CNA Skill: Counting and Recording a Radial Pulse

Regular monitoring of your patient’s radial pulse can help you to detect changes in their condition and assist in providing potentially life-saving care. A change in the heart rhythm of a patient can be an early indication of a more serious problem. Before you begin, wash your hands carefully to avoid spreading infection.  Greet your patient, and explain that you are going to take his/her pulse.  Verify the identity of your patient, and then follow these steps:

• Have the patient extend his/her arm, and take the patient’s hand.  Slide your index and middle finger along the thumb to the hollow of the wrist to locate the radial artery.  This can be done on the left or right arm, depending on what is comfortable for you and the patient.
• Apply pressure with your fingertips until you can feel the patient’s pulse.  Once you feel a regular heart rate, count the number of beats you feel in thirty seconds.  Multiply the result by two to get the patient’s pulse.
• If the patient’s heart rate is not regular, you will need to count the beats for a full minute.
• Record the results in the patient’s chart as directed.
• Wash your hands properly.

There are several indicators of an abnormal pulse.  For adults, the pulse rate should be between sixty and eighty beats per minute.  Patients who are physically fit or who are resting may have a lower rate.  Certain medications can either increase or decrease heart rate, so ask your patient if he or she takes any medication.  A higher than normal pulse rate is usually the result of exercise, stress, caffeine, or drug use.  If the patient is fighting an infection, they may have an elevated heart rate and you will want to look for other signs such as fever that may indicate a problem.  If the patient is experiencing significant blood loss, they may also have an elevated heart rate.  If you cannot see an open injury, look for signs of internal bleeding.  Careful monitoring of the pulse is a useful diagnostic tool for both the nurse’s assistant and the rest of the medical staff.

Examiners Checklist For This Skill:

1) Performed beginning tasks
2) Positioned resident, sitting or lying down.
3) Located radial pulse at wrist.
4) Placed fingers over radial artery. Student does this first, then evaluator locates pulse on opposite wrist.
5) Determined whether to count for 30 seconds or 60 seconds.
6) Counted pulsations for 30 seconds and multiplied the count by 2; or for one minute if irregular beat. Student must tell when to start and end count.
7) Recorded the pulse rate within + or – two beats per minute of pulse rate recorded by evaluator.

Expert Tip by Tanya Glover, CNA

The radial pulse of our patients can tell us many things. This is why it is so important. In most facilities, getting the radial pulse is part of the vital sign assignments. Even though when you take the skills test you are instructed to take the pulse in increments of 30 seconds and multiply by 2, many CNA’s at the nursing home will only do a 15 second count and multiply by 4. Make sure you follow your own guide for the skills test, but keep in mind that 15 seconds is typically plenty for on the job work.

When you get your 15 second count and tally up the whole number, keep in mind what the proper beats are. This can vary from patient to patient. If you have gotten a strange reading on a patient, especially one you are not familiar with, redo your count by going all the way to 60 seconds. If the rate is still unusual, alert the hall nurse and they will come do their own count. When doing your end of shift charting, make sure that you note the abnormality and that you alerted the hall nurse of the reading.

Though it is tempting, never skip taking the radial pulse during your vital rounds. I know how tedious it can be. Typically we do not have the time to do our vital rounds until the end of the day. By this time we are ready to get home and skipping over things can seem appealing and very tempting. After all, the next CNA will be in soon and they will know if there is something wrong with the patient, right? WRONG. It is likely that they are assuming the same thing-that you already did your job so there is no need to go behind you to check vitals.

If you do vital rounds on the same patients all the time, note in the chart if there are any changes that may require attention. Keeping your patients safe is you number one priority and taking their pulse and other vitals is right up there with knowing CPR.