HELP!!! I can't COUNT the Apical Pulse!!

RNMBA · Sep 4, 2003

You don't have to worry about counting both sounds. The "lub-dub" of normal heart sounds is counted as one pulse.

The two normal heart sounds (S1,S2) together make up one cardiac cycle. The peripheral pulses are caused by cardiac systole which actually occurs between the two heart sounds. Counting the apical pulse is important because the heart may be generating pulses that are too weak to detect by counting peripheral pulses.

Like most of our clinical skills listening to heart sounds takes practice. It may sound easy in theory but you can hear a lot of strange sounds in someone's chest and it takes experience to know what you are doing.

kwagner_51 · Sep 4, 2003

Quote "You don't have to worry about counting both sounds. The "lub-dub" of normal heart sounds is counted as one pulse." Quote

RNMBA,

THAT is my problem. I count both of them!!! I know I'm not supposed to but I don't know how to stop myself. This is just soooo frustrating!! I practiced BP's until my kids ran screaming outta the room!! :)

When I got my stethescope out tonight to practice some more, they just looked at me with terror in their eyse!! :) Here comes their sadistic mother again!!

Ignore me! I'm tired and rambling.

Thanks again!

Jaggeddoll · Sep 4, 2003

I learned Apical last week and it made me nervous at first. I figured that I'd just count the pulse the way I felt worked best for me, and like you were saying it was "ah one ah two" etc. It works, and you DO sound like a doofus, but it works. You dont necessarily have to say it OUT LOUD :) Hope that was some help :) Good luck!!

Gen

Brownms46 · Sep 4, 2003

Originally posted by kwagner_51
Quote "You don't have to worry about counting both sounds. The "lub-dub" of normal heart sounds is counted as one pulse." Quote

RNMBA,

THAT is my problem. I count both of them!!! I know I'm not supposed to but I don't know how to stop myself. This is just soooo frustrating!! I practiced BP's until my kids ran screaming outta the room!! :)

When I got my stethescope out tonight to practice some more, they just looked at me with terror in their eyse!! :) Here comes their sadistic mother again!!

Ignore me! I'm tired and rambling.

Thanks again!

Tell them to save the terror looks for when you need to start practicing IV starts on them:D!

essarge · Sep 4, 2003

Your idea of being "Lawrence Welk" is a good one if you are having problems. Just count lub (one) dub (and).

If that doesn't work well, try taking the total and dividing it in half until you get the hang of it.

RNMBA · Sep 4, 2003

Originally posted by essarge
Your idea of being "Lawrence Welk" is a good one if you are having problems. Just count lub (one) dub (and).

If that doesn't work well, try taking the total and dividing it in half until you get the hang of it.

That's a good idea unless there are abnormal heart sounds. S3's and S4's would triple or even quadruple the number of sounds without increasing the number of cardiac cycles.

Don't stress too much about the learning. You will learn the same way we all did, one experience at a time.

Genista, BSN, RN · Sep 4, 2003

It sometimes helps to palpate the radial pulse as you listen to the apical pulse with the stethoscope. It'll be second nature after awhile.

LeesieBug · Sep 4, 2003

Yep, yep...I do the "one and two and three and" thing, focusing on the first beat I hear. Get a rhythm going in my head like I am counting CPR chest compressions. I am new at this, too, but this works well for me.

jenac · Sep 4, 2003

How about asking your instructor for help? Explain what your doing wrong, and get some extra help. We had extra labs after school several times for extra practice. If he/she has one of the teaching stethascopes, listen together and ask her to count out loud untill you get the hang of it. My OB instructer use to tap her finger in time to Peds apicals untill we all got the hang of it. :)

When you're listening, face down, and close your eyes-you'll hear better and be able to concentrate better.

Like everyone else has said-in time, it will be so easy. It just takes practice. Good luck.

Friendli · Apr 13, 2011

Thank you for posting this question- I have the same one! I thought I had gotten the swing of it but my instructor told me that the radial and apical should be the same! I yi yi! Thanks for all the responses too!