one rise and one fall of the chest. Continues counting for 1 full minute.
• Notes the rhythm and depth of the respirations, and whether the person seems to be having any difficulty breathing.
• Adjusts equipment for safety: lowers the bed to the level specified in the person's care plan. Makes sure the wheels on the bed are locked and the call the light is accessible to the person. Lowers or raises the side rails according to the person's care plan.
• Cleans up the working area and performs hand hygiene.
• Records and reports person's name, the time, and the respiratory rate, rhythm and depth.

Attitude Measuring Person's Respiratory Rate

• Maintains professionalism all throughout the procedure.
• Establishes rapport with the person.
• Preserves person's dignity.
• Provides privacy for the person all throughout the procedure.
• Provides comfort and safety for the person.