Am I an idiot? Should I give up?

[mialander]

In my 2nd year of clinicals & I have not come across any patients with irregular heart beats until today. My patient had atrial fibrillation and it was difficult for me to count the apical correctly. The beats were so irregular and fast. I got it wrong - twice.

1. how do you count an apical in this situation?

2. am I an idiot and should I give up nursing?

[SubSippi]

If a patient is in afib and is getting digoxin, they should be on telemonitoring. When someone is hooked up to that kind of monitoring a machine counts the beats. I have had lots of afib patients and have never been depended on to get the rate, that's ridiculous.

[adjappleton]

How do you keep track of time with your eyes closed, or do you check the time when your start and then whenever you stop, note the time and recalculate as needed for rate? I definitely agree closing your eyes or staring off into space helps your hearing (or whatever sense) focus!

[SaoirseRN]

The trademark of afib is that it is irregularly irregular and your instructor very well could get a different reading. Watching a patient who is monitored and in afib, their heart rate can very greatly by the second. If it is THAT rapid that you can't count, they will need medication regardless of whether you counted 100 or 120.

[ChristineN, BSN, RN]

If a patient is in afib and is getting digoxin they should be on telemonitoring. When someone is hooked up to that kind of monitoring a machine counts the beats. I have had lots of afib patients and have never been depended on to get the rate, that's ridiculous.[/quote']

Just because someone has baseline afib and is on Digoxin PO is not a good reason to have someone on tele. Many of these pts have been on Digoxin for years at home. If they are not in the hospital for a cardiac reason they could very easily be on a non-tele unit

[veggie530]

Yes, my instructor listed with her stethoscope at the same time. Afterward, she just looked at me blankly like I was mentally challenged and did not discuss it further for the rest of the day.

Two of my fellow students also listened to the same patient and got around the same apical pulse # as me, so their count was also off by 20 bpm. It was important because the pt was getting digoxin. I understand it's something I should be able to do but having never heard that kind of heart beat before, I haven't really been able to practice.

Who cares? Keep listening to heart beats and tell your teacher to take the stick out of her nose. After she's done with you, of course.

[OCNRN63, RN]

A cardiologist taught me to tap my foot in time with the beats when I'm counting an apical pulse. Just focusing on moving my foot helped me to catch each pulse more accurately.... try it, it may work for you also.

​I was just going to say that I used to tap my foot or my finger along with the beat; it worked for me.

[Lev, MSN, RN, NP]

You aren't an idiot. A fib can be very fast and it is irregular. So harder to count. Practice counting peripheral pulse (radial) first and then move to apical. Closing eyes helps.

[SubSippi]

Just because someone has baseline afib and is on Digoxin PO is not a good reason to have someone on tele. Many of these pts have been on Digoxin for years at home. If they are not in the hospital for a cardiac reason they could very easily be on a non-tele unit

So if someone who has this condition is in the hospital with someone non-related, they don't need to be tele monitored? I guess I feel like anyone with an arrhythmia might as well be monitored, but I'm new, so everything feels like a big deal.

Why would someone with baseline afib need their atrial pulse counted with each assessment? It seems like it's likely to not be very accurate, or that if accuracy was really important they would be on tele.