Failed PULSE!!

Nursing Students Student Assist

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Can you believe it? I'm Nursing I and just had my first skills test, passed everything but can you believe I failed Pulse Rate???

I feel like a total incompetent! Pulse---the easiest thing to do, right?

Let me explain, for the test we were paired up with another student. Well, I did recognize that my partner had an irregular beat and counted for a full minute but I couldn't keep track of it to get the rate right. Her pulse was fast then there would be a pause then it would be slow then speed up again. Sometimes it was strong then I could barely feel it. I must have taken her pulse about 5 times and each time I came up with a competely different number. There was no set pattern to her pulse that I could find.

This has been a real blow to my confidence. I feel like, man, if I can't take a darn pulse what good am I? I begin clinical at the hospital on Thursday and am now terrified.

Does anyone have any pointers on dealing with this type of pulse? The professor told me not to worry about it, that I would have alot of practice at clinical but she didn't explain what if anything I could do to count it properly (if there is anything other than just practice).

Any tips, thoughts would be appreciated.

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Specializes in ER/ICU/STICU.

Try tapping your fingers with each beat and count the number of taps. Technically if they have an irregular heart beat you can come up with different HR's, that's why the are irregular.

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Specializes in Med-Surg, Ortho, & Tele all on one ward!.

Practice. Friends, roommates, classmates, boyfriend, parents. Anyone that is willing to give you 1 minute of their time. We used to joke in school that it wasn't just us going through nursing school- our family and friends were going through it too. :) You can also practice the different pulses- PT, DP, radial, brachial, etc. Doing it a few times will help you get used to counting at different rates. Careful though about bugging your family/friends too much- you have a long way to go still and you don't want to burn them out yet, haha:roll

Hang in there, you can do it. People can mess up things here and there and still make it through. I remember I bombed my first foley check off, and at the time it felt like the end of the world. Stay positive, and good luck on your second try.

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Specializes in ACHPN.

Try listening to the apical pulse with your stethescope while feeling the radial other peripheral pulse. Most of the time they match up. It can help you get the "feel of things " when are hearing them. Somethimes the rhythm is so irregular that some beats are not strong enough to produce a peripheral pulse, therefore the peripheral pulse is different than the apical pulse. In that instance, the apical pulse should be documented. This seems to happen often with dynamaps in patients with very irregular afib. The dynamap will only read a portion of the heartbeats, falsely lowering the actual heart rate.

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McGyverRN & ArmyKitten

Gave you some excellent advice, I agree 100%.

ONe more thing, don't beat yourself up over it. It happens, and for your test subject to have an irregular pulse, didn't help. Regradless, it happens. In fact the other day (i'm a senior by the way ready to graduate), I had to take a newborns RR, I haven't done that in over 8mo, and even back then I don't think I was that good at it. That kid was breathing so fast, I just couldn't get it. I felt like a complete idot. I stared at her chest for over 5min. I placed my hand over her belly to feel it, whiped out a stethoscope, and still fumbled over getting a number, I actually had to get the nurse. Of course I was hoping it wasn't me, like maybe the nurse would have a problem, or that perhaps the kid, was breathing abnormally fast....nope....just me, couldn't get it. So just practice, and know that skills will come.

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Thank you so much for help--I feel better about it and yes, I'll be practicing on everyone that'll let me....lol.

If I have the problem in the future, would I listen to the apical and count from that? Would that be permissible? Do experienced nurses need to do that sometimes?

Thanks for your help!

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Specializes in ACHPN.

Yes, the apical pulse is the actual heart rate. I often use the apical pulse when documenting heart rate.

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Thank you so much for help--I feel better about it and yes, I'll be practicing on everyone that'll let me....lol.

If I have the problem in the future, would I listen to the apical and count from that? Would that be permissible? Do experienced nurses need to do that sometimes?

Thanks for your help!

Shh... secret... I always do that! Mostly in peds but even in adults. I've got my stethoscope there anyway and listening to the apical gives me extra time to really hone into the heart rhythm or extra sounds. I would especially do it if the rhythm was very irregular or pulse thready. Since adults aren't my thing I do sometimes have trouble picking up a pulse on an elderly person or at least keeping it for a full minute without compressing the artery too much. So... apical for me. That's the good news, the bad news is you still have to get tested on it and after that continue to practice until you're comfortable. And you will be!

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