How to Take an Apical Pulse

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One of the primary measures of health used by practitioners is a patient's vital signs. Vital signs include temperature, blood pressure, respiration and pulse. Pulse can be measured by several different methods, including the radial pulse (the pulse taken on your wrist) and apical pulse (taken near your heart with a stethoscope). If a radial pulse is abnormal or seems to skip a beat, the apical pulse should be measured. The most reliable method of measuring pulse is by listening to the apical pulse. When assessing an apical pulse, the practitioner is able to reliably assess the rate and rhythm of the patient's heart rate.

Things You'll Need

  • Stethoscope
  • Watch with second hand or digital display
  • Provide patient privacy. Assist the patient to sit up or assume a semi-sitting position. Expose the patient's chest.

  • Examine the chest to find the anatomical landmarks for proper stethoscope placement. Locate the first intercostal space on the left side of the chest, which is the space between the first and second rib. Count down until you find the fifth intercostal space, between the fifth and sixth ribs. Draw a straight line from the nipple to the fifth intercostal space. This is where you will place the stethoscope head.

  • Use your hand to warm the stethoscope diaphragm, the flat disk side of the stethoscope. Place your stethoscope diaphragm at the previously designated place. Listen for the heartbeat. The heart beats with two distinct sounds (lub-dub). Each set of sounds (lub-dub) is one heartbeat.

  • Count the heartbeat for 60 seconds using your watch. While listening to the heart rate, note any discrepancies in rate or rhythm. At the end of that 60-second period, you have accurately measured the patient's apical pulse.

Tips & Warnings

  • Maintain a quiet environment while assessing apical pulse.
  • If assessing the apical pulse of a child, note that a child's typical pulse rate is faster than that of an adult.
  • Contact a physician if the adult patient's heartbeat is less than 60 beats per minute or greater than 100 beats per minute, or if there is any discrepancy in the heart rate rhythm.

References

  • "Fundamentals of Nursing, sixth edition". Patricia Potter, RN, MSN, PhD, CMAC, FAAN, et al.; 2005
  • Photo Credit Jupiterimages/Polka Dot/Getty Images Jupiterimages/Comstock/Getty Images
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