Help! Counting apical pulse A-Fib

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I'm a new grad and I recently started working in a nursing home. A resident has A-fib and needs loprressor and has parameters to hold if under 55. I had trouble counting her apical pulse because I do not hear a lub dub in the sense that all the beats sound the same and are spaced out much more than a regular lub dub. I'll hear two beats than three, than two than 4 and it's very irregular. I'm unsure if I count each beat I hear or if one sound is lub and the other is fun. Hard to explain the sounds but it's like beat...beat......beat...beat...beat....beat.....beat..beat....beat...beat... So the dots represent that the spacing is not even at all where normal hear best is lub dub..lub dub..lub dub. I never had the opportunity to have clinical on a cardiac unit and I'm just not sure how to count the beats in this situation. I'd really appreciate some help. My personal pulse ox gives me a very low pulse but I know this is incorrect and that I need to count the apical pulse for 1minute. I also noticed that if she sits up her heart rate will speed up greatly. Please help! Thanks!

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Because in atrial fib there is no lub but just uncoordinated irregularly-timed electrical signals (the atria are fibrillating), all you will hear apically (and feel with fingers on a pulse) is the dup, the ventricular response.

Which WILL be irregular, because the AV node is not letting through every last little uncoordinated and irregularly-timed electrical signal sent from the atria.

Listen for and count all the dups in a minute.

:)

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Thank you! I appreciate it.

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Also thanks for explanation that helps.

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