From the Guidelines
A patient's pulse can provide critical information about their condition, including heart rate, rhythm, strength, and character, which can indicate various cardiovascular and other health issues. The pulse rate, for instance, can signal conditions such as tachycardia or bradycardia, with the latter being defined as a heart rate typically less than 50/min if bradyarrhythmia is present 1.
Key Aspects of Pulse Assessment
- Heart rate: Normally 60-100 beats per minute in adults, with rates outside this range potentially indicating conditions like tachycardia or bradycardia.
- Rhythm: Regular or irregular, with irregularities possibly indicating arrhythmias such as atrial fibrillation.
- Strength or amplitude: Can suggest cardiac output issues, with a weak pulse potentially indicating heart failure or shock, and a bounding pulse might suggest hypertension or aortic regurgitation.
- Character: Whether it feels normal, thready, or bounding, providing additional diagnostic clues.
Clinical Implications
Assessing the pulse is crucial in clinical settings, as it guides the assessment of the patient's condition and the appropriateness of their clinical state, especially in cases of adult bradycardia with a pulse, where identifying and treating the underlying cause is paramount 1. This includes maintaining a patent airway, assisting breathing as necessary, administering oxygen if hypoxemic, and using cardiac monitoring to identify the rhythm and monitor blood pressure and oximetry.
Diagnostic and Therapeutic Approach
Given the information provided by the pulse, healthcare providers can quickly assess a patient's hemodynamic status and detect potential cardiovascular problems requiring intervention. For example, a patient with bradycardia may require a 12-Lead ECG if available, without delaying therapy, and IV access should be established 1. The pulse, therefore, serves as a fundamental vital sign that offers insights into the patient's overall cardiovascular health and guides further diagnostic and therapeutic approaches.
From the Research
Pulse Information
The pulse can provide valuable information about a patient's condition, including:
- The degree of relaxation, regularity of cardiac contractions, and sufficiency of cardiac output 2
- The presence of an arrhythmia, as indicated by a pulse deficit (the difference between the apical and peripheral pulse rates) 3
- Cardiac autonomic activity, through the assessment of heart rate variability and pulse rate variability 4
Pulse Characteristics
A patient's pulse can be characterized by its:
- Rate: the number of beats per minute 2
- Rhythm: the regularity or irregularity of the heartbeat 3, 2
- Strength: the amplitude or force of the pulse 2
Assessment and Interpretation
Nurses should be competent in taking and interpreting the pulse, and developing their expertise in this vital sign 5. Assessment of the pulse should always be done with care, and any deviations from the norm should be reported to a senior clinician 2. The pulse can be examined at various sites, including the radial, brachial, and carotid pulses 5.
Relationship to Cardiovascular Health
Pulse rate variability has been used to assess cardiovascular health, but its relationship to heart rate variability is not entirely understood 4. Further research is needed to evaluate the usefulness of pulse rate variability in assessing cardiac autonomic activity and mechanical and vascular autonomic responses to cardiovascular changes 4.