Pulse – Vital Signs (Nursing)

00:00 Let's talk about the pulse or otherwise known as heart rate in our vital signs series. So the normal range of a pulse or heart rate is known to be 60-100 beats per minute. This is important for us to know because variation of this is going to tell us many things about our client's condition. So let's take a minute and talk about what can we even learn about a client from their pulse. Well, our pulse and the quality of that actually can indicate our whole body's fluid volume status. So if we're really low on fluid or we're really dehydrated or we've lost a lot of blood, for example, we can have a weak pulse. And on the other side of that, we should have a normal healthy bounding pulse. Now the rate, meaning how fast that pulse is, can also be a clue that we have some irregular things going on with our heart.

00:58 If it's too fast or too slow or if it's not being regularly, meaning on time, or if it's really irregular and when we feel the rate. That also can tell us some other things about our client's condition. So let's take a moment about the physiology of our pulse. So if you guys remember back to your physiology course, we're looking at that SA node. Do you all remember what that's called? We call that the pacemaker of the heart. So anytime you have electrical pulse, this is going to originate, hopefully, in a healthy heart from the SA node and you will get beats of 60-100 beats per minute. This is where our heart's electrical conduction system starts. Now, this is important because here with the pulse, we're measuring what we call our cardiac output. So when you hear about cardiac output, what we're talking about is first our stroke volume, meaning if the amount of blood pumped by that ventricle in about a minute. We're also going to take that by our heart rate and this overall gives us something we call cardiac output, and this tells you a lot about our perfusion status. Now the pulse itself is that palpable bounding of blood flow noted at those various points in the body, for example like in your neck or in your wrist for example. And again, this is an indicator of our circulatory status in our body. Now the pulse rate, or otherwise known as heart rate, is the number of pulsing sensations that you can feel in a minute. Now let's talk about some causes of an abnormal pulse. This is important on our assessment piece. So if we're going too fast, otherwise known as tachycardia, when we hear the word tachycardia think of tachy meaning fast. So if you remember, 60-100 is our normal pulse range so anything above 100 is considered tachycardia. So again, anything outside or high above that 100 beats per minute is considered tachycardia. So this could be maybe just 105 beats per minute or even like 180 beats per minute. There is a range of how fast that tachycardia can get. Now, this can be related to lots of things. So commonly it could be related to even anxiety. So think about those tests when you go in for a nursing exam and you can feel your heart rate going because you're anxious. That could be a reason of tachycardia as well as activity intolerance. So maybe you try to just go out your door and you haven’t been training and you're trying to go run a marathon. Well, your heart rate may pick up because we're not used to that type of activity. Also, we can have another issue called too slow otherwise known as bradycardia. So bradycardia is defined as a heart rate less than 60 because remember our normal heart rate is about 60-100.

03:55 So this could mean anything from heart rate of 55 or even like 45 which is really low. So the there's many things that can cause bradycardia, one of those being hypothermia or a patient being exposed to extreme cold or really low body temperature, or certain medications we can give can slow the heart rate quite a bit. Also keep in mind on assessment our pulse could be irregular. This could mean a patient has what we call a dysrhythmia meaning that pulse is not beating on regular intervals which is a regular characteristic of a pulse. That's what we want to see, but sometimes we'll feel or we'll hear a pulse and it's really irregular. That could mean we have something called heart dysrhythmia and abnormal electrical conduction issue. This could be from electrolyte imbalances, that's our most common cause such as a high potassium for example or if there are different medication interactions that can cause this as well. So when we talk about a pulse, remember we talked about the characteristic or the quality of the pulse here. So if you look at this graph here, you see that it goes all the way from 0 being no pulse which is a problem. Right? We call that asystole and that is a bad sign, from 0 all the way to 4+.

05:20 Now, 4+ of top here is bounding and strong. That's what we should see in a normal healthy patient. Now, sometimes there are some variations if you think about age as well. So maybe a younger patient may have a bounding pulse, maybe our little bit older normal healthy adult may have anywhere from like a 2+ or 3 pulse when we feel our pulse. Now, if you look at the 1+, this can be an issue and sign that our fluid volume status is low. So we were talking about assessment and the characteristic of the pulse. Let's talk about all those pulse points that we have on our body. If you take a look at this image, there are a lot of those. Right? So first one I want to point out is what we call the apical pulse. This is the one where we take our stethoscope, we're going to assess it and listen to our patient's chest. We're going to pick up the apical pulse. Now, this one is ideal to use if your patient has an irregular heart rate or rhythm, for example. So many times we can get a pulse from here and use auscultation with our stethoscope. Now it's also important when we're talking about pulse. Here are 4 pieces that we're going to consider. What's the rate? Is it too fast, is it too slow such as tachycardia or bradycardia? What's the rhythm? So, is it coming in at a very normal rate? What's the strength? Is it bounding, is it diminished? And, if we're talking about assessing pulses in an extremity, we're talking about equality. So if I take a pulse in my radial, so on my wrist, on my right and left wrist, they should be equal when I feel them. So the preferred sites for a pulse are really common sites that you're going to use most often is either your brachial or your radial which is down here by your wrist.