Do you have a heart?

Marie_LPN, RN, LPN, RN · Jun 5, 2004

That's because their heart isn't in the best of shape usually.

Good sealing eartips, and a non-cheaply-made stethoscope helps. When i mean cheaply made, i mean the super cheapo 5 dollars specials that you couldn't hear a train whistle through.

(BTW, your sig line is a little large)

moia · Jun 5, 2004

it is not necessary to listen at the chest for a heart beat...go somewhere else...try radial ..most eldely I can bet it's a dig patient have bounding radial pulses...if you absolutely must listen to their chest positioning can be everything..sit them up leaning slightly forward and go for the apex and move up.

Ask them to take a deep breath and hold it for a (silent) count of 5...breath sounds can muffle..for the really thick chested guys try listening from the back.

Sometimes feeling a radial pulse and then listening for the heart beat can help...you can also try listening over the sternum.

If they are bedbound turning onto their right side might help.

reddgott · Jun 5, 2004

LPN2b2004 It was a little large, sorry I was working on it. btw I just graduated in may myself.. congradulations.

reddgott · Jun 5, 2004

it is not necessary to listen at the chest for a heart beat...go somewhere else...try radial ..most eldely I can bet it's a dig patient have bounding radial pulses...if you absolutely must listen to their chest positioning can be everything..sit them up leaning slightly forward and go for the apex and move up.
Ask them to take a deep breath and hold it for a (silent) count of 5...breath sounds can muffle..for the really thick chested guys try listening from the back.
Sometimes feeling a radial pulse and then listening for the heart beat can help...you can also try listening over the sternum.
If they are bedbound turning onto their right side might help.

Wow you sound like my old nursing instructor, great tips. Its not dig though its Metaproprol or something like that, I'm still not that familiar with it, as I probly should be. I sound like a lousy nurse but I am brand new to this.

ChrisA · Jun 5, 2004

I sound like a lousy nurse but I am brand new to this.

Naw...you sound like a nurse who's learning. Lousy nurses don't sound like anything. They just go ahead and do things without questioning, without asking, and without wondering if they could be doing things better.

nursemike, ASN, RN · Jun 6, 2004

I was trying to get an apical on an older, heavier woman in clinicals, but all I could get were bowel sounds. When my instructor popped in to see how I was doing, patient told her, "He's playing with my boob." Patient finally took mercy and suggested I try [above her breast. Patient was a retired nurse.

reddgott · Jun 6, 2004

I was trying to get an apical on an older, heavier woman in clinicals, but all I could get were bowel sounds. When my instructor popped in to see how I was doing, patient told her, "He's playing with my boob." Patient finally took mercy and suggested I try [above her breast. Patient was a retired nurse.

nursemike? thats another male nurse issue. some elderly females get all uncomfortable with your hand moving around on thier chest with the bell. It sounds trivial, but it happens.

Another question I have is if it would be prudent to double check your findings with a pulse ox, just to see if you are hearing it right? How accurate are those things. It just makes me nervous to pass cardiac meds without 100% sureity that I heard an apical of say 64 or 62 when the parameters are hold if

rnmi2004 · Jun 6, 2004

I personally have never had a problem hearing the apical pulse, but I was wondering if anyone here knows why certain meds (like Digoxin) you are supposed to check the apical pulse. Why not the radial pulse? I know that there can be a pulse deficit, but how often is that a factor? Any input would be appreciated. TIA!

meownsmile, BSN, RN · Jun 6, 2004

Sometimes listening on the left lateral chest wall under the armpit even with the nipple line will work.

Jay-Jay, RN · Jun 6, 2004

Nursemike, one thing to remember about elderly females.....see cartoon for details! :D

Your instructor probably told you to search for the apical pulse around or below the left nipple, right? He/she never mentioned that gravity takes its toll over the years on us females! :rotfl:

psychnurse1998 · May 2, 2008

it is not necessary to listen at the chest for a heart beat...go somewhere else...try radial ..most eldely I can bet it's a dig patient have bounding radial pulses...if you absolutely must listen to their chest positioning can be everything..sit them up leaning slightly forward and go for the apex and move up.
Ask them to take a deep breath and hold it for a (silent) count of 5...breath sounds can muffle..for the really thick chested guys try listening from the back.
Sometimes feeling a radial pulse and then listening for the heart beat can help...you can also try listening over the sternum.
If they are bedbound turning onto their right side might help.

I think its very important to check an apical pulse. Many irregular pulses may be avaraged out in the radial pulse and you wont detect them. Also some of the heart sounds changes that dont take a cardiologist to know something is very wrong, would be missed. Diminshed heart sounds, could also be a sign of cardiac tamponade. I hope someone that works in a cardiac unit can correct me if I am wrong. I found a cd with abnormal heart sounds very informative, and helpful if one has to listen to heart sounds.