Assessing an Apical Pulse

Purposes:
1. To obtain the heart rate of an adult with an irregular peripheral pulse
2. To establish baseline data for subsequent evaluation
3. To determine whether the cardinal rate is within normal range and the rhythm is regular
4. To monitor clients with cardiac, pulmonary or renal disease and those receiving medications to improve heart
action.
Equipment:
1. Clock or watch with a sweep second hand or digital seconds indicator
2. Stethoscope
3. Antiseptic wipes
Steps Rationale
Perform hand hygiene and observe
appropriate infection prevention procedures.
Introduce self and verify the client’s identity
using agency protocol.
Inform the client about the reason for the site
at which the pulse is measured
Provide for client privacy
Position patient appropriately in a comfortable
supine position or in sitting position.
Explain the normal range Allay fear and anxiety
Inform client to remain silent. Have the client
breathe through the nose
Cleanses the earpiece and diaphragm of the The diaphragm needs to be cleaned and
stethoscope with an alcohol swab disinfected if soiled with body substance. It
harbors pathogenic bacteria
Raises the clients gown to expose the sternum Minimal exposure
and the left side of the chest
Locate the apical impulse
 Palpate the angle of Louis
 Slide your index finger to the left of the
sternum and palpate the second
intercostal space
 Place your middle o next finger in the
third intercostal space until you locate
the 5th intercostal space
 Move your index finger laterally along
the 5th intercostal space toward the
MCL. Normally the apical impulse is
palpable or at just medial to MCL.
Warm the diaphragm of the stethoscope by The metal of the diaphragm is usually cold and
holding it in the palm of the hand for a can startle the client when placed
moment (5-10 seconds) immediately on the chest
Insert the earpiece of the stethoscope into This position facilitates hearing
your ears in the direction of the ear canals, or
slightly forward
Tap your finger lightly on the diaphragm This is to be sure it is the active side of the
head. If necessary, rotate the head to select
the diaphragm side.
Place the diaphragm of the stethoscope over Heartbeat is normally the loudest at the apex
the apical impulse and auscultate to hear the of the heart
S1 and S2 (lub-dub) sound. Each lub dub is considered as one heartbeat
The s1 heart sound (lub) occurs when AV
valves close after the ventricles have been
sufficiently filled.
The S2 heart sound (dub) occurs when the
semilunar valves close after the ventricles
empty

Starts to count while looking at the second A 60 second count provides a more accurate
hand of the watch (60 seconds) assessment of an irregular pulse.
 If you have difficulty hearing the apical This positioning moves the apex of the heart
pulse, ask the supine client to roll onto closer to the chest wall
his or her left side or the sitting client
to lean slightly forward
Assess the rhythm and the strength of the
heartbeat
 Rhythm by noting the pattern of
intervals between the beats. A normal
pulse has equal time periods between
beats
 Strength (volume) normally, the
heartbeats are equal in strength and
can be described as strong or weak.
Makes the client comfortable
Document the pulse rate and rhythm
Washes hands