? about Physical Assessment

zambezi, BSN, RN · Oct 6, 2004

First off, never feel bad for asking questions...it is better to ask than to make it up or go on in the dark...That said, a lot of finding pulses is practice...Take a look at the common places that pulses can be palpated...radial, carotid (but don't feel both of these at once!), femoral, pedal, tibial. Other less common pulses are the brachial (more common to check on babies) and popliteal. You may need to look at a picture to find where all of these are. The great thing about this is that you can practice on anyone, including yourself! Practice is key here. Practice on your family. The pulses may not be the in quite the same spot from person to person. It may not have the same intensity...sometimes, you just can't feel it (you probably want to try with a dopplar if you can't feel it, just for a baseline). Sometimes, the pressure you use to feel with varies as well...Truly, practice makes perfect. Start with people that are warm and have good blood pressures without any peripheral vascular disease, that usually makes it a little easier too...Make sure you also look at color, cap refill, and the temp of the extremity you are feeling when doing the assessment...

This is a quote from DRYSOLONG from another thread about B/Ps that I thought was really well written on the same subject! ->

I take pulse at all the various sites at each assessment, but - to be fair - I work in an intensive care environment. If you felt a distal pulse at 8 and do not feel one at 12 - RED FLAG - Where's that doppler? I guess it is not done as frequently in Med/surg, but it really provides important information about CV function, hydration status, BP (as systolic BP drops, you lose your distal pulses - patient may start exhibiting s/s shock - If you can feel a carotid pulse, SBP is usually at least 60. If you can feel carotid and femoral, SBP usually at least 70. If you can feel the radial, SBP usually at least 80) and perfusion (has your patient had a recent fem/pop? did you lose your pedal pulse in that foot all of a sudden? better call the surgeon!!)

Starashe, BSN, RN · Sep 14, 2009

Pulses are sometimes hard to find, but they are important. Find anyone you know who you can look for pulses! other students are the best guinea pigs!

kafluknik · Sep 14, 2009

I agree with the 2-PP. Practice does make perfect. You can practice on anyone. It would be a good idea to start with healthy people since they have better circulation.

One of my classmates who've never practiced that much had a CHF patient and she was unable to find the tibial, dorsalis pedis and other lower arteries...she was in such a panic poor girl. However, when she tried it with a much healthier patient she was able to she was so happy!!! :yeah:

Good luck to you and keep palpating those pulses LOL!!! one at a time on the carotid, please.

Daytonite, BSN, RN · Sep 15, 2009

first of all, we have a sticky on assessment that has a number of weblinks to some fine medical school sites as well as videos that teach and show you these things. sometimes reading another viewpoint or seeing another person doing them is helpful. https://allnurses.com/nursing-student-assistance/health-assessment-resources-145091.html - health assessment resources, techniques, and forms

second, practice on every two legged willing volunteer you run into and don't be shy about asking. people love to assist in "playing" nurse. go with some fellow students to a friendly bar, a pizza hangout or the student cafeteria and have some fun with some willing patrons.

now, here's the wisdom. . .it will take a long time for you to get really proficient in assessing all the parts of the human body. this is not something that is learned overnight. have patience. we all went through this anxiety and we all survived and got better at it. it takes time, experience and doing a lot of assessments.