Clinical Skills for Healthcare Assistants and Assistant Practitioners

Angela Whelan, Elaine Hughes, Angela Whelan, Elaine Hughes

• Publisher: Wiley-Blackwell
• Year: 2016
• Print ISBN: 9781118256411
• eBook ISBN: 9781118281970
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

Clinical Skills for Healthcare Assistants and Assistant Practitioners is an accessible, easy-to-read guide, outlining the fundamental and core skills integral to clinical practice.

Fully updated in its second edition, this book is divided into three sections; the first looks at fundamental skills applicable to all staff, such as accountability, communication and record keeping. Section two explores core clinical skills such as respiratory care, pulse, blood glucose management and catheter care. Section three outlines complex clinical skills that require more in-depth training, such as medication and intravenous cannulation.

An invaluable resource for healthcare assistants and assistant practitioners, this book will also be of use to newly qualified practitioners, and students in health and social care.

Section II

Core clinical skills

Chapter 5
Pulse

Learning objectives

• Define what a pulse is
• Explain how a pulse is initiated by the heart
• List the different locations where a pulse can be felt
• Identify common factors that can affect the pulse rate

Aim of this chapter

The aim of this chapter is to understand how a pulse is generated and felt within the body, the common sites and factors influencing its rate, rhythm and amplitude (strength).

What is a pulse?

A pulse can be felt where an artery is near the surface of the body and lies over a bone or another firm background. A pulse is the rhythmic expansion of the artery wall as it is stretched by a wave of blood that is pumped through the vessels with each heartbeat (Waugh and Grant 2010; Thibodeau and Patton 2007; Rawlings-Anderson and Hunter 2008). The heartbeat occurs when the ventricle of the heart (see ‘Relevant anatomy and physiology’) pumps blood into the aorta, which is already full with blood, and then into the arterial system (Maddex 2009). In normal cardiovascular health, one heartbeat corresponds to one pulse beat (Maddex 2009).

Reasons for performing a pulse reading

A pulse rate is often requested as part of ‘routine’ observations. It can be taken as a baseline (a reading taken that acts as a reference for future readings), to monitor changes in a patient's condition (e.g. after surgical intervention) or to check that medication is working correctly (e.g. after administration of a medication to correct an abnormal heartbeat (Marieb and Hoehn 2007).

Relevant anatomy and physiology

The pulse is strongest in the arteries closest to the heart, becoming weaker in the arterioles and then disappearing altogether in the capillaries (Tortora and Derrickson 2011). The most common location for taking a pulse reading is the radial site (located inside of the wrist and underneath the thumb). It is often the first choice because many patients are familiar with this site and it is easily accessible and non-invasive. However the choice of site will often vary with the patient and the presenting clinical situation. If the patient was acutely unwell, perhaps with a condition that reduces blood volume – such as shock, haemorrhage or a collapse with unknown cause – a pulse may not be easy to palpate at sites away from the heart because blood will be directed to the major organs. In such instances the radial pulse may be weak or difficult to find and the carotid or femoral site would be more appropriate (Figure 5.1). In children under the age of 2 the heartbeat is usually auscultated (listened to) via a stethoscope at the apex of the heart. In adulthood the apex can be located on patients' left-sided chest wall in the space between the fifth and sixth ribs (fifth intercostal space) on a line with the midpoint of the left clavicle (collar bone) (Herbert and Sheppard 2005) (Figure 5.1). In children up to the age of 7 the location of the apex beat can be found at the fourth intercostal space (Kyle 2008). Listening to the apex is deemed more appropriate because the vessel walls in neonates and infants are not fully developed, making palpation difficult. However, it is good practice in children's nursing to check for the presence of the brachial pulse (Ball and Bindler 2008). Pulses in the lower legs are usually palpated only when assessing the circulation (flow of blood) to the limbs, which may be affected by vascular problems or after surgery or trauma to the limbs (Maddex 2009).

Figure 5.1 Sites for taking a pulse.

In some patients locating a pulse may prove challenging, despite them being clinically well. This can be due to slightly unusual anatomy or the presence of cardiovascular disease. It is also a skill that can prove difficult initially and practise is recommended, especially when accessing the carotid pulse...

Table of contents

• Cover
• Title Page
• Copyright
• Table of Contents
• Preface
• Acknowledgements
• Introduction
• Section I: Fundamental skills
• Section II: Core clinical skills
• Section III: Complex clinical skills
• Index
• End User License Agreement