UNCONTROLLED WHEN PRINTED
 Description
 Indications
  • Measure and record a patient’s pulse and respirations.
  • To verify correlation with ‘Heart Rate’ displayed on pulse-oximeter or monitor.
 Contraindications
Contraindications
 Patient Factors & Considerations

Pulse

  • Do not use your thumb to palpate the pulse.

Respirations

  • Distract the patient’s attention from respirations when measuring.
 Procedure
  • All relevant infection control methods to be utilised.
  • Locate the pulse best suited for assessment on the patient’s body.

Pulse

  • Explain the procedure to the patient.
  • Palpate the site with the index and middle finger, ensuring not to apply too much pressure.
  • Measure the pulse for a total of 15 seconds noting the rate, character and strength.
  • The total obtained after 15 seconds is multiplied by 4 to obtain the pulse rate per minute.

Respirations

  • Explain the procedure to the patient.
  • Visualise the chest rise and fall.
  • Measure the respirations for a total of 30 seconds noting the rate, rhythm, effort, depth and any accessory muscle use.
  • The total obtained after 30 seconds is multiplied by 2 to obtain the respiration rate per minute.
Pulses
 Success
Success
 Discontinue
Discontinue
Additional Information
  • If pulse not found at peripheral site, assess pulse at a more central location.

Settings
Extended Care:
Colour assist:

References
References

Document Control


Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Version

Published Date

Review Date

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