How to Take the Pulse of a Patient With Parkinson's Disease

Parkinson's disease (Parkinson disease, PD or paralysis agitans) is a progressive, degenerative disease of the brain that affects approximately one in 100 individuals above age 60. The typical symptoms of Parkinson's disease are resting tremor, rigidity, bradykinesia (slow movement) and postural instability. You need extra care if you have to take the pulse rate of a patient with Parkinson's disease. It might be difficult to extend the forearm because of rigidity, and the tremors may make the counting of the pulse rate confusing.

Things You'll Need

• Digital wristwatch or analog wristwatch with a second hand
• Stethoscope (optional)

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Instructions

• 1

  Position your patient properly. You may ask your patient with PD to sit on a chair or to lie in bed, whichever is more comfortable.

• 2

  Identify the hand with less tremors. The classic pill-rolling tremors seen in Parkinson's disease involve both upper extremities, but the involvement is usually asymmetric. Take the pulse rate from the less affected side.

• 3

  If your patient is seated, position the preferred forearm on an adjacent table. If your patient is lying in bed, sit on an adjacent chair and gradually pull your patient's forearm toward you.

• 4

  Rest your patient's forearm on a small pillow or on a part of his body. This is because a floating, extended arm will worsen the tremors of Parkinson's disease.

• 5

  If the elbow joint is rigid, use one hand to grasp the wrist and your other hand to support the elbow when positioning the forearm. This will prevent an unintentional injury when you take the pulse of a PD patient.

• 6

  Pinpoint the radial pulse. Using the pads of your index and middle fingers, locate the point of strongest pulsation on your patient's wrist. The radial artery is located on the same side of your wrist as your thumb.

• 7

  Compress the radial artery using your two fingers. Exert just enough force so that you can feel the strong pulsation with every heartbeat. Don't press too hard; you don't want to obliterate the radial pulse.

• 8

  If the rhythm of the pulse is regular (i.e., like the cadence of a marching army), count the number of pulsations for 15 seconds. Multiply the number of pulsations by 4. The product is your patient's pulse rate per minute.The normal pulse rate is 60 to 100 beats per minute.

• 9

  If the rhythm of the pulse is unusually fast or slow, count the number of pulsations for 60 seconds. There is no need for a multiplier; this is the pulse rate per minute.

• 10

  If the rhythm of the pulse is irregular (i.e., there are skipped beats), don't rely on the patient's radial artery pulsation. Using your stethoscope, listen to your patient's heartbeat through his chest for 60 seconds to determine the heart rate. Otherwise, you might miss the irregular beats.