Which finger placement would the student nurse use to measure a patients pulse rate?

Pulse assessment is a vital component of good nursing care. Nurses must feel confident in their ability to accurately measure the pulse to assess patients’ health statuses

Abstract
Assessing the pulse is a common procedure and an important aspect of many nursing interventions; it should always be done with care and reassessed as needed. Assessment should always be taken seriously, with any deviations from the norm reported to a senior clinician, and pulse rate, rhythm and strength must always be documented. Pulses indicate numerous patient characteristics including the degree of relaxation, regularity of cardiac contractions and sufficiency of cardiac output. This article considers the relevant anatomy, physiology and practice of pulse assessment and recording.

Citation: Lowry M, Ashelford S (2015) Assessing the pulse rate in adult patients. Nursing Times; 111: 36/37, 18-20.

Authors: Mike Lowry is lecturer in nursing; Sarah Ashelford is lecturer in biological sciences; both at the University of Bradford.
This article has been double-blind peer reviewed
Scroll down to read the article or download a print-friendly PDF here

Learn the procedures, steps, risks, and requirements for taking vital signs.

Vital signs are essential to any treatment or diagnosis in healthcare. In addition, they are a tool for medical professionals to measure a patient’s health. Generally, vital signs include pulse, respiration, temperature, and blood pressure. This procedure is performed during healthcare checkups or emergencies. Vital signs can even be measured at home. Mastering this skill is of the utmost importance for the safety of patients and medical professionals.

As you can imagine, vital signs are crucial for most treatments. Not only do they provide key information about your organs, but they provide healthcare professionals with a general snapshot of your body’s internal functions. Therefore, it’s essential to follow the proper methods when taking a patient’s vital signs.

This article focuses on the art and science of taking vital signs, one of the most critical procedures for medical staff.

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Vital Signs Definition

What Does it Mean to Take Vital Signs?

The term “vital signs” refers to a person’s pulse, respiration, temperature, and blood pressure. These medical signs give healthcare professionals a window into the patient’s essential bodily functions. They help assess a person’s general physical health and may provide clues to underlying diseases. They are also used to monitor a patient’s recovery after surgery.

What is the Purpose of Taking Vital Signs?

Measuring vital signs is a standard procedure that’s performed for the following reasons:

1. to help assess the general physical health of a person
2. give clues to possible diseases
3. show progress toward recovery

How Long Does it Take to Take Vital Signs?

Although it depends on the type of vital signs, this procedure usually takes about three to five minutes to complete. For instance, a healthcare professional will often count your pulse for 60 seconds or for 15 and multiply by four to determine beats per minute. On the other hand, some instruments can give you a temperature reading in 30 seconds or less.

Who Can Take Vital Signs?

Various healthcare professionals can take vital signs. This includes but is not limited to EMTs, paramedics, medical assistants, nurses, and doctors.

While vital signs are not commonly measured in dental offices, doing so may provide significant benefits. For instance, dentists or Dental Assistants can use them to identify medical emergencies that may require immediate assistance.

• Pulse rate: If a Dental Assistant takes their patient’s pulse rate, they should note if the pulse is overly weak or strong (this can indicate an underlying health issue). While the average pulse rate of a child is between 70 to 120 beats per minute, adults usually have a pulse rate between 60 and 100 beats per minute.
• Respiration rate: Once a DA has taken the patient’s pulse rate, they count the number of breaths the patient takes for 15 seconds. Then, they multiply that number by four to determine the breaths per minute. For reference, the average, healthy adult takes between 12 and 20 breaths per minute.
• Temperature: Since the COVID-19 pandemic began, it has become much more common for Dental Assistants to take a patient’s temperature. The average body temperature of a healthy adult is 98.6 degrees Fahrenheit when taken orally.
• Blood Pressure: When taking a patient’s blood pressure, the DA should pay attention to both the systolic and diastolic pressures. The healthy range for adults and children can vary.

