How to Assess the Apical Pulse

Introduction

• Presented by: Sarah from RegisteredNurseRN.com
• Purpose: Demonstrate how to assess the apical pulse.

Required Equipment

• Stethoscope
  • Use the diaphragm of the stethoscope.
  • Clean all parts of the stethoscope (diaphragm, bell, ear pieces, tubing) before assessing each patient.
• Hand Hygiene: Important before starting the procedure.
• Patient Communication: Explain the procedure to the patient.

Importance of Assessing Apical Pulse

• Essential before administering cardiac glycoside medications like digoxin.
• Normal Range for Adults: 60-100 beats per minute

Locating the Apical Pulse

• Point of Maximal Impulse (PMI): Located at the apex of the heart.
• Location Details:
  • Fifth intercostal space midclavicularly on the left side.

Steps to Find the Apical Pulse

1. Position the Patient
   • Have the patient laid back slightly or fully.
   • Laying back provides the best access.
2. Locate the Sternal Notch
   • A notch between the clavicles.
3. Find the Angle of Louis (Sternal Angle)
   • A protrusion below the sternal notch.
4. Identify the Second Intercostal Space
   • Slightly left from the sternal angle.
5. Navigate to the Fifth Intercostal Space
   • Start at second space, move down through third and fourth to fifth.
6. Midclavicular Line
   • Align at the midpoint of the clavicle.

Considerations

• For women with large breasts, ask the patient to lift the breast.
• Difficulties may arise in patients with large or obese chests due to the thickness of the tissue.
• Thin chest wall patients are more likely to allow palpation of the pulse.

Measuring the Apical Pulse

• Use the diaphragm of the stethoscope.
• Procedure:
  • Listen for one full minute.
  • Count each beat.
• Example Measurement: Apical pulse of 61 beats per minute.

Conclusion

• Emphasize the importance of the range (60-100 bpm for adults).

Closing

• Encouragement to subscribe for more educational videos.