Checking HR before Giving Digoxin

[cat2007]

Hello - I am a second year nursing student (ADN). In clinical we are to check the apical HR with our stethoscopes before giving Digoxin. I work at a hospital as a nurses aide and the nurse went by the HR recorded on the BP machine.

I was just wondering if this is ok. Thanks for your advice. I have learned so much from reading this forum.

[Pheebz777, BSN, RN]

what about tele-monitors? are they as reliable as taking a patient's apical?

[UM Review RN, ASN, RN]

what about tele-monitors? are they as reliable as taking a patient's apical?

If it's a machine, it can make mistakes. I've seen patients Code while they were pacing to the monitor. I've heard of monitors that were labelled wrong. And there are lots of reasons that you need to actually listen to the patient's heart, regardless of whether or not you're counting the beats.

Besides, after you do this a few thousand times, you can auscultate the heart and make an educated guess as to the rate and sometimes even the rhythm. Murmurs, clicks, rubs and so forth are important to add to your assessment if you know how to do it, and in some cases, hearing a new murmur could actually save someone's life.

[HappyNurse2005, RN]

And there are lots of reasons that you need to actually listen to the patient's heart, regardless of whether or not you're counting the beats.

yeah, i hope you're not implying that soemoen looking at the monitor for heart rate doesn't actually ever listen to the pt's heart. It's pretty common sense that we need to listen to the heart.

[UM Review RN, ASN, RN]

yeah, i hope you're not implying that soemoen looking at the monitor for heart rate doesn't actually ever listen to the pt's heart. It's pretty common sense that we need to listen to the heart.

I never assume that a new nurse has "common sense" because the poor dears are usually too overwhelmed to think straight.

[Skynet]

I'm wondering why isn't a radial pulse sufficient? It's less intrusive and less time consuming.

[kaliRN]

op, i always check an apical and you've already heard from the wise as to why. i just wanted to add, as a new rn, i find myself doing things "by the book" - that is in line with best practice and the p&p of the facility. a seasoned rn may do things differently because of their experience. the nurse you saw give dig using the bp machine's data could have counted an apical during an earlier assessment and found it in line with the monitor, thus feeling confident it was accurate. maybe its just her practice. either way, i think there's an important distinction between learning from the wisdom of an experienced rn and practicing as one. nurses develop bad habits and it can be hard to distinguish when it is one when you are new to nursing. further, i can't complete an assessment in the time or the manner that someone with 20 years of experience can. i haven't listened to as many hearts or seen as many similar clinical presentations. i hope we would have the same data set and follow the same plan of care at the end of the day - but my best chance at achieving that is to do things systematically, thoroughly, and honestly. i think by thinking critically about why you saw a gap in a practice standard, you caught onto something important for your patient's safety :)

originally posted by angie o'plasty:

"i never assume that a new nurse has "common sense" because the poor dears are usually too overwhelmed to think straight."

i really needed the laugh i got from this, truer words were never spoken. praise be for the shared wisdom here, for the support of others, and for our inexplicable moments of clarity.

skynet: i believe if you read through the previous posts you'll find several answers to your question. there is a great deal of critical assessment data you must listen to obtain. plus, as angie o'plasty mentioned digoxin is often prescribed for a-fib, the hallmark irregularity can also be a ticket to a pulse deficit.

[meadowsong, ASN, RN]

Like others have mentioned, I always do an apical pulse for a full minute. After all, it only takes a minute Plus, it can be interesting to listen to those irregular heart rates.