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Training Requirements for Taking Vital Signs

The requirements for taking vital signs vary and depend on your location and profession. For instance, Dental Assistants typically need to graduate from an accredited program and pass an exam. However, some may learn through on-the-job training.

Dental Assistant programs usually take about one year or less to complete. They include both clinical and classroom instruction. The Commission on Dental Accreditation (CODA) accredits over 250 Dental Assisting programs in the United States. These programs provide knowledge and practical experience.

Taking Vital Signs Procedure

Like any other skill, taking vital signs requires time and practice. So, the first step is to understand the proper techniques and procedures.

Taking Vital Signs Prep

It’s beneficial to ensure you have the proper training for this procedure. You should also check your employer’s policy and procedures. While taking vital signs in a dental office is not common, you never know when this skill might be necessary.

Taking Vital Signs Steps

Here are the general guidelines you should follow:

Pulse

1. Wash your hands thoroughly.
2. Ensure that your patient is relaxed before you begin.
3. Use the radial artery to find their pulse. You can find it on the inside of their wrist (closest to their thumb).
4. Place your first and second fingertips—not your thumb—in a firm yet gentle manner on the patient’s wrist.
5. Look at a clock or watch and wait for the second hand to hit the 12.
6. Start counting the beats of their pulse.
7. Count the patient’s pulse for 60 seconds or until the second-hand returns to the 12.
8. While counting, remember not to watch the clock constantly but instead concentrate on your patient’s pulse beats.

Respiration Rate

1. Wash your hands thoroughly.
2. Put your fingers on the patient’s wrist (either side is fine).
3. Count their breaths for one minute. Keep in mind that an inhale plus an exhale equals one respiration.
4. Document their respiration rate. Include any relevant observations, such as wheezing, agitation, etc.

Temperature / Digital Thermometer

1. Wash your hands thoroughly.
2. Encase the thermometer mouth tip with a sanitary plastic shield.
3. Press the button to turn on the thermometer.
4. Put the thermometer under your patient’s tongue and ask them to keep their mouth closed.
5. Remove the thermometer after it beeps to signal completion.
6. Record their temperature, including necessary information like the date, time, and method used.
7. Always clean and sterilize the thermometer.

Blood Pressure / Stethoscope, Cuff, or Aneroid Monitor

1. Wash your hands thoroughly.
2. Disinfect the stethoscope.
3. Ensure that the blood pressure monitor is working correctly.
4. Place your fingers on the underside of the patient’s elbow to locate their pulse (referred to as the brachial pulse).
5. Wrap the deflated cuff snugly around the patient’s upper arm. This should be at least one inch above where you detected the brachial pulse.
6. Place the stethoscope earpieces in your ears and put the diaphragm (disk) over the brachial pulse.
7. Twist the knob on the air pump clockwise to close the valve.
8. Pump air and inflate the cuff until the dial pointer hits 170.
9. Turn the knob on the air pump counterclockwise so that you can open the valve to deflate the cuff.
10. When the dial pointer falls, closely observe the number and listen for a thumping sound.
11. Record the number displayed as the first thump is heard (systolic pressure).
12. Record the number displayed as the last thump is heard (diastolic pressure).
13. Deflate and remove the cuff from the patient.
14. Document these results and include any unusual observations.

Recovery

Although vital-sign measurements do not typically cause side effects, taking a patient’s blood pressure may cause brief bruising or dizziness. However, if the patient doesn’t have an arm injury, an ill-fitting cuff is the main culprit behind arm pain during a blood pressure reading.

Necessary Equipment for Taking Vital Signs

Typically, the supplies for taking vital signs include the following items:

• Thermometers
• Stethoscopes
• Blood Pressure Devices
• Combo Kits (Stethoscope + Blood Pressure)
• Pulse Oximetry
• Electrocardiogram (ECG)
• Penlights

Potential Risks or Complications of Taking Vital Signs

It’s essential that you correctly measure a patient’s vital signs. Incorrect measurements could lead to misdiagnosis with potentially fatal consequences. While taking vital signs can sound mundane, remember that doing so could help save a life one day.

