peripheral and apical pulse

RADIAL PULSE

Most commonly used pulse site; located on the thumb side of the wrist.

RADIAL PULSE LOCATION

Thumb side of the wrist.

HOW TO FIND RADIAL PULSE

Use your index and/or middle fingers in the groove on the thumb side of the wrist. Start with light pressure and increase until you feel the pulse.

WHY NOT USE THE THUMB?

The thumb has its own pulse and can interfere with an accurate count.

PULSE RATE

Number of heartbeats per minute.

PULSE RHYTHM

Whether the pulse is regular or irregular.

PULSE QUALITY

Strength of the pulse, such as strong, weak, thready, or bounding.

FIRST PULSE ASSESSMENT

Count for 60 seconds.

REGULAR PULSE

Can count for 15 seconds and multiply by 4, or 30 seconds and multiply by 2.

IRREGULAR PULSE

Always count for a full 60 seconds.

BILATERAL RADIAL PULSES

Check both wrists at the same time and compare the quality/strength.

BRACHIAL PULSE

Pulse located at the inner elbow/antecubital fossa.

BRACHIAL PULSE USE

Most frequently used for blood pressure and for identifying a pulse during infant CPR.

PRONATION

Turning the palm downward; can make the brachial pulse easier to feel.

CAROTID PULSE

Pulse located on the side of the neck between the trachea and sternocleidomastoid muscle.

CAROTID SAFETY

Palpate lightly and never compress both carotid arteries at the same time.

WHY NOT PRESS HARD ON THE CAROTID?

It can stimulate the vagus nerve and lower heart rate and blood pressure and may reduce blood flow to the brain.

DORSALIS PEDIS PULSE

Pulse located on the top of the foot.

DORSALIS PEDIS LOCATION

Between the great toe and second toe, moving toward the top of the foot.

DORSALIS PEDIS PRESSURE

Use very light pressure because it is easily obliterated.

DORSALIS PEDIS USE

Assesses circulation to the foot.

FEMORAL PULSE

Pulse located deep in the groin.

FEMORAL PULSE USE

Assesses circulation to the leg and is used to check for a pulse during CPR.

POSTERIOR TIBIAL PULSE

Pulse located on the inner side of the ankle below the medial malleolus.

POSTERIOR TIBIAL USE

Assesses circulation to the lower extremity.

POPLITEAL PULSE

Pulse located behind the knee.

POPLITEAL PULSE USE

Used when pedal pulses are absent or when taking a thigh blood pressure.

TEMPORAL PULSE

Pulse located on the side of the forehead.

TEMPORAL PULSE LOCATION

Lateral and superior to the eye.

TEMPORAL PULSE USE

Frequently used in infants because it is easily accessible.

CHILD UNDER 3 YEARS

Use an apical pulse because the pulse rate is faster and small arteries are harder to palpate.

FEAR AND PULSE RATE

Fear can increase the pulse rate.

OLDER ADULT PULSE ASSESSMENT

Allow the patient to rest 15-20 minutes after activity because the pulse returns to baseline more slowly.

WEAK OR FAINT PULSE

Use a Doppler ultrasound device to detect blood flow.

WHEN TO USE A DOPPLER

When a pulse is weak, faint, difficult to palpate, or when determining whether a pulse is truly absent.

DOPPLER GEL

Use transmission gel; do not substitute water-soluble lubricant.

DOPPLER ANGLE

Hold the probe at approximately a 45-degree angle to the artery.

DOPPLER COUNT

Count for 60 seconds.

SIGNS OF POOR CIRCULATION

Cool skin, decreased capillary refill, and bluish or ashen skin.

ABSENT PULSE

Complete absence of a pulse requires immediate intervention.

APICAL PULSE

Pulse heard directly over the heart with a stethoscope.

WHEN TO ASSESS APICAL PULSE

Digitalis therapy, blood loss, cardiac or respiratory disease, or conditions affecting oxygenation.

