When the nurse takes a pulse reading, they must press lightly against the artery wall, with their index and middle fingers. They must not use their thumb, as the thumb has a pulse of its own, and this would lead to incorrect results. They need to have a watch or clock, to time and count the pulses in a minute. The nurse must count the beats for a minimum time of sixty seconds so they can determine any irregularity. Nowadays, nurses can also get a pulse reading by utilising a digital monitor from a finger or wrist device or using a digital blood pressure machine. The nurses always have to check that machines are in good working condition.
According to Marieb (2001), the pulse may vary depending on a person’s posture. For example, the pulse of a healthy man might be sixty six beats per minute, when lying down, this may increase to seventy when sitting up and eighty if he were to stand up suddenly. If the blood volume drops suddenly e.g. due to a haemorrhage, or if the heart becomes weakened by a disease, such as heart disease, the stroke volume, which is is the amount of blood pumped by the left ventricle of the heart in one contraction, declines and the cardiac output, which is the volume of blood being pumped by each heart ventricle in one minute, is maintained just by increasing the rate of the pulse. The cardiac output is equal to the heart rate multiplied by the stroke volume ().
According to Ganong (1995) the neutral changes in the heart are caused by activation of the automatic nervous system. The sympathetic nervous system increases heart rate, while the parasympathetic nervous system decreases it. Ganong (1995) also explains that the chemical regulation of the heart is affected by the hormones adrenaline and thyroxine, and also by the electrolites sodium, potassium and calcium. When there are high or low levels of electrolytes particularly the three named above, it can cause an alteration in the rate and rhythm of the heart. For example, hyperkalaemia (increased level of potassium in blood) causes ventricular fibrillation. If a pulse is irregular, it could be highly difficult to measure the pulse rate accurately. It also could be difficult to get an accurate pulse reading in babies and young children as their pulse rate is faster than in a healthy adult. Sometimes with elderly patients it is difficult to detect the pulse, they often suffer from arterosclerosis, where calcium has been deposited into the muscular walls of the arteries, which causes them to become harder than normal, the pulse is harder to detect. This can lead to mistaken results and affects the accuracy of the procedure.
According to Marieb (2001), there are two types of heart rate which affect the pulse, they are Tachycardia and Bradycardia. Tachycardia is an abnormally fast heart rate, which is over a hundred beats per minute in an adult. This might result from an incresed sympathetic response due to physical or emotional stress, or an increase in the body temperature due to an infection, or certain drugs (e.g. Salbutamol) or heart disease. Bradycardia is an abnormally slow heart rate, which is slower than sixty beats per minute. This may result from a low body temperature, certains drugs (e.g. β-blockers) or activation of the parasympathetic nervous system.
In work environments, when using digital recorders, it is essential the nurse checks the manufacturer’s instructions for safety issues and potential risks, and the nurse must also check the level of accuracy. The level of accuracy of the equipment, such as a digital blood pressure recorder, is stated in the manufacturer’s instructions. All electrical equipment are potential hazards, such as electrical shocks to the patient or the nurse. Nurses must check for malfunction of the equipment, loose and faulty plugs, trapped wires and so on. If the nurse finds a fault in any kind of equipment, they must report the problem inmediatly verbally and make sure that a written form is attached to the damaged equipment, so nobody will use it.
When a nurse measures a patient’s pulse rate, they must explain and discuss the procedure to the patient, make sure the patient understands and gives consent. It is important to always ask for consent before carrying out any procedure on a patient, this complies with Nursing Midwifery Council’s (NMC) code of professional conduct. The NMC code of conduct (2004) states “You must obtain consent before you give any treatment or care” (page 5). The nurse should measure the pulse under the same conditions every time, they should ensure the patient is comfortable and relaxed. The nurse should count the pulse for sixty seconds, as this is sufficient time to detect irregularities or other defects. They should record the pulse rate in the appropiate chart in order to monitor differences and detect trends, and they have to make sure that any irregularities are reported verbally to the appropriate staff.
There are many psychological aspects which relate to the procedure of taking the pulse. How the patient feels can be a factor, for example, if they feel embarrassed, anxious or scared, these conditions can cause the patient to increase the pulse rate. Nursing practice brings nurses into contact with all kinds of people: lonely, anxious, devalued, discriminated, emotionally vulnerable or unable to express their feelings. Communication is an essential tool for nurses, which enables them to meet the needs of the patients. Good communication skills are vital, communication in hospitals involves much more than just giving and receiving information. It involves the use of body language, reflective listening, understanding and reassurance to patients. Body language and facial expressions are extremely important because the patient can pick up instantly how the nurse is feeling and his or her intentions, Baillie(2001), explains how a nurse’s posture can affect a patient’s impression.
According to Abraham Maslow, the goal of human life is personal growth, which is developing personal ability and potential. Before an individual can reach their potential there are levels of need called deficiency needs, which must be met first. Maslow’s levels of deficency needs are set out as hierarchy in a pyramid.(Refer to Appendix 2). Maslow’s hierarchy of needs emphasises the importance of communication to the individual patient, as communications breaks down barriers and reduces feelings of threat. Communication enables people to value others and build a positive concept, contributes to the importance of emotional and physical safety to the patient, it also helps to build their self-esteem and feel valued. Poor communication is very stressful for patients. Effective communication reduces the psychological and emotional factor, such as feelings of embarrassment or anxiety, which contributes to inaccurate pulse readings. According to Moonie (2000), Maslow believes that people have a range of different types of needs. Adults can only live a fulfilled life when their physical, safety, belonging and self-esteem needs are met.
