What is a palpable radial pulse

Observation of the vital signs pulse and blood pressure

 

The pulse control is a simple and important examination method for monitoring the circulatory system. The pressure wave or the impact of the pulse wave in the blood vessels is referred to as a pulse.


The origin of the pulse

The heart can be clearly described as the motor of the circulatory system. It is a muscular hollow organ with two atria and two chambers. Vessels running towards the heart are called veins. The veins from the body's circulation transport the oxygen-poor blood to the heart. This blood goes through the pulmonary circulation, where it is enriched with oxygen, after which it flows back to the heart. Now the heart pumps the oxygen-enriched blood back into the circulation via so-called arteries.

The heart works like a pump. Regular, rhythmic contraction is called systole, relaxation is called diastole. When contracting, approx. 70-100 ml of blood is pressed into the large body artery, the aorta. This leads to an expansion of the artery. Since this is elastic, it tries to contract again, thereby pushing the blood forward. The movement continues evenly and can be felt as a pulse wave. It can be felt wherever an artery runs on the surface.

Arteries suitable for pulse control

The radial artery is selected for routine pulse control. Place the tips of the ring, middle and index fingers below the thumb in the pit between the spoke and tendon cord.

It is wrong to feel the pulse with your thumb because you will also feel your own pulse. To determine the number of pulse waves, you need a watch with a second hand or a so-called pulse watch. This is a small hourglass that is calibrated for 15 seconds.

Procedure: Hold the watch in one hand and feel the pulse with the other hand. The patient's forearm is loosely positioned. The artery is pressed against the spoke with the fingertips until the pulse can be clearly felt. When measuring the pulse, the pulse waves are counted for 15 seconds, then the measured value is multiplied by 4 and entered in an existing documentation system.

In special situations the pulse must be counted in full for over a minute. If you have a known heart disease, the pulse is very fast, slow or irregular, you should count the pulse for one minute. Do not count the pulse if the patient has recently exerted themselves physically. The normal value for a healthy adult is around 60 to 80 beats per minute.

Deviations

 

  • an accelerated pulse rate of 100 beats per minute and more is called tachycardia.

An accelerated pulse can have various causes such as excitement, exertion, fever, reduced cardiac output (heart failure), blood loss or an overactive thyroid

 

  • a slowed pulse rate below 60 beats per minute is called bradycardia.

Causes for this can be sleep, hunger, collapse, heart disease, digital overdose (e.g. Lanitop, Novodigal, Digimerk). Other normal values: newborns: 140 / min, children / 10 years: 90 / min, seniors: 80-85 / min. Any deviations from the normal frequency must be reported to the doctor. Further assessment criteria from the pulse rate are the pulse rhythm and the pulse quality.

Normally, pulse waves follow each other at regular intervals. If there are deviations, one speaks of an arrhythmia (also: arrhythmia). Arrhythmias can trigger anxiety. The patient then needs encouragement and reassurance. As a caregiver, you shouldn't get nervous. To properly detect arrhythmias, the pulse is counted for one minute. If there are arrhythmias, the doctor will be notified.

 

Possible forms of arrhythmia

 

  • Extrasystoles: Between the basic rhythm there are additional beats with a longer pause. Causes for this can be: smoking, fear, nervousness, heart disease
  • Twin pulse (bigeminus): Each pulse beat is accompanied by an extra beat (double beat). Causes for this can be digitalis overdose or conduction disorders
  • Absolute arrhythmias: the pulse beats are completely irregular. Causes for this can be heart muscle diseases or disturbances in the conduction of stimuli in the heart
     

The pulse quality
 

It depends on the elasticity, tension and filling of the vessel. Usually the pulse should be soft and full. A soft pulse is easy to impress, difficult to palpate and occurs with low blood pressure (hypotension), pronounced heart failure (heart failure) or fever. A hard pulse is difficult to impress, but it is easy to feel. It can occur with pronounced arteriosclerotic vascular damage, high blood pressure (hypertension) and increased intracranial pressure, caused by brain tumors or brain edema. A thread-like, rapid pulse occurs in shock or circulatory failure. The doctor must be notified immediately. The assessment of the pulse quality requires a lot of practice; if you are unsure, it should be checked by a nurse or doctor.

 

The blood pressure

 

Blood pressure is the measurable pressure in the arteries. It depends on the cardiac output as well as the nature and elasticity of the arteries. When measuring blood pressure, a distinction is made between the systolic (upper) and diastolic (lower) values. The systolic value indicates the minimum pressure in the arteries during the relaxation phase of the heart. The blood pressure is measured using a blood pressure device and a stethoscope. You can hear a tone. The blood pressure value is expressed in mmHg (mm of mercury). The measurement process is called RR measurement (after its Italian inventor Riva-Rocci).

The blood pressure depends on
 

  • the cardiac output
  • the vascular resistance

According to the WHO, high blood pressure is present at values ​​from 150/90 mmHg. They are the natural result of fright and exertion. Pathological hypertension can occur with kidney diseases, arteriosclerosis, obesity.

Hypertension can occur even without an apparent cause. One then speaks of essential hypertension.

Low blood pressure is below 100/90 mmHg (according to WHO) and can be caused by bleeding or cardiovascular diseases.

 

execution

 

You will need a blood pressure monitor and a stethoscope. Before the measurement, the patient should not be upset or physically exerted. The measurement is made when the patient is lying or sitting. The patient's arm should be slightly bent at the level of the heart. Support if necessary. The upper arm must not be constricted by clothing. Place the evacuated cuff of the blood pressure device around the left or right bare upper arm tightly and without wrinkles and close, close the valve of the rubber balloon. Put on the stethoscope and place the diaphragm in the crook of the elbow. Pump air into the cuff and feel the pulse at the same time.
 
When the pulse can no longer be felt, the pressure is increased by about 50 mmHg. Open the valve slowly, releasing the pressure by a maximum of 3 mmHg per second. Read the value on the manometer at the first audible tone (systolic value). Read the second value on the manometer at the last tone or when the tone becomes noticeably quieter (diastolic value). Remove the cuff and note the values. After a faulty measurement, do not measure again until after a break of around 15 minutes.

To avoid possible sources of error in the measurement, practice the measurement under the guidance of a nurse. Another possibility for measuring blood pressure is offered by digital blood pressure measuring devices, some of which allow blood pressure to be measured on the wrist. If frequent monitoring of blood pressure is required, the use of a digital measuring device is recommended.