BEFORE APICAL PULSE AFTER ACTIVITY

Wait 10-15 minutes after recent activity.

APICAL PULSE LOCATION

Fifth intercostal space at the midclavicular line.

PMI

Point of maximum impulse; the area where the apical pulse is generally best heard.

APICAL PULSE STETHOSCOPE

Place the diaphragm over the PMI.

S1 AND S2

Normal heart sounds heard as "lub-dub."

COUNTING APICAL PULSE

Count each "lub-dub" as one heartbeat.

APICAL PULSE COUNT

Count for a full 60 seconds.

WHY COUNT APICAL FOR 60 SECONDS?

To ensure accuracy and detect slow or irregular rates.

APICAL RATE LESS THAN 60

If the patient is taking cardiac medication, withhold it and consult the provider about whether the dose should be adjusted, according to the source.

SYMPTOMS WITH APICAL RATE LESS THAN 60

Chest pain, dizziness, and dyspnea should be assessed.

APICAL RATE GREATER THAN 100

Obtain a complete set of vital signs and assess possible causes.

CAUSES OF FAST PULSE

Pain, anxiety, fever, dehydration, decreased oxygenation, hypotension, and decreased exercise.

APICAL-RADIAL PULSE DEFICIT

The difference between the apical pulse and radial pulse.

PULSE DEFICIT FORMULA

Apical rate − Radial rate = Pulse deficit.

PULSE DEFICIT EXAMPLE

Apical 84 − radial 80 = 4 beats/min pulse deficit.

WHY DOES A PULSE DEFICIT OCCUR?

A heartbeat may be heard at the heart but may not produce enough blood flow to create a palpable peripheral pulse.

DYSRHYTHMIAS AND PULSE DEFICIT

Atrial or ventricular dysrhythmias can cause heartbeats that do not perfuse.

BEST WAY TO CHECK PULSE DEFICIT

Two nurses count the apical and radial pulses simultaneously for 60 seconds.

NURSE 1

Auscultates the apical pulse.

NURSE 2

Palpates the radial pulse.

INCREASED PULSE DEFICIT

Indicates decreased cardiac output; notify the provider.

ANY APICAL-RADIAL PULSE DEFICIT

Abnormal according to the source.

WHAT TO DOCUMENT FOR A PULSE

Rate, rhythm, quality, and site.

RADIAL DOCUMENTATION EXAMPLE

Radial pulse 64 beats/min, regular, strong bilaterally.

APICAL DOCUMENTATION EXAMPLE

Apical pulse 64 bpm, regular rhythm, strong.

PULSE DEFICIT DOCUMENTATION EXAMPLE

Apical-radial pulse deficit 4 beats/min.

PULSE USED FOR BLOOD PRESSURE

Brachial pulse.

PULSE USED FOR FOOT CIRCULATION

Dorsalis pedis pulse.

PULSE USED FOR LOWER-EXTREMITY CIRCULATION

Dorsalis pedis and posterior tibial pulses.

PULSE BEHIND THE KNEE

Popliteal pulse.

PULSE IN THE GROIN

Femoral pulse.

PULSE AT INNER ANKLE

Posterior tibial pulse.

PULSE AT THUMB SIDE OF WRIST

Radial pulse.

PULSE AT INNER ELBOW

Brachial pulse.

PULSE AT SIDE OF NECK

Carotid pulse.

PULSE AT SIDE OF FOREHEAD

Temporal pulse.

APICAL MEMORY TRICK

5th intercostal space + midclavicular line = apical pulse.

IRREGULAR PULSE MEMORY TRICK

Irregular = full minute.

PULSE DEFICIT MEMORY TRICK

Apical − Radial = Deficit.

CAROTID MEMORY TRICK

Never check both sides at the same time.

DORSALIS PEDIS MEMORY TRICK

Top of foot.

POSTERIOR TIBIAL MEMORY TRICK

Inner ankle.

POPLITEAL MEMORY TRICK

Behind the knee.