Pulse Assessment for Student Nurses
Learn how to assess pulse rate, rhythm and strength, recognise important changes and use pulse findings as part of a wider assessment of patient deterioration.
What are you assessing when you check a pulse?
Palpating a pulse gives you information about the cardiovascular system. The pulse should be assessed alongside blood pressure, respiratory rate, oxygen saturation, temperature, consciousness and the patient's overall condition.
How fast?
A commonly taught resting reference range for many healthy adults.
Regular or irregular?
An irregular pulse may require further assessment and appropriate escalation.
What does it feel like?
Consider whether the pulse feels strong, weak or difficult to palpate in the clinical context.
How to assess a radial pulse
The radial pulse at the wrist is commonly used for routine pulse assessment. Follow your local teaching, supervision and clinical procedure.
Prepare the patient
Introduce yourself, confirm identity, explain what you are doing and ensure the patient is comfortable.
Locate the radial artery
Use your fingertips to gently palpate the pulse on the thumb side of the patient's wrist.
Assess the rate
Count the pulse accurately for an appropriate period according to local procedure and your clinical teaching.
Assess rhythm
Consider whether the beats occur at regular intervals or whether the rhythm feels irregular.
Consider pulse strength
Note whether the pulse feels easy to detect, weak or unusually forceful within the context of the patient's condition.
Record and interpret
Document the finding accurately and compare it with previous observations, NEWS2 and the wider clinical picture.
Why fingertips rather than your thumb?
Your thumb has its own palpable pulse, which can make assessment more difficult. Using the pads of your fingers helps you focus on the patient's pulse.
Tachycardia and bradycardia
Heart rate terminology can help describe what you find, but the cause cannot be determined from the pulse rate alone.
| Finding | General meaning | Clinical thinking |
|---|---|---|
| Tachycardia | A heart rate faster than the expected resting range. | Consider the wider picture, including pain, fever, anxiety, dehydration, blood loss, infection and physiological stress. |
| Bradycardia | A heart rate slower than the expected resting range. | This may be normal for some individuals or associated with medication, conduction problems or other clinical causes. |
| Irregular rhythm | The pulse does not occur at evenly spaced intervals. | An irregular pulse should be interpreted in context and may require further clinical assessment. |
| Weak pulse | The pulse is difficult to palpate or feels reduced in strength. | Consider perfusion, blood pressure and the patient's overall cardiovascular condition. |
Do not diagnose from the pulse alone
A fast, slow or irregular pulse can have many possible causes. Student nurses should recognise the finding, gather the appropriate observations and communicate abnormalities to the appropriate registered practitioner.
Changes that deserve attention
- A pulse rate that has changed significantly from the patient's previous observations.
- A new tachycardia or bradycardia.
- A newly irregular pulse.
- A weak pulse combined with low blood pressure or other signs of poor perfusion.
- Increasing pulse rate alongside fever, pain, breathlessness or worsening clinical condition.
- Changes in consciousness, dizziness, collapse or chest discomfort alongside an abnormal pulse.
- Several NEWS2 parameters becoming abnormal together.
Trends matter
A pulse rising from 72 to 94 to 108 bpm over several observations provides different information from a single isolated reading. Always look at previous observations when they are available.
Putting the observations together
Example
At the beginning of the shift, your patient's pulse was 78 bpm. Several hours later it is 112 bpm.
You also notice that their blood pressure is lower than previously, respiratory rate has increased and they say they feel dizzy when sitting upright.
The important finding is the combined pattern, not simply the pulse rate of 112.
As a student nurse, obtain accurate observations, recognise the deterioration and promptly communicate the findings to the appropriate registered practitioner.
Pulse assessment errors to avoid
- Recording rate without rhythm. Consider whether the pulse feels regular or irregular.
- Using your thumb. Your own pulse can interfere with assessment.
- Ignoring previous observations. Compare the current pulse with the patient's trend.
- Assuming every abnormal rate is an emergency diagnosis. Describe and escalate the finding rather than guessing the cause.
- Looking at the pulse in isolation. Assess blood pressure, respiration, oxygenation and the patient's overall condition.
- Ignoring symptoms. Dizziness, chest discomfort, breathlessness or altered consciousness may make an abnormal pulse more significant.
Recognise → assess → communicate → escalate
Notice the change
Identify a new change in rate, rhythm, pulse strength or the patient's clinical appearance.
Build the picture
Confirm the pulse and review blood pressure, respiration, oxygenation, temperature, symptoms and previous observations.
Report clearly
Communicate abnormalities and trends clearly and follow local escalation procedures when deterioration is suspected.
Further learning: Royal College of Physicians — National Early Warning Score (NEWS2) .
Blood Pressure Assessment for Student Nurses
Learn how to understand systolic and diastolic blood pressure, obtain an accurate reading and recognise changes that may indicate problems with circulation or patient deterioration.
Continue to Blood Pressure Assessment →