Pretending to palpate pulses

  1. 0 I know that nurses are often time crunched and some pulses are often hard to palpate, but...
    I had a patient in clinicals who had just had iliac stent placement for PVD, so palpating pulses distal to this stent were vital to the assessment. I informed the nurse that I couldn't feel the politeal and asked if she could check. She comes in and places 2 fingers on the patient's knee and says "Yeah, I can feel it really lightly."



    Now, if my understanding of anatomy is correct- is the politeal not palpated BEHIND the knee???
    I reached over to feel what she claimed to be feeling and she smiled and walked away to document positive pulses. Aarrggg!
  2. Visit  nessajune21 profile page

    About nessajune21

    Joined Jun '08; Posts: 134; Likes: 114.

    15 Comments so far...

  3. Visit  RN1982 profile page
    4
    Did she even bother to palpate the pedal pulses? Posterior tibial? I hardly ever palpate the popliteal because IMHO, if the patient has a PT and DP pulses then they obviously are getting arterial flow to the extremities.And I've never known the popliteal pulse to be palpated anywhere besides the back of the knee.
    BBFRN, FireStarterRN, Jo Dirt, and 1 other like this.
  4. Visit  nessajune21 profile page
    1
    The patient had a BKA, so this was really the only assessment point for this extremity!
    :uhoh21:
    BBFRN likes this.
  5. Visit  RN1982 profile page
    0
    Quote from nessajune21
    The patient had a BKA, so this was really the only assessment point for this extremity!
    :uhoh21:

    Oh...:stone
  6. Visit  SuesquatchRN profile page
    6
    Well, I guess that answers Michigan's question.

    I often have trouble finding distal pulxes, at least, strongly enough to count them. But no, I don't fake finding them. I ask another to assess and expect that they really will.
    BBFRN, nursemary9, romantic, and 3 others like this.
  7. Visit  Keysnurse2008 profile page
    3
    [[/b]
    Quote from nessajune21
    the patient had a bka, so this was really the only assessment point for this extremity!
    :uhoh21:
    omg......hmm....that is just ahuge patient safety issue. i mean that is someones mother, brother, father, sister , child or friend lying there......that patient is somebody special to someone.......and that is just wrong. i hate that you had to witness that...and i hope the patient is ok. i mean those stents can occlude etc etc etc...bad things can happen.
  8. Visit  MoopleRN profile page
    1
    Quote from nessajune21
    I know that nurses are often time crunched and some pulses are often hard to palpate, but...
    I had a patient in clinicals who had just had iliac stent placement for PVD, so palpating pulses distal to this stent were vital to the assessment. I informed the nurse that I couldn't feel the politeal and asked if she could check. She comes in and places 2 fingers on the patient's knee and says "Yeah, I can feel it really lightly."



    Now, if my understanding of anatomy is correct- is the politeal not palpated BEHIND the knee???
    I reached over to feel what she claimed to be feeling and she smiled and walked away to document positive pulses. Aarrggg!
    I'm assuming you're a student here (and that it can be intimidating to question a staff nurse's assessment/intervention).... You don't say what happened afterwards other than the staff nurse charted a + popliteal pulse on a site that wasn't correct to assess (and smiled about it.... what was that all about, I wonder?). You also don't mention any assessment of the stump (color/temp)... Anyhoodles, I hope you discussed the whole popliteal thang with the nurse.

    Never be afraid to question! Sometimes the students know more than the nurses!
    BBFRN likes this.
  9. Visit  yeSICU profile page
    3
    As mentioned above color, blanching, temp, mottling, are all other signs of blood flow status. Not every one is as adept at palpating as another. There have been patients that I have felt a weak pulse and another nurse said they were doppler only (and vice versa). I have had patients where I could feel them half of the time and could only doppler them the other half. The nurse should have used this as a teaching opportunity, and then you probably wouldn't be asking this question. That all goes back to the fact that some nurses are just not teachers. I can always tell the poor nurses that orient with them because they are great at the "tasks" but they are very unsure of their assessment skills ( more so than normal of course as a new nurse...lol)
    RN1989, nursemary9, and nessajune21 like this.
  10. Visit  nessajune21 profile page
    0
    Quote from yeSICU
    The nurse should have used this as a teaching opportunity, and then you probably wouldn't be asking this question.
    I'm not asking a question. I KNOW where the pulse is. I am just shocked that a nurse would not- but would pretend to.

    I think it is horrifying that someone would disregard such a vital component of this patient's care!
  11. Visit  spuropathy profile page
    0
    :chuckle

    Im sorry, I couldn't control myself.

    Maybe she was a new grad. Or an old one, Im not sure if they emphasize on teaching pedal/popliteal/femoral pulses.
  12. Visit  GOMER42 profile page
    1
    Quote from yeSICU
    The nurse should have used this as a teaching opportunity, and then you probably wouldn't be asking this question.
    You can't teach what you don't know!

    That nurse obviously didn't have a clue, so if she were to take this as an opportunity to teach, then she would have been passing on the dummy torch of pseudo-knowledge!
    Acosmo27 likes this.
  13. Visit  yeSICU profile page
    3
    You are probably right about the dummy torch... but it really bugs me that so many nurses can't simply say, "I don't know". If that was the case, she should have directed the student/poster and herself to someone that did. There is no place for egos when someone else's well being is concerned. It is not a sign of weakness or stupidity, but I dare say a sign of intelligence and compassion to seek out answers to make sure you are providing competent and safe nursing care, and teaching a new nurse how to do the same.
    SuesquatchRN, BBFRN, and pagandeva2000 like this.
  14. Visit  pagandeva2000 profile page
    1
    Never had to search for a distal pulse except once in my clinic; hypertensive patient to receive clonidine 0.1mg po. One arm was used for dialysis, the other was formally used, but was still damaged, so, the doctor left instructions to take the pressure on a leg. I had to dig really deep for the popliteal before I discovered something really faint and attempted. I had gotten 180/98 and I still didn't think I was right. Asked another nurse and she told me to 'just use the electronic b/p". I had to go to a few before finally, someone told me I can better feel the popliteal by laying the patient down on the exam bed. The RN that told me this took over and did the rest.

    Next time I work on the floor, I will try and find a pedal pulse to get a bit of practice. Hope there is a doppler around just in case.
    SuesquatchRN likes this.


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