Method of Taking Pulse

Subject: Fundamentals of Nursing

Overview

Method of Taking Pulse

S.N. Nursing Action Rationale
1

Identify the patient.

Determine the need to assess the client's pulse.

 

Ensures that right procedure is performed for right patient.

Obtains any specific instruction and information.
2 Explain procedure to patient. Obtains patient's cooperation and reduces anxiety.
3 Assess for factors that may alter pulse. Check if the patient had been involved in any activity. If so, allow the patient to rest for 10 minutes before taking pulse.

Allows to accurately assessing for presence and significance of pulse alteration. Activity can increase the pulse rate.

4 Close the door or use screen. Maintains privacy.
5 Wash hands. Prevents cross infection.
6 Prepare all equipment.

Arranging articles aids for smooth functioning.
7 Assist the patient to a comfortable position, help patient get into supine or sitting position.

Position ensures easy access to pulse measurement site.
8

Select the pulse site. For radial pulse, keep the arm, resting over chest or on the side with palm facing downward.

Usually radial pulse is selected.
9

Palpate and check pulse.

Place tips of 3 fingers other than thumb lightly over pulse site. Do not press the artery with more force. After getting the pulse regularly, count the pulse for one whole minute looking at the second hand on the wrist watch.

Thumb is not used for assessing pulse as it has its own pulse which can be mistaken for patient's pulse.

Irregularities can be noticed only if pulse is counted for one whole minute.
10

Assess for rate, rhythm, and volume of pulse and condition of blood vessel.

Normal pulse is regular and the rate is 70 to 80/m.

 

 

 
11 Assist client in returning to comfortable position. Ensures client's comfort.
12 Wash hands Reduce chance of infection
13 Record pulse in nursing progress sheet or graphic chart in red and other details in the nurse's notes.  Helps to communicate findings. 
14

Report abnormal findings to the nurse in-charge or physician.

  

Points to Remember:

  • Never click on pulse rate simultaneously, since this results in a reflex reduction in blood pressure and heart rate.
  • When the pulse cannot be felt at other locations, the carotid pulse is utilized to treat shock and cardiac arrest sufferers.
  • The pulse during sleep is measured in hyperthyroidism.
  • Before administering the medication to patients receiving digitalis, count the patient's pulse.
  • After strenuous activity, at times of stress, or during and after unpleasant treatments, the pulse shouldn't be monitored.
  • Using the client's data, ascertain the client's prior baseline pulse rate.
  • Encourage the customer to unwind and stop talking.
Things to remember

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