358 Chapter 16 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. 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 listening for 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 think about 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. 3. Carotid pulse: taken by feeling the carotid artery. It is usually taken when a resident is unconscious (for example, during CPR). Of these three, the radial and apical arteries are used most often. A nursing assistant may also measure pulse at the carotid and brachial arteries. The Stethoscope A stethoscope is used to help measure an apical pulse. It is also used when taking blood pressure, which is discussed later in this section. The stethoscope increases the sound of a pulse and transfers it to the user’s ears. The diaphragm, or larger, flat surface of the stethoscope makes sound louder, while the bell on the other side helps you hear fainter sounds (Figure 16.15). Before using a stethoscope, always disinfect the earpieces, diaphragm, and bell by rubbing them lightly with antiseptic or alcohol wipes. When cleaning the earpieces with alcohol, give the alcohol time to evaporate, as it can be painful in the ear canal. Wipe the tubing if it has come in contact with the resident or bed linen. 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 the resting pulse rates in adults is 60–100 bpm. Earpiece Brace Diaphragm Bell Tubing 279photo Studio/Shutterstock.com Figure 16.15 Place the earpieces of the stethoscope firmly in your ear canals, making sure they fit snugly. Rub the diaphragm to make sure you can hear sounds clearly through the stethoscope. Procedure Measuring a Radial Pulse 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 be a sign of 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. Copyright Goodheart-Willcox Co., Inc.