Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I'm going to demonstrate for you how to assess the apical pulse. So when you're assessing the apical pulse, you will need your stethoscope because we will be using the diaphragm of the stethoscope to assess the apical pulse and you'll always need to clean your stethoscope before you do this procedure, especially in between patients. So clean the diaphragm, the bell, and the ear pieces, and the tubing in between all your patients.
And you'll want to perform hand hygiene and explain to the patient what you're going to be doing. So what we're going to be doing is we're going to be assessing the apical pulse. You have to do this a lot of times before you give like those cardiac glycoside medicines like digoxin because we want the heart rate to be within a certain range, specifically for adults, 60 to 100 beats per minute.
Now, where do we find the apical pulse? We find it at the point of max impulse so where is that that is going to be found at the fifth intercostal space mid clavicularly and it's found where the apex of the heart is so if you take the heart and in a sense it's flipped upside down it's going to be at the bottom the apex so let me show you how to find that so first what we're going to do is we're going to position our patient by having them laid back you can have them set up slightly but laying back is the best and the first thing we want to do is we want to find our landmark So we can get to that fifth intercostal space midclavicularly, and it's going to be on the left side. So you want to find the sternal notch, which is right here, and it's true to its name.
It's a notch, literally, and it's found in between the clavicles right here. And then you're going to go down slightly, and you're going to feel this hump as you go down, a little protrusion. And this is called the angle of Lewis, also called the sternal angle.
Then it goes a little bit slightly left. from there and you're going to be at the second intercostal space. So it's a great way to start finding your intercostal spaces. So you're going to feel in between and you should be in between two ribs and we're going to go mid clavicularly. So midway where the clavicle is.
So about right here. And we're just going to find our way down to the fifth intercostal space. So we're at the second. So we're going to feel a little bit. Here's the third.
I'm going to go a little bit more. Here's the fourth. the fourth and then here's our fifth so right here now here's some tips women who have very large breasts you're going to have them lift their breasts so you can get underneath this area because you cannot listen through thick tissue and be able to hear the apical pulse appropriately so you will have to have them assist you with that now once you find it you're just going to feel with your hand the pulsation it should be a very light thumb thumping sensation.
Now this cannot be felt on all patients. Patients who have very large chest, obese, you may not be able to feel it. So don't be alarmed if you can, but patients who have thin chest walls, you can feel it and I can feel it on this patient.
Now, after you do that, get your stethoscope ready and you're going to be again using the diaphragm of the stethoscope and we are going to be listening. for one full minute to each beat. We're going to count them and we're going to see what his apical pulse is.
And his apical pulse was 61. And remember we want it between 60 to 100 beats per minute in an adult. Okay, so that is how you assess an apical pulse. Thank you so much for watching and don't forget to subscribe to our channel for more videos.