whats the best way to take the heart rate?

[chiuli]

I was hanging blood and the cna took the pre vitals for me. She attached the blood pressure cuff and it showed the blood pressure and pulse which were all normal.

Then after 15 minutes I went in the room and took the vitals the same way. The pulse was showing up as 40. So I checked the radial which was about 45. 2 other nurses came in the room and helped me get the apical which was impossible to hear since the patient had wheezes throughout all lobes and major crackles from pulmonary edema. The telemetry showed that his pulse was in his 80's and he wasn't in any distress.

Im curious how should I take the vitals next time so they're a little more accurate. Should I get the pulse from the telemetry monitor?

[MunoRN, RN]

HR and pulse are usually related, but they aren't the same thing. HR is most accurately determined by telemetry. Pulse is how much of that heart rate translates into a detectable pulsation of flow at whatever spot you are measuring a pulse. A HR of 80 and a pulse of 40 is usually due to bigeminy; their heart is contracting 80 times a minute, but only every other contraction may be creating enough output to be felt at the radial, femoral, etc. artery.

For the purpose of monitoring for a reaction to blood, just make sure you are using the same measuring tool throughout, preferably the HR on tele (and give this particular guy extra lasix with the blood).

[CCL RN, RN]

So many people think pulse and HR are the same thing. I'm glad it was explained by the PP.

Not to be picky, but you said you hung blood, and then came back in 15 mins for a check. I know it may be difficult to do, but you really should hang out with the pt for the first 15 mins, just to be sure that he doesn't have a blood transfusion rxn, acute P. Edema, etc. Agree, sounds like 20 of lasix is in order...

[Diddledi]

I am a nursing student and it is great to be able to read such succinct explanations about the diff. between HR and pulse. Thanks so much. I am hoping to head into cardiac nursing so the more I learn now, the better :-)