Investigation of the arterial pulse in a patient
The nature of the pulse depends on the magnitude and speed of ejection of blood by the heart, as well as the condition of the artery wall - primarily on its elasticity.
Pulse is usually examined on the radial artery;for this, the nurse with the fingers of the right hand covers the patient's arm in the area of the wrist joint. The first finger is located on the rear of the forearm, and II-V fingers press the radial artery to the radius.
The following pulse properties should be defined: rhythm, frequency, voltage, filling, magnitude.
1. Rhythm. Determine but the intervals between pulse waves. Pulse oscillations of the artery wall should appear at regular intervals - a rhythmic pulse. With irregularities in the rhythm, there is an abnormal alternation of pulse waves - the pulse is irregular.
2. Heart rate. It is counted for 1 minute. At rest, a healthy person has a pulse of 60 to 80 beats per minute. With increasing heart rate( tachycardia), the number of pulse waves increases. Increased pulse in healthy people can occur with emotional and physical exertion, in patients with febrile conditions, hypertensive and ischemic heart disease. Slowing of the heart rhythm is called bradycardia. It occurs with some infectious diseases, poisonings, frostbite.
3. Pulse voltage. Determine the strength with which to press the radial artery to completely stop its pulse fluctuations. The pulse voltage depends primarily on the magnitude of systolic blood pressure. If the arterial pressure is normal and the artery is squeezed with moderate effort, then talk about the pulse of moderate stress. With high arterial pressure, the artery is harder to squeeze - this pulse is called strained, or hard. If the pressure is low, the artery contracts easily - the pulse is mild.
4. Filling of the pulse is characterized by filling the artery with blood and depends primarily on the amount of cardiac output, i.e.from the amount of blood that is thrown into the systole into the arterial system, as well as from the total amount of circulating blood in the vascular system. If the cardiac output is normal, then the pulse is complete. With circulatory failure, large blood loss, the filling of the pulse decreases. Such a pulse is called empty.
5. The pulse value depends on the voltage and filling. Sometimes the magnitude of the pulse waves can be so insignificant that they are difficult to determine. Such a pulse is called threadlike.
In addition to the radial artery, the pulse is examined on other vessels: temporal, carotid, femoral, popliteal arteries, arteries of the rear of the foot.
On the carotid arteries, the pulse should be examined alternately on each side without strong pressure. With significant pressure on the carotid arteries, a sharp slowdown in cardiac activity, up to cardiac arrest and a drop in blood pressure, is possible. The examinee may have dizziness, fainting, convulsions.
On the femoral artery, the pulse is examined in the inguinal region with a straightened thigh with a slight turn to the outside. On the popliteal artery, the pulse is determined in the popliteal fossa in the position of the patient lying on the abdomen.
The pulse on the posterior tibial artery is examined behind the inner ankle, pressing the artery to it.
The pulse of the arteries of the rear of the foot is examined on the back surface of the foot, in the proximal part of the first intercellular space.
The data obtained by examining the pulse on the radial artery is recorded in the medical history, indicating the rhythm, frequency, tension, and filling. In addition, the pulse rate data is marked daily in red pencil in the temperature sheet in column "P"( pulse).