Chapter 4 – Cardiovascular System Show Auscultation of the apical pulse involves assessing the rate and the rhythm. This is best done at the apex, which is landmarked at the 5th intercostal space (for adults) and the 4th intercostal space (for children) at the left midclavicular line. See Figure 4.7. Figure 4.7: Location of apical pulse Illustration by Hillary Tang from https://pressbooks.library.ryerson.ca/vitalsign2nd/chapter/apical-pulse/ (image was cropped and illustrated upon for the purposes of this chapter) Auscultation of the apical pulse involves the following steps (see Video 4.8): 1. Keep the client in a supine position and continue to drape.
2. Cleanse the stethoscope. 3. Physically landmark the location of the apical pulse. 4. Place the diaphragm of the stethoscope at the correct location with a complete seal. 5. Count the rate for one minute and report beats per minute.
6. Note the rhythm (e.g., regular or irregular rhythm).
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7. Note the findings
See Audio 4.1 to listen to a normal apical pulse. Listen for the “lub dub.” And then listen again, and count the pulse and report the beats per minute. (Find the answer at the bottom of this page) Audio 4.1: Normal apical pulse (Attribution statement: taken from https://wtcs.pressbooks.pub/nursingskills/chapter/9-3-cardiovascular-assessment/) Video 4.8: Auscultation of apical pulse ANSWER: The apical pulse rate in Audio 4.1 is 64 beats per minute. Notify the physician/nurse practitioner if a client has an irregularly irregular rhythm and is showing signs of bradycardia or tachycardia. Additionally, a pulse deficit is of concern because it is suggesting that the heart is not perfusing the periphery. Thus, you should perform a full cardiac assessment. Unless the client is showing signs of clinical deterioration and requires prompt intervention, you should first complete a full cardiac assessment so that you can provide a full report of the relevant cues and share recommendations for actions. Activity: Check Your UnderstandingWhy would you take an apical pulse instead of radial?Doctors believe that taking the apical pulse (the pulse site over the apex of the heart), rather than the radial pulse, is the most accurate, non-invasive way of assessing cardiac health. The apical pulse provides information on the heart's count, rhythm, strength, and quality.
Who should have an apical pulse taken instead of a radial pulse?Apical pulse is preferred in cases when the radial pulse is difficult to palpate, when the pulse is irregular, greater than 100 beats per minute, or less than 60 beats per minute when measured by other means (electronic, radial, etc.).
Under which circumstances is the apical pulse checked?The apical pulse is best assessed when you are either sitting or lying down. Your doctor will use a series of “landmarks” on your body to identify what's called the point of maximal impulse (PMI).
What are three reasons that the nurse would obtain an apical pulse?Conditions that require assessment of the apical pulse include digitalis therapy, blood loss, cardiac or respiratory disease, or other conditions that affect oxygenation status.
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