Ateneo de Zamboanga University

COLLEGE OF NURSING
PERFORMANCE EVALUATION CHECKLIST

NAME: _____________________________________ DATE PERFORMED: _________________

YEAR & SECTION: ______________

ASSESSING AN APICAL PULSE

Definitions:
Apical Pulse is a pulse point on your chest that gives the most accurate reading
of your heart rate. It’s also called the point of maximal impulse (PMI) and the apex beat.

Purpose:
This can help your provider identify problems with your heart.

Legend (Rating Criteria):

5 – Expert (student performs all tasks proficiently and independently).
4 – Competent (student performs efficiently in an effective and efficient
manner).
3 – Progress Acceptable (performance is usually effective and but not always).
2 – Needs Improvement (progress in performance is too slow to judge
satisfactorily; task performance is not most of the time).
1 – Progress Unacceptable (no progress in performance has been
demonstrated, and or performance is consistently ineffective and inefficient).

PREPARATION
Assess:
• Clinical signs of cardiovascular alterations.
• Factors that might alter pulse rate.
Assemble equipment:
• Watch with a second hand or indicator
• Stethoscope
• Antiseptic wipes
• If using Doppler Ultrasound (DUS), assemble the
transducer probe, the stethoscope headset,
transmission gel, and tissues/wipes.
PROCEDURE 1 2 3 4 5
1. Introduce yourself and verify the client’s identity.
Explain to the client what you are going to do, why it
is necessary, and how the client can cooperate.
2. Perform hand hygiene and observe other
appropriate infection control procedures.
3. Provide for client privacy.
4. Position the client appropriately in a comfortable
supine position or assist to a sitting position. Expose
the area of the chest over the apex of the heart.

5. Locate the apical impulse.

Palpate the angle of Louis, just below the
suprasternal notch and felt as a prominence.
Slide your index finger just to the left of the client’s
sternum and palpate the second intercostal space.
Place your middle or next finger in the third
intercostal space and continue palpating downward
until you locate the fifth intercostal space.
 Move your index finger laterally along the fifth
intercostal space towards the MCL. Normally, the
apical impulse is palpable at or just medial to the
MCL.
6. Auscultate and count heartbeats.
Use antiseptic wipes to clean the earpieces and
diaphragm of the stethoscope.
Warm the diaphragm of the stethoscope by holding
it in the palm of your hand for a moment.
Insert the earpieces of the stethoscope into your
ears in the direction of the ear canals, or slightly
forward, to facilitate hearing.
Tap your finger lightly on the diaphragm to be sure it
is the active side of the head.
Place the diaphragm of the stethoscope over the
apical impulse and listen for the normal S1 and S2
heart sounds.
If you have difficulty hearing the apical pulse, ask
the supine client to roll onto left side, or the sitting
client to lean slightly forward.
If the rhythm is regular, count the heartbeats for 30
seconds and multiply by 2. If the rhythm is irregular,
count the beats for 60 seconds.
7. Assess the rhythm and the strength of the heartbeat.
Assess the rhythm of the heartbeat by noting the
pattern of intervals between the beats.
Assess the strength (volume) of the heartbeat.
TOTAL

________________________
Clinical Instructor
(Sign over printed name)