A patient’s behaviour has a strong effect on the pulse, for example, if a patient experienced psychological and/or physical trauma due to an accident, they may be unable to cope sufficiently, which may result in mental illness, such as post-traumatic stress syndrome. They may be anxious because a close family member was killed in the accident. This would suddenly increase the heart rate as the patient re-lived this experience in their mind, causing the pulse rate to be inaccurate. It is important for nurses to take these factors that contribute to stress into account in order to get an accurate pulse reading. Furthermore, the impact of hospitalisation and treatment can cause a lot of stress. Some patients may feel that their stay in hospital is a negative experience, as they associate hospitalisation with pain, death, deterioration of their condition or illness. Some patients may find it difficult to cope with sudden changes to their daily routine. They may not feel comfortable or happy with the hospital routines of when to eat, sleep and wash at regular times. Patients may become depersonalised and may feel that they have lost control. They may feel angry as they feel a loss of privacy and independence, which contributes to the stress which they may be experiencing. Pain after operations or/and treatments can also cause stress for them. Patients can feel patronised if they are talked to using overly simplistic language or if the nurse speaks too loudly and slowly to an elderly patient, assuming they have a hearing problem, again this would cause stress for the patient. There are many other factors which contribute to stress or depression when hospitalised, for example, if a patient had an accident and suffered memory loss as a result, they may feel very stressed. In some conditions patients may lose the ability to make decisions about their health. Separation from families and work can have a large effect on a patient and can contribute to higher levels of stress, especially when patients have to cope with the sudden change of environment and people.
There are many sociological aspects which can affect the pulse rate of an individual, such as age, gender, disease, illness and disability (Marieb 2001). These sociological factor affect an individual patient’s susceptibility to disease, especially heart and lung disease, which affects patient’s heart rate, physiological response to stress, and therefore pulse rate. According to Watson (2000), increasing age slows the heart rate; infants have a heart rate of 120-140 at birth, which decreases throughout life and into old age. Watson also explains that women have a slightly faster pulse rate than men. Social inequalities also play a role in the variation of pulse rates of different patients. Social stratification is the hierarchical organisation of groups of people within a society into different levels, within the social order, according to a single or group of social characteristics. This is an important feature of societies, because an individual person’s place in society can influence their access to resources and benefits, such as income, housing, education, and it can also influence their life chances and health status. Class, poverty, wealth, race, ethnicity and area of residence are all factors which can have an impact on health. People may have health inequalities because there is a different rate of access to medical treatment. Some people live in an environment which offers them many opportunities to have a healthy and successful lifestyle. The environment in which people live in contributes to stress levels and mental health of a person. People living in households with relatively low incomes would be stressed from financial problems. Low income is related to poor health, poor housing and unsafe environments. Opportunities to work are the most important route out of low income. There are more consequences of being unemployed, as unemployment can contribute to ill health and future employment opportunities. If a patient were unemployed for a long period of time, they are most likely to suffer from stress or depression, due to a lack of independence and achievement, which will increase their pulse rate. Pollution causes respiratory diseases and breathing problems, such as asthma and bronchitis, which may affect the pulse rate. According to the Acheson’s Report (1998), air pollution is responsible for 10,500 hospital admissions for respiratory disease a year. The experience of illness itself is stressful to a patient, thus increasing the pulse rate. A lack of rest can cause stress, which weakens the immune system and makes patients more susceptible to infections, thus increasing the pulse rate. Health can be affected by socio-economic factors, for example, access to good quality health services, shops selling good quality food at affordable prices. Also, some people may experience disadvantages or discrimination due to factors such as age, ethnicity, gender or disability. This make them particulary vulnerable to social exclusion.
‘Diet is an important lifestyle factor affecting health’ (WHO 2002). Studies have shown that there is a clear decline in vitamin intake, with rising family size, and declining income. Diet can be crucial in both preventative and curative health, The Acheson Repot (1998) refers to ‘food poverty’ and states that people in low socio-economic groups ‘spend more on foods richer in energy and higher in fat and sugar, which are cheaper per unit of energy than foods rich in protective nutrients, such as fruit and vegetables’. People on low incomes eat less healthy partly because of cost, rather than lack of concern or information. Income is the most important thing for the majority of people, as income enables individuals to pay for their clothes, food, housing, and support their families. The less wealthy families are, the more illness they will tend to endure, if this is cardiovascular or lung illness, then this can have an effect on a patient’s pulse.
The NMC code of professional conduct (2004) explains that nurses must: respect the patient regardless of age, race, ability, sexuality, economic status, lifestyle, culture, religious or political beliefs. They must protect confidential information, maintain their professional knowledge and competence and be trustworthy. Registered nurses must be responsive to the patients needs and respect their choice if they refuse treatment.
From this assignment I can conclude that, in order to perform the skill of taking the pulse rate, the nurses need to remember the main functions of the heart, arteries, and the circulatory system, they must remember that the average pulse rate in an adult is between 60-80 beats per minute at rest, and be able to recognise abnormalities in the pulse such as tachycardia, bradycardia or arteriosclrosis. They must be able to apply this knowledge to their practice, and be prepared to report abnormalities of the pulse rate to a higher member of staff immediately. They must obtain consent and explain the procedure to the patient. Nurses have to monitor carefully the rhythm, amplitude and strength of the pulse rate. Each procedure must be documented on the appropriate chart, legible and accurate.
Nurses must take into account the psychological factors that can affect the pulse rate, such as fear, depression, anger, aggression, embarrassment, stress or anxiety. Moreover they must understand the sociological factors that affect the pulse, such as age, gender, disability, housing, diet, life-style, race, unemployment and the effects of low income. Nurses must use effective communication in order to make patients feel valued. They also have the duty to give the patient maximun privacy and help promote independence. Nurses must respect the patient and their rights, foster equality and they must have a non-judgemental attitude towards patients.
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-http:/www.bris.ac.uk/Debts?anatomy/calnet/page3.htm
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