Assessment: Pulse Rate – Apical Pulse

Equipments:

• Watch with a second hand
• Alcohol swab
• Stethoscope
  

Nursing Procedures:

1. Raise patient's gown to expose sternum and left side of chest
2. Cleanse earpiece and diaphragm of stethoscope with an alcohol swab
3. Put stethoscope around your neck
4. Position patient on left side and locate suprasternal notch
5. Palpate second intercostals space to left of sternum
6. Place index finger in intercostals space and counting downward until fifth intercostals space is located
7. Move index finger along fourth intercostals space left of the sternal border and to the fifth intercostals space, left of the midclavicular line to palpate the point of maximal impulse, see picture
8. Keep index finger of nondominant hand on the PMI
9. Inform the patient that you are going to listen to his/her heart and instruct him/her to remain silent
10. Put earpiece of the stethoscope in your ears with dominant handa and grasp diaphragm of the stethoscope in palm of your hand for 5-10 second
11. Place diaphragm of stethoscope over the PMI and auscultate for S1 and S2 to hear lub-dub sound, see picture
12. Identify the regularity of rhythm
13. Count lub-dub sound as one beat while looking at second hand of watch. For a regular rhythm count rate for 60 seconds, while for an irregular count it for a full minute and noting number of irregular beats
14. Record by site the rate, rhythm and number of irregular beats