The pulse is an expansion of the artery each time the heart contracts. By taking the pulse on any part of the body you can usually know the heartrate. While this acceptable most times, in cardiac patients it is expected that the nurse will listen to the apical heartrate.
Taking a radial pulse involves, as all skills do, the basic steps of identifying yourself to the patient, identifying the patient, explaining what you plan to do and good hand hygiene. Gloves are not needed unless the patient is on some sort of precautions that require protective gear.
Many times nurses take the pulse for 15 seconds and multiply by 4 or count for 30 seconds and multiply by 2. That is only if the pulse is regular.
If there are any irregularities or if the patient is on digoxin, a cardiac medication that reduces the heartrate, then the pulse is taken for a full 60 seconds.
Irregular heartbeats can be regularly irregular, meaning it is not a steady thump-thump-thump. Instead it has either a hesitation or a faster rhythm that has a pattern you can identify and anticipate.
For example, 3 steady thumps then a hesitation followed by another 3 steady thumps. If this pattern continued through the 60 seconds it would be a regular irregularity.
Or it could be irregularly irregular. (Only in the medical field, eh?)
Some irregularities can be a challenge to count because you can’t anticipate when the next beat will be.
A pulse can be taken with the patient in any position. Don’t be afraid to position the patient’s arm and wrist the way you need to in order to palpate (feel) the pulse easily.
Sometimes if the patient has a weak pulse, too much pressure on the artery will obliterate the pulse. Try pressing a little more lightly to allow the blood to flow through the artery so you can feel it.
Having a really tough time feeling the radial pulse? Try having the patient hang their arm down to allow circulation to the wrist more pronounced.
Any rate between 60 and 100 beats per minute is considered WNL (Within Normal Limits).
Some patients become anxious if there is a change in the rate that is not “normal” for them. It needs to be explained to the patient that the heartrate changes from moment to moment in response to the body’s needs.
While less than 60 is considered abnormal in most cases, a highly trained athlete can have rates in the 50s with no problems.
60 beats per minute is usually the cut off for giving the medication digoxin.