Pro Tips for Mastering the Art of Taking Vital Signs

Tips for vital-sign measurement include practice, memorization, and sanitary practices. In addition, here are other pro tips that may assist you in the future:

• Ask your patient for help –If you need to take a patient’s temperature orally, ask them to place the thermometer under their tongue. This is to ensure that it goes all the way underneath the tongue. Plus, it’ll lessen the risk of jabs to tender spots.
• Memorize temperature ranges – Temperature readings will differ depending on the type you use (i.e., oral, axillary, tympanic, or rectal). For instance, rectal and tympanic readings usually range from 0.5 to 1.0 degrees Fahrenheit higher than an oral temperature. In comparison, axillary and temporal readings could be 0.5 to 1.0 degrees Fahrenheit lower than oral temperatures.
• Recommend that your patients hydrate – Like with phlebotomy, it’s easier to perform this procedure if your patient is well hydrated. Request that your patients hydrate before they arrive for their appointment.
• Practice until you perfect your grip – This is one of those things that you want to get just right. Although you don’t want to press too hard, you also don’t want to let your grip slip. So instead, use just enough pressure to feel their pulse before you loosen your grip.
• Make sure your patient has a straight arm for a brachial pulse –This type of pulse requires a straight arm. Why? It will help push the artery toward the surface. So, gently put your fingers on their inner elbow and move outward by about one inch. Search in small increments until you find it.
• Don’t let your patient know when you count –Because you don’t want your patient to alter their breathing, it’s best to try and count their respirations without them knowing it. It helps to count their respirations immediately after you take their pulse. Keep your fingers on their radial artery and act as if you’re still taking their pulse while you’re actually counting respirations instead.
• Ensure your patient is as calm as possible –To get the most accurate reading, strive to measure your patient’s vital signs when resting. Ask them not to eat, drink, smoke, or exercise 30 minutes before the appointment.
• Keep everything clean –Thoroughly wash your hands before AND after you take a patient’s vital signs. In addition, you must clean and sanitize each piece of equipment that was in use. Before you store each piece in its rightful place, double-check manufacturer instructions or your facility’s rules.

Why Should Dental Assistants Learn How to Take Vital Signs?

Healthcare professionals should learn how to take and record basic vital signs. Although it may sound simple to do so, the accurate measurement of vital signs is crucial to ensure your patient’s overall health.

Thankfully, Dental Assistants can help in this area. For example, if a patient feels anxious before an exam, a DA may take their blood pressure. In addition, DAs might take each patient’s temperature before entering the exam room. This step is often performed due to the COVID-19 pandemic. Alternatively, an emergency could arise in which a DA would need to check a patient’s vital signs. It’s not an exaggeration to say that Dental Assistants significantly increase the efficiency of the dental care team.

While measuring vital signs isn’t always a job requirement for DAs, it is a beneficial skill that could lead to more opportunities. Therefore, it would be advantageous for DAs or aspiring Dental Assistants to pursue training in this area. Once experienced, a DA would likely become more helpful to their employer and earn better career prospects.

Start Your Career in Dental Assisting

Measuring vital signs is a basic skill aspiring Dental Assistants should consider learning for their careers. It’s also an essential practice for the diagnosis of various medical issues.

After all, vital signs measure your body’s basic functions and give medical professionals a window into the state of your health. Plus, they help physicians diagnose diseases, monitor the effects of treatments, determine medication dosages, and more.

If you’re inspired and want to pursue a career in medicine, Unitek College offers several healthcare programs, such as our Dental Assisting program.

Contact us today to learn more about our programs and tuition assistance options. Take the first step toward a rewarding future in healthcare!

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