Anyone doing Apical/Radial anymore?

[renerian, BSN, RN]

I think one person can do it alone to find an initial problem. I have seen Drs do it all the time alone. Tell me when you can actually get two nurses at the patients bedside or in the home? LOL. Sorry Medicare does not cover that!

Maybe two is the optimal way in certain settings but I don't think it has to only be done that way. I have picked up many times variations, called the docs attention to it and they assessed it and prescribed an intervention. You can quickly identify an apical to radial difference. JMHO

renerian

[nimbex, RN]

Not 2 person, but with irregular rhythm (we have monitors), I do feel the radial as I listen, in the case above, good point, should do with everyone... thanks

[Ortho_RN]

We do it.. And yeah they do teach it in nursing school.. I actually did it today with my patient... Me and a classmate listened... And we were doing it to check the irregular rhythm...

[KP RN]

Let me clarify, I routinely feel for the radial pulse, and at the same time listen to the apical. I don't have another nurse do it with me however!!

I can't remember the significance of the widening pulse pressure (the difference between systolic and diastolic B/P)...but doesn't it have to do with increased intracranial pressure?? Can someone refresh me on this??

You know, I turned 40 recently and the memory isn't as good as it used to be!! teeheehee!

[Hellllllo Nurse, BSN, RN]

Thanks, Boggle.

I saved your reply, and I will be digging out my books to read up on this.

[jmeidl, LN]

Let me clarify, I routinely feel for the radial pulse, and at the same time listen to the apical. I don't have another nurse do it with me however!!

I can't remember the significance of the widening pulse pressure (the difference between systolic and diastolic B/P)...but doesn't it have to do with increased intracranial pressure?? Can someone refresh me on this??

You know, I turned 40 recently and the memory isn't as good as it used to be!! teeheehee!

You are refering to part of cushings triad. The widening pulse pressure is part of the the compensating for changes (usually increasing ICP). The other two are the drop in pulse and irregular respirations.

[jmeidl, LN]

Helllllo Nurse, ( did I miss an l??), pulse pressure is the differnce between the systolic and diastolic pressure

The Apical/Radial assessment must be done with 2 people. At the same time, one nurse counts apical and one nurse counts radial for a full minute. If the radial rate is lower than the apical rate, the number of beats difference is a the pulse deficit. ( apical 80, radial 78 = pulse deficit of 2.) Yes, it indicates perfusion problems.

I don't see how you can do this technique/assessment alone.

But, I also have OFTEN checked a radial as I have listened to an apical and noted beats that did not perfuse to the wrist. That is different than the A/R assessment.

I'm trying to determine if the full minute, 2 person A/R assessment described above is still being done in the real world. If so, when and why and in what setting?

This is still being taught in nursing schools. The students that I see struggle with this...not with the concept or the significance of the findings, .....but with the actual synchronizing of the timing and counting apical and radial rates.

So, what do you all think???

When I am doing a pulse I always feel the radial and listen for the apical. If I hear a heart tone but no corresponding radial there is a problem in perfusion. I find this alot with afib with a rapid ventricular response. I do this solo and let the MD know with a full set of vital signs.

[canoehead, BSN, RN]

Never do it.

[pagandeva2000, LPN]

I remember this subject in school (fundamentals of nursing) but forgot what it pertained to. In addition, I have not seen it EVER in practice. Maybe it is done somewhere, but I have not seen it.

[WalkieTalkie, RN]

That's what my radial art line is for

[RNperdiem, RN]

I very vaguely remember something like this in nursing school.

In daily practice, the patients are on heart monitors that give you a good look at heart rate and rhythms.

My assessment always includes checking all peripheral pulses(important in trauma patients).

[Roy Fokker, BSN, RN]

Monitors are nice but the monitor that lies between your ears is the one you should trust

I always palpate a peripheral pulse while my stethoscope is listening in on the apical. Always. It's part of my "quick primary" assessment.

cheers,