Pulse rate issues

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    Okay before I go into details I just want to let you know I do plan to practice; Iím just looking for information to help me improve and to change up my technique so I can practice that and succeed.

    Today we had vital signs check offs. I passed everything BUT pulse rate. I am retaking this class and I also failed that part last time. I have a make-up lab I think in a month (need to check the syllabus). But anyway, Iím not a 100% sure what/how I did it wrong. Youíd think counting would be easy? Well apparently I canít count! This morning tested my skills on my husband 72 pr. When I tested it with a mechanical cuff, also 72. But every now and then I started counting to fast usually when I was tired or nervous and got way higher than the mechanical reading. I practiced this skill more than anything else. This morning I reread and found a new technique; bend the elbow at a 90 degree angle. Did it and I match the machine right on. Well in our vital sign check off lab my partner had to rest his hand on his lap because our chairs had no arm rests. I couldnít bend his elbow and hold it while I took a pulse.

    If I was in a clinical setting (hope to someday be) Iíd bend it at a 90 degree angle and support it on a table. I saw the instructor just deal with the awkward angle so I thought ďoh ya so can IĒ. Does the angle make a huge difference?

    Also when I felt it never went away but itís like my fingers went stupid and they felt as if they were pulsing (my thumb was not included when I palpated). I have one more shot at this I donít want to waste my money again and I told myself if I failed again Iíd never continue with nursing. I just feel like the huge disappointment is just too costly and devastating (Iím on student loans too). I just really want to be a nurse; Iíve studied and worked soooo hard! Iím not use to giving my all and failing over and over. I feel so silly since everyone else can do it with no sweet. I just donít understand why I canít feel it or distinguish it from each wave (separating them from one another). I feel it, I can find it. Iím not pushing super hard. Do you think the angle I was tested at probably is the culprit? If thatís truly the case Iíll ask to support the arm.

    I just want some advice, any advice on your techniques and how you passed it. Iím failing compared to people who also never have done pulse rate, practiced 10 minutes in the lab and passed. Iíve spent 30 minutes to 2 hours a day in the lab practicing this week. The weeks before at least once to twice a day on my husband. Iíve practiced soooooooo much and I still canít compare to other students who just stayed the day before for just 10 minutes. My partner who does it for a living even failed. So I keep going back in my mind the angle or my nerves made it so I couldnít count and felt my own pulse; I honestly donít know.

    Please donít say practice more; I obviously plan to. Please give me tangible explanations or advice. I really really want to pass. Iíve worked so hard not to fail so soon. This honestly has me questioning if Iím even nursing material itís just really hard to watch myself fail on something that sounds like it should be so simple.
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  3. 8 Comments so far...

  4. 1
    I bleieve a lot has to do with nervousness. Try using your stethoscope to listen for pulses in different parts of the body on different people (family and friends). I believe you will get better with time and practice. No other way that I know. SORRY

    Have you had your hearing checked?
    turnforthenurseRN likes this.
  5. 1
    Make sure the wrist where you're feeling the radial artery is flexed a bit (bent) with the fingers resting gently, lightly curled towards the palm. When the wrist is bent backward and the fingers straight, the artery retreats behind a protective layer of muscle and bone; if you imagine putting up your hands to fend off something sharp or dangerous, you will see why this would be a good idea from a bleeding-avoidance standpoint. Actually, most arteries you can palpate have a similar philosophy of life-- you can feel popliteals better with the knee slightly bent, and the brachial with the elbow slightly bent, for the same reason.

    When the wrist is flexed a little you can feel a little depression between the head of the radius and the big tendons that run down the wrist from the hand. That's the little valley where the artery likes to nestle. Palpate gently while you move the wrist into position and it'll jump right up at your fingertips; bend the wrist back and it will vanish like mist.
    turnforthenurseRN likes this.
  6. 1
    Oh wow I feel such a huge difference! I've been searching all day online for answers and everything! I've tried the inner aspect of my wrist, the outer part, old vital sign videos where they do the classic monotone long drawn speeches; just everything! I think I burst a blood vessel focusing on my wrist like I could some how telepathically or through osmosis just become one with the pulse! Thanks so much <3
    GrnTea likes this.
  7. 1
    Glad to help. I like you too.

    http://allnurses.com/misc.php?do=getsmilies
    tyvin likes this.
  8. 0
    Quote from GrnTea
    Make sure the wrist where you're feeling the radial artery is flexed a bit (bent) with the fingers resting gently, lightly curled towards the palm. When the wrist is bent backward and the fingers straight, the artery retreats behind a protective layer of muscle and bone; if you imagine putting up your hands to fend off something sharp or dangerous, you will see why this would be a good idea from a bleeding-avoidance standpoint. Actually, most arteries you can palpate have a similar philosophy of life-- you can feel popliteals better with the knee slightly bent, and the brachial with the elbow slightly bent, for the same reason.

    When the wrist is flexed a little you can feel a little depression between the head of the radius and the big tendons that run down the wrist from the hand. That's the little valley where the artery likes to nestle. Palpate gently while you move the wrist into position and it'll jump right up at your fingertips; bend the wrist back and it will vanish like mist.
    This will help me as well thank you !!!
  9. 0
    Oh my goodness what difference...found it right off too....hate having to feel around for those things...hehe...now if only that popliteal was easy to feel!
  10. 0
    Try closing your eyes!!!! I have the same problem so I will find the pulse, wait til the sec hand is at 12,3,6 or 9 and close my eyes. I take the full minute to be 100% sure and I normally open my eyes just before its up. It means you don't have any distractions and can just count. Also if you get say 75 bpm get another student to do the same and check.
  11. 0
    Something I learned in my peds rotation to keep track of beats is to simultaneously tap it out on your leg with the hand that's not taking the pulse.


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