Nursing Care Related to the Cardiovascular and Respiratory Systems


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1-19. PULSE


a. Each time the heart beats, the left ventricle contracts and sends blood through the arteries. The pulse is the rhythmic expansion of the arteries that results from each heartbeat. The pulse may be felt most strongly over the following areas:

(1) Radial artery in the wrist at the base of the thumb.


(2) Temporal artery in front of the ear.


(3) Carotid artery in the neck.


(4) Femoral artery in the groin.


(5) Over the apex (tip) of the heart (apical pulse).

b. Two other locations for palpation of the pulse are the popliteal artery at the back of the knee and the pedal pulses of the foot. Pedal pulses are located on both the lateral and medial aspects of the ankle and on the top of the foot. These pulses are often difficult to locate.


c. The physician may request that both a radial and apical pulse be taken simultaneously to see if there is a difference in rates. A significant difference is indicative of vascular disease. This difference between the apical and radial pulse is known as the pulse deficit.


d. When the pulse is being counted, the rate, rhythm, and volume (force) should be noted.

(1) Rate may be noted as normal, fast (tachycardia), or slow (bradycardia). An average pulse rate for a resting adult is 70-80 bpm (beats per minute). Rates faster than 100 bpm are considered to be tachycardia. Rates slower than 60 bpm are considered to be bradycardia.

NOTE: A well-trained athlete may have a resting pulse of less than 50 bpm.

(2) Rhythm is the regularity of the pulse beats. Rhythm is described as irregular when you can feel the pulsations occur at different rates. A normal rhythm has the same time interval between the beats.


(3) Volume is the force or strength of the pulse. Terms used to describe the volume (force) of the pulse are weak, thready, or feeble for a pulse that lacks strength, and strong, full, or bounding for a pulse that feels forceful. Additionally, the force may be regular or irregular.

e. There are many factors that affect the pulse rate. Some are listed below.

(1) Sex. Women have a slightly faster pulse rate than men.



(2) Age. The pulse rate gradually decreases from birth to adulthood then increases with advancing old age.


(3) Body temperature. The pulse rate generally increases 7-10 beats for each degree of temperature elevation.


(4) Digestion. The increased metabolic rate during digestion will increase the pulse rate slightly.


(5) Pain. Pain increases pulse rate.


(6) Emotion. Fear, anger, anxiety, and excitement increase the pulse rate.


(7) Exercise. The heart must beat faster during exercise to meet the increased demand for oxygen.


(8) Blood pressure. In general, heart rate and blood pressure have an inverse relationship. When the blood pressure is low, there is an increase in pulse rate as the heart attempts to increase the output of blood from the heart (cardiac output).

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