Do you have a heart?

[reddgott]

what a teaser! but seriously, why is it that every resident that requires an apical pulse before given certain meds, is the hardest beat to find out of all the residents in the unit. i can walk up to any resident and place the stethascope pretty much on the money, hear a loud lub-dub all day. but the one that must be heard is the stubbornest to find. i know interstitial spacing and blah blah blah, but c'mon why? any tricks or tips would be wonderful.

[psychnurse1998]

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.

Great post Mike. I kept telling myself by the left nipple, must be below. I better try above and maybe the heart sounds wont be so diminshed. Over the years my assignments have been mostly male patients so it has not been a problem.

[psychnurse1998]

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:

Thanks Jay jay,...darn law of gravity, gets me every time. Super man defied the laws of gravity, and I guess wonderwoman did too,..no wonder i was confused. But still for clarity, on a younger woman, is the pulse clearer above the breast also, or does it vary?

[Virgo_RN, BSN, RN]

I like Erb's point.

[blueheaven]

why is it that every resident that requires an apical pulse before given certain meds?

The reason for this is that sometimes pts will have atrial fibrillation (irregular heart beat) and not all the beats that you hear apically will cause a pulse wave radially so you need an accurate heart beat count before giving certain meds which may be controlling the irregular beat....Hope this helps!!!!!!!!