468 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. the diaphragm and ensure you can hear a sound clearly. If you cannot, rotate the diaphragm and try again. If it still does not work, try this process again with a different stethoscope. Pulse Rate Measurements Pulse rate is measured by “feeling” or “hearing” pulse and counting the number of beats in one minute using a watch with a second hand. Pulse rate is reported in beats per minute, or bpm (for example, 72 beats per minute or 72 bpm). Resting pulse is taken when a resident is breathing normally and resting (sitting in a chair or in bed). The average ranges for normal resting pulse rates are found in Figure 18.18. Pulse rate can be affected by activity, anxiety, excitement, pain, fever, medications, sleep patterns, and diseases or health conditions. For instance, during exercise, the average person’s pulse rate can range from 90 to 120 beats per minute. In contrast, if a person is an athlete, resting pulse can be as low as 40–60 beats per minute. This is because an athlete’s body is in such good condition that the heart does not have to work as hard to pump blood. A pulse that is slow (fewer than 60 beats per minute) is called bradycardia. A pulse that is fast (100 beats or more per minute) is called tachycardia. When taking a pulse, remember that you are not only counting the number of beats, but also deter- mining the rhythm (pauses between beats). The rhythm may be described as normal (regular) or intermittent (irregular). The quality of the pulse can be full (bounding) or weak (thready). A thready pulse is hard to feel. When you consider all of these factors, you might report a pulse as 82 bpm and regular. Pulse is documented in a resident’s electronic record or a form provided by the healthcare facility. Any irregularities of the pulse must be reported to the licensed nursing staff. Average Resting Pulse Rates Per Minute Adults 60–100 bpm Teenagers 60–100 bpm Children 70–120 bpm Infants 120–160 bpm Figure 18.18 Illustrated here are the resting pulse rates for infants, children, teenagers, and adults. Rationale Counting a radial pulse is the most common method of measuring heart rate and its quality. A pulse that falls outside the normal range may indicate a health issue, disease, or condition. Preparation 1. Ask the licensed nursing staff how this procedure fits into the plan of care, if there are doctor’s orders for the procedure, if there are any special instructions or precautions, and if the resident can be moved into the positions required for this procedure. 2. Wash your hands or use hand sanitizer before entering the room. 3. Knock before entering the room. 4. Introduce yourself using your full name and title. Explain that you work with the licensed nursing staff and will be providing care. 5. Greet the resident and ask the resident to state her full name, if able. Then check the resident’s identification bracelet. 6. Use Mr., Mrs., or Ms. and the last name when conversing. 7. Explain the procedure in simple terms, even if the resident is not able to communicate or is disoriented. Ask permission to perform the procedure. 8. Bring the necessary equipment into the room. Place the following items in an accessible location: • a watch or clock with a second hand (not a digital watch) • pen and pad, form, or digital device for recording the pulse Measuring a Radial Pulse Procedure