This document provides instructions for assessing pulses and reflexes during a physical examination. It describes taking pulses in the radial, femoral, and apical locations and counting for different time periods based on the patient's age. Reflexes should be tested at the biceps, brachioradialis, triceps, patellar, tibialis posterior, and Achilles tendons by tapping with a reflex hammer while the muscle is placed in slight stretch. Reflexes should be graded on a scale of 0 to 5 based on their intensity and presence of clonus.

2.  Observer should note its intensity,
rate, rhythm, and if any blood vessel
tenderness, tortuosity, or nodularity
exists.
 A satisfactory pulse can be taken
radially in children older than 2 yrs old
 In infants and younger children
the apical pulse is more reliable
 Count the pulse for 1 full minute in
infants and young children b/c of
possible irregularities in rhythm
 When frequency apical pulses are
needed, use shorter counting time
(15-30 sec intervals)
 Compare radial and femoral pulses at
least once during infancy to detect the
presence of circulatory impairment,
such as coarctation in the aorta.

4. A reflex is a motor response to a sensory
stimulation that is used in an assessment to
observe the integrity of the nervous system. They
elicit a muscle contraction when the muscle's
tendon is stimulated.
The patient should be relaxed. The muscle should
be placed on a slight stretch. A reflex hammer taps
the tendon with an anticipated immediate
response. Both sides of the body should be
assessed. Reflexes can be graded as normal,
exaggerated, or depressed, or no a scale of 0-4.
Biceps Tendon
Brachioradialis Tendon
Triceps Tendon
Patellar Tendon
Tibialis Posterior Tendon
Achilles Tendon

5. 0 absent reflex
1+ trace, or seen only with
reinforcement
2+ normal
3+ brisk
4+ nonsustained clonus (i.e.,
repetitive vibratory movements
5+ sustained clonus