رجل عمره ٧٤ سنة عنده رجفان أذيني ويأخذ ديجوكسين. يشتكي من تعب. الممرض وزميلته يعدّان النبض في نفس الوقت دقيقة كاملة: النبض الكعبري ٧٢ والقمي ٩٠، والإيقاع غير منتظم. ماذا يوثق الممرض؟

A 74-year-old man with atrial fibrillation on digoxin reports fatigue. The nurse and a colleague count simultaneously for a full minute: radial pulse 72 and apical 90, irregularly irregular. What does the nurse document?

1. A normal finding because the gap is under 20
2. Pulsus paradoxus of 18 on inspiration
3. A pulse deficit of 18
4. Sinus tachycardia requiring digoxin to be held now

Answer: C) A pulse deficit of 18. A pulse deficit is the apical minus radial rate counted simultaneously, meaning some beats do not reach the periphery; it is common in AF. It is documented and reported so rate control can be reviewed.