Nursing & Healthcare Programs

Measuring the Apical Pulse

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

The apical pulse rate is the most accurate non-invasive measurement of heart rate because it is measured directly over the apex of the heart. Apical pulse is preferred in cases when the radial pulse is difficult to palpate, when the pulse is irregular, greater than 100 beats per minute, or less than 60 beats per minute when measured by other means (electronic, radial, etc.).

Measuring the Apical Pulse

  1. Gather your supplies:
    • Gloves
    • Stethoscope
    • Clock or watch with seconds displayed, or a second hand
    • Alcohol swabs
  2. Introduce yourself to the patient, perform hand hygiene, and clean the bell of the stethoscope with an alcohol swab.
  3. Ensure patient privacy by closing the curtain or door.
  4. The patient should be sitting or lying supine. Adjust the bed covers and/or the patient’s clothing so that the sternum and left side of the chest are exposed.
  5. Place the bell of the stethoscope at the fifth intercostal space, at the left midclavicular line. This is the location of the apex of the heart.
    • To find the correct location, first locate the sternal notch at the top of the sternum. Directly beside this is the second intercostal space. Count down three more to reach the fifth intercostal space.
    • The midclavicular line is an imaginary line drawn straight down from the middle of the clavicle (in this case, the left clavicle).
    • Place your stethoscope where the imaginary line and the fifth intercostal space intersect. This is generally just below the breast tissue.
    • It is kind to warm the stethoscope in your hands before placing it on the patient to avoid an unexpected chill.
  6. Listen for the “lub-dub” of normal heart sounds. These are the S1 and S2 heart sounds. You may need to adjust your stethoscope a bit to the right or left, or down to the sixth intercostal space to account for normal anatomical variances or serious heart disease.
  7. Once you regularly hear the pulse, note the second and begin counting the beats (“lub” or “dub”, not both, as they are parts of the same beat), for one full minute.
  8. Observe if the pulse rhythm is regular or irregular, such as occasionally or regularly skipped beats or delays between “lub” and “dub” on some beats.
  9. Replace the patient’s clothing and bed covers.
  10. Perform hand hygiene and clean the bell of your stethoscope with an alcohol swab.
  11. Document the pulse rate and pattern in the patient’s record, and inform the nurse of any rate or rhythm abnormality or significant change from the previous measurement per institutional or unit protocol.

Amanda R. McDaniel, MS, BSN, RN

References

Fetzer, S. J. (2014). Vital signs and physical assessment. In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 81-85). St. Louis, MO: Mosby Elsevier.

More Resources

Measuring the Respirations

Respiration is a vital sign that is measured frequently in the healthcare setting. Taking this measurement requires no equipment and relatively little time. However, it is a measurement that must be taken accurately, as a change in respiration may indicate the worsening of a patient’s condition.

Moving the Resident from a Bed to a Stretcher or Gurney

Moving a patient from a bed to a stretcher can pose huge safety risks to both the patient and to the health care workers completing the transfer. Always use the appropriate amount of people to complete a transfer, which may vary according to the patient’s weight and/or the facility’s policy. In some cases, a mechanical lift may be needed.

Handwashing for CNAs

Handwashing is considered the single most important practice to prevent the spread of infection. Even when hands look clean, they could potentially be crawling with dangerous microorganisms and pathogens. Using soap and friction during handwashing helps loosen the oils on the skin, allowing dirt and pathogens to be rinsed away.

person wearing orange and white silicone band

Applying Restraints

Restraints have very strict guidelines for use due to the number of complications that can result. Use of restraints is associated with increased physical and psychosocial health issues. Restraints are only considered necessary when restraint-free alternatives have failed and the patient or others are at risk of harm without the restraints. It is illegal to use restraints for the staff’s convenience or to punish the patient.

Making an Occupied Bed

If a patient is bedridden or on bedrest, the bed linens will need to be changed while the patient is in the bed. For safety reasons, the nurse’s aid should avoid making an occupied bed if the patient is able to get out of bed. Bed linens should be changed according to the facility’s policy or anytime they are wet or soiled.