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How to Measure a Pulse. Vital Signs in the Ambulatory Setting: An Evidence-Based Approach. Cecelia L. Crawford RN, MSN. Pulse Measurement – An Overview. Equipment for accurate pulse measurement Watch or clock with second hand or digital second counter Stethoscope for apical pulse (optional)

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How to Measure a Pulse

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How to measure a pulse l.jpg

How to Measure a Pulse

Vital Signs in the Ambulatory Setting:An Evidence-Based Approach

Cecelia L. Crawford

RN, MSN


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Pulse Measurement – An Overview

  • Equipment for accurate pulse measurement

    • Watch or clock with second hand or digital second counter

    • Stethoscope for apical pulse (optional)

    • Pen or pencil

    • Flowsheet, chart, or medical record

    • Clean hands and fingers!

  • Waited 5 minutes if patient was active

  • Patient in a comfortable & relaxed position

  • Enough time to count the pulse


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Pulse – It’s All About The Numbers!

Terminal Digit Preference

  • Some people may show a preference for certain numbers in pulse readings*

    • Zeros, even numbers, odd numbers

  • Be aware you might “like” some numbers more than others!

(*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)


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Pulse Procedure

  • Wash hands & put on gloves, if appropriate

  • Provide privacy

  • Assist patient to a comfortable & relaxed position


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Pulse Procedure - Radial

4. Do NOT use your thumb

  • Thumbs have a pulse, which can be mistaken for a patient’s pulse

    5. Place fingertips of first 2 or middle 3 fingers over the radial pulse area

  • Thumb side of patient’s forearm at the wrist

    6. Lightly press your fingertips on the pulse area


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Pulse Procedure - Brachial

4. Used for infants and small children

5. Place fingertips of first 2 or middle 3 fingers over the brachial pulse area

  • Inside of the elbow

    6. Lightly press your fingertips on the pulse area


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Pulse Procedure

7. Begin to count rate when pulse is felt regularly

8. Count for 60 sec

9. Count for 30 sec and multiply X2

  • Shorter time counts = inaccurate data


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Pulse Procedure

  • If pulse irregular or skipping, count for 60 sec


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Pulse Procedure – Apical (Optional)

Listen to the heart with a stethoscope to count the pulse if:

  • Pulse is difficult to feel or count

  • Pulse is very fast or very slow


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Pulse Procedure – Machine Taken

  • Automated BP machines can take pulse readings

  • Accurate with strong, normal pulses

  • Inaccurate with:

    • Very fast or very slow pulses

    • Weak, skipping or irregular pulses

    • Arm movement or agitation

  • When in doubt – count it yourself!


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Pulse Procedure

10. Inform the RN or MD if pulse is:

  • Difficult to feel or count

  • Very fast or very slow

  • Irregular or skipping

  • An Apical pulse


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Normal Pulse Rates

Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)


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Pulse Procedure

11. Discuss pulse rate with patient or parent

12. Remove gloves & wash hands


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Pulse Procedure

13. Document the Results

  • Flowsheet, clinic record, or clinic chart

    14. Communicate the Results

  • RN

  • MD


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Pulse Measurement in the Clinic

  • YOU can make the difference:

    • Welcoming presence

    • Decrease any anxieties & fears

    • Reassure patients & family

    • Accurate vital signs


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