• Regular Pulse Per Minute
• Regular Pulse Reading
• Normal Pulse For Adult Woman
• What Is A Normal Pulse Reading

Part II: Assessment Techniques

If pulse is regular but volume diminishes from beat to beat, this might indicate left-sided heart failure and is called pulses alternans. If the volume of the pulse diminishes on inspiration, might indicate constrictive pericardial disease, the condition is called pulsus paradoxus. Carotid, brachial, femoral, popliteal, posterior tibialis,. Your pulse is your heart rate, or the number of times your heart beats in one minute. Pulse rates vary from person to person. Your pulse is lower when you are at rest and increases when you exercise (more oxygen-rich blood is needed by the body when you exercise). Knowing how to take your pulse can help you evaluate your exercise program.

Inspection

As you prepare to begin the actual assessment, you already have obtained and recorded the patient history and you arm yourself with pertinent data such as their chief complaint and allergic history.

Also keep in mind to allow a certain amount of time in order to complete a thorough exam. Many nurses do not have large blocks of time for completion of the assessment but you must be as thorough as possible. If this is an admission assessment, you must allow enough time to be complete. If this is an on-going assessment, not as much time will be required.

Begin Exam

• Patient undresses, but allow for privacy.
• Have the patient sit upright and inspect the thorax from the front.
• Now inspect from the back of the patient.

You will inspect for posture and symmetry of the thorax, color of the skin, gross deformities of the skin or bone structure, the neck, face, eyes, and any abnormal contours. Breathing patters will also be noted. Be especially aware of the presence of cyanosis. Central cyanosis is a condition which will cause the lips, mouth, and conjunctiva to become blue. Peripheral cyanosis will cause blue discoloration mainly on the lips, ear lobes, and nail beds. Peripheral cyanosis might indicate a peripheral problem of vasoconstriction, and would generally be less severe than central cyanosis, which could indicate heart disease and poor oxygenation.

Thorax

Inspect for symmetry of thorax, point of maximum intensity (PMI). PMI is easier to find if the patient will lay on the left side. PMI may also be palpated. Check skin color of thorax.

Eyes

Arcus Senilis is a light gray ring surrounding the iris, common in older patients; in younger patients it might indicate a type of lipid metabolism disorder, which is a precursor to coronary artery disease.

Xanthelasma is yellowish raised plaques on the skin surrounding the eyes. Can also appear on the elbows. This is a possible indication, or sign of hypercholesterolemia, often a precursor to coronary artery disease (atherosclerosis).

Palpation

Palpation, or touching, is the next part of the exam. In the stop above, if we noted any abnormalities, we will now palpate and evaluate them further.

Skin: temperature, texture, moisture, lumps, bumps, tenderness.

Examination of extremities for edema might also indicate a cardiovascular problem. Examine the feet, ankles, sacrum, abdomen, trunk, and face for edema. If you notice puffiness of frank edema, then palpate the area for pitting edema. Most facilities recognize the following scale:

Breathing: lay hands the chest at different locations and feel the respiratory patterns, feel the ribs elevate and separate during normal breathing.

Pre-Cordial Areas you can feel the pounding of the heartbeat, normal and abnormal pulsations o the chest wall; PMI, as mentioned above.

Arteries: Assess all pulses

You undoubtedly assessed the apical pulse earlier when you took the patient’s vital signs, if not, now is the time. Assess the following pulses:

• Apical heart rate – monitor for a full minute, note rhythm, rate, regularity.
  
• Radial pulse – monitor for a full minute. Note the rhythm, rate, and the regularity. Note any differences from right to left radial, a large difference might indicate arterial blockage or even enlarged ventricles. If pulse is regular but volume diminishes from beat to beat, this might indicate left-sided heart failure and is called pulses alternans. If the volume of the pulse diminishes on inspiration, might indicate constrictive pericardial disease, the condition is called pulsus paradoxus.
  
• Carotid, brachial, femoral, popliteal, posterior tibialis, and dorsalis pedis pulses – when checking these pulses do it the same way as the others mentioned in this section; right then left side. When you check the carotid, press gently and do not rub.

