Monitoring pulse in adults

• Understand the rationale for taking a pulse as a fundamental aspect of nursing care
• Know the most common anatomical positions for measuring the pulse rate
• Understand the importance of developing an accurate technique
• Know what are normal and abnormal pulse rates and patterns for adults

When nursing patients in clinical practice, registered nurses must use their nursing expertise and critical thinking skills (Nursing and Midwifery Council (NMC), 2015). This is achieved through the use of the nursing process. The nursing process is a five-step framework (Stonehouse, 2017) comprising:

• assessment
• diagnosis
• planning
• implementing
• evaluation

During the assessment stage, registered nurses will collect clinical patient data to establish a patient's physiological benchmark (their normal observations). Patient assessment includes the measurement of four primary vital signs:

• body temperature
• heart rate/pulse
• respiration rate
• blood pressure

These vital signs indicate the status of the body's life-sustaining functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress towards recovery. The normal ranges for a person's vital signs vary with age, weight, sex, and overall health.

It is also important that experienced RNs pass on their knowledge and skills

Taking a pulse

Before taking a patient's pulse, nurses should observe their overall presentation: do they look red, hot and sweaty, well perfused, or pale and clammy? A combination of observation skills will support the nurse in identifying a patient's altered health state. The pulse can be affected by many factors, including anxiety and exercise (Table 2).

The pulse is a measurement of the heartbeat—if someone is anxious or has been exercising (perhaps rushing to get to a hospital appointment, or has just walked back from another room) their heartbeat will usually increase to ensure their body has enough oxygen circulating to meet the requirements of exercise or the ‘flight or fight’ response. When approaching all patients to take a pulse, and particularly a patient with a visual or hearing deficit, it is important that the nurse explains what they are doing, so as not to cause surprise or anxiety,

Consent

Registered nurses should always obtain consent where possible. They should ensure that the patient fully understands what is required to measure the pulse, including what the pulse is and where it will be taken. The registered nurse should ensure there are no physiological barriers at the pulse site, such as restricted blood flow or injury. If nurses are unsure they should consult a senior colleague.

Palpating a pulse

Registered nurses should follow infection control procedures, including observing hand-hygiene requirements and using personal protective equipment if required.

The first, second and third fingers should be used to gently press on the radial artery just below the wrist (Figure 2). Pressure must be firm enough to restrict the blood flow through the artery, which will allow the registered nurse to feel the ‘pulse’ of the blood. It should be noted that using the first and second finger is also satisfactory. The

References

Alexis O. Providing best practice in manual pulse measurement. Br J Nurs. 2010; 19(4):228–234. https://doi.org/10.12968/bjon.2010.19.4.46784 

Dougherty LLister SE, eds. The Royal Marsden Hospital manual of clinical nursing procedures. (9th edn). Professional edition. Oxford: Wiley-Blackwell, 2015 

Douglas G, Nicol F, Robertson C (eds). Macleod's clinical examination. (13th edn). Edinburgh: Churchill Livingston; 2013

NHS. Postural tachycardia syndrome (PoTS). 2018. https://www.nhs.uk/conditions/postural-tachycardia-syndrome/ (accessed 15 December) 

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses and midwives. 2015. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (accessed 15 December 2022) 

Nursing and Midwifery Council. Future nurse: standards of proficiency for registered nurses. 2018a. https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nurses/future-nurse-proficiencies.pdf (accessed 15 December 2022)

Nursing and Midwifery Council. Standards of proficiency for nursing associates. 2018b. https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nursing-associates/nursing-associates-proficiency-standards.pdf (accessed 15 December 2022) 

Royal College of Nursing. Standards for assessing, measuring and monitoring vital signs in infants, children and young people. 2017. https://www.rcn.org.uk/professional-development/publications/pub-005942 (accessed 15 December 2022) 

Royal College of Physicians. National early warning score (NEWS) 2: standardising the assessment of acute-illness severity in the