f. Count Pulse Beats and Note Abnormalities. Count the pulse beats felt
during a 60-second period. Use the clock or watch. As you count the beats, note the
strength and regularity (rhythm) of the beats.
If you are using the dorsalis pedis site, use gentle pressure when palpating
the artery. Too much pressure at this or other sites may press the artery
closed and stop blood from flowing pass the site.
g. Record Pulse Rate. By convention (general agreement), the patient's pulse
rate is recorded as an even number (ending in 0, 2, 4, 6, or 8). For example, if you
counted 72 beats during the 60-second period, you would record "72." Suppose,
however, that you had counted 83 beats during the 60-second period. Would you
record a pulse rate of "82" or "84"? By convention, an odd pulse rate is recorded as the
next higher rate. Therefore, a pulse rate of 83 would be recorded as "84."
Once you have sufficient practice in taking pulses, you may wish to use a
shorter method of determining the pulse rate of a patient with a regular pulse.
You may count the number of pulse beats that you feel during a 30-second
period and multiply this number by 2. If, for example, you counted 37 pulse
beats during a 30-second period, you would record "74" (37 X 2 = 74). This
method will always give you an even number as your pulse rate. This method
is used only if the patient has a regular rhythm. If the patient has an irregular
pulse, you must use a least a 60-second time period. Your SOP may
require you to count the pulse beats for 120 seconds and divide by 2 if the
patient's pulse is irregular.
h. Record any Abnormalities. If you noticed anything about the patient's pulse
that is not normal (irregular, intermittent, thready, bounding, and so forth), record your
observations on the form or piece of paper. If the patient's pulse is very different from
the previous time (for example, a patient whose pulse was normal four hours ago and is
now irregular), notify the appropriate nursing personnel.
i. Take Pulse at Other Sites, if Needed. Sometimes a pulse cannot be taken
accurately at a particular site because of blockage in the artery or other reasons. In
such a case, you should take a pulse at another site in order to check your results.
Sometimes a physician will order that the apical pulse be taken in addition to the pulse
at another site. Such a procedure allows the physician to check the pulse at a particular
site against the rate and characteristics of the actual heartbeat (apical pulse).