Do not palpate carotid on persons with known carotid disease or bruits; listen with stethoscope instead; and do not palpate both carotid pulses at the same time.

Carotid Artery:

• Plateau pulse – slow rise and slow collapse pulse; may be caused by aortic stenosis, slow ejection of blood through a narrowed aortic valve.
  
• Decreases amplitude (grade point pulse) – due to hemorrhagic shock, pulse is weak due to decreased blood volume.

Bounding Pulse - (Grade IV) can be due to hypertension, thyrotoxicosis, others; associated with high pulse pressure, the upstroke and downstroke of the pulse waves are very sharp.

It is common to use +1, +2, etc. when recording pulses:

• 0 = absent
• +1 = diminished or decreased
• +2 = normal pulses
• +3 = full pulse or slight increase in pulse volume
• +4 = bounding pulse or increased volume

Veins – neck, arms, legs, etc.

Next: Part II: Assessment Techniques, Con't.

The pulse rhythm, rate, force, and equality are assessed when palpating pulses.

Regular Pulse Per Minute

Pulse Rhythm

Regular Pulse Reading

The normal pulse rhythm is regular, meaning that the frequency of the pulsation felt by your fingers follows an even tempo with equal intervals between pulsations. If you compare this to music, it involves a constant beat that does not speed up or slow down, but stays at the same tempo. Thus, the interval between pulsations is the same. However, sinus arrhythmia is a common condition in children, adolescents, and young adults. Sinus arrhythmia involves an irregular pulse rhythm in which the pulse rate varies with the respiratory cycle: the heart rate increases at inspiration and decreases back to normal upon expiration. The underlying physiology of sinus arrhythmia is that the heart rate increases to compensate for the decreased stroke volume from the heart’s left side upon inspiration.

Points to Consider

If a pulse has an irregular rhythm, it is important to determine whether it is regularly irregular (e.g., three regular beats and one missed and this is repeated) or if it is irregularly irregular (e.g., there is no rhythm to the irregularity). Irregularly irregular pulse rhythm is highly specific to atrial fibrillation. Atrial fibrillation is an arrhythmia whereby the atria quiver. This condition can have many consequences including decreased stroke volume and cardiac output, blood clots, stroke, and heart failure.

Normal Pulse For Adult Woman

Pulse Rate

The pulse rate is counted by starting at one, which correlates with the first beat felt by your fingers. Count for thirty seconds if the rhythm is regular (even tempo) and multiply by two to report in beats per minute. Count for one minute if the rhythm is irregular. In children, pulse is counted for one minute considering that irregularities in rhythm are common.

Pulse Force

The pulse force is the strength of the pulsation felt when palpating the pulse. For example, when you feel a client’s pulse against your fingers, is it gentle? Can you barely feel it? Alternatively, is the pulsation very forceful and bounding into your fingertips? The force is important to assess because it reflects the volume of blood, the heart’s functioning and cardiac output, and the arteries’ elastic properties. Remember, stroke volume refers to the volume of blood pumped with each contraction of the heart (i.e., each heart beat). Thus, pulse force provides an idea of how hard the heart has to work to pump blood out of the heart and through the circulatory system.

Pulse force is recorded using a four-point scale:

• 3+ Full, bounding
• 2+ Normal/strong
• 1+ Weak, diminished, thready
• 0 Absent/non-palpable

Practice on many people to become skilled in measuring pulse force. While learning, it is helpful to assess pulse force along with an expert because there is a subjective element to the scale. A 1+ force (weak and thready) may reflect a decreased stroke volume and can be associated with conditions such as heart failure, heat exhaustion, or hemorrhagic shock, among other conditions. A 3+ force (full and bounding) may reflect an increased stroke volume and can be associated with exercise and stress, as well as abnormal health states including fluid overload and high blood pressure.

Pulse Equality

What Is A Normal Pulse Reading

Pulse equality refers to whether the pulse force is comparable on both sides of the body. For example, palpate the radial pulse on the right and left wrist at the same time and compare whether the pulse force is equal. Pulse equality is assessed because it provides data about conditions such as arterial obstructions and aortic coarctation. However, the carotid pulses should never be palpated at the same time as this can decrease and/or compromise cerebral blood flow.