How do you count an apical hr in infants?

TexasPediRN · Nov 9, 2005

Try soothing the infant while you listen. Talk to the baby but still listen to the heart sounds.

Make sure you can see your watch while you are counting. I either put my arm over them so they dont go anywhere, or right above their head. Its hard when they are squiming/crying but do your best, and if you need to do it again, its ok. If mom/dad questions it, just tell them how babys squim and wiggle and you want to get a proper heart rate.

When you count- I try not to listen to anything else, but i do look at the baby and make a few 'shhhh' sounds or "hellooo sweetie"..the eye contact helps as they can get mesmerized almost by it.

Counting itself: 1 2 3 4 5 6 7 8 9 10

2 2 3 4 5 6 7 8 9 10

3 2 3 4 5 6 7 8 9 10

By saying the first number (ie 3 for 30 beats) it can help you to keep track.

you will hear the lung sounds, and its the best way to count respirations! Ignore them when you listen to the apical, and ignore the apical when you listen to lung sounds. I promise its not as hard as it sounds.

I find it hard to count resps on a squirmy infant whose going all over the place, so if you take them when you listen for the apical, it works great and everything is done in that one step instead of 2.

I also recommend when mom and dad go out of the room- hop on it there and just practice!! Practice makes perfect, and you'll soon get it :)

Good luck :)

And dont worry about not being prepared for the NICU- if this is what you want to do, a hospital will train you for it. you are getting infant experience now, and thats great! You're also getting experience at working with staff, family members, etc. See how much you've done so far! Bet ya you dont realize how much you know/have done.

Editorial Team / Admin · Nov 9, 2005

Try soothing the infant while you listen. Talk to the baby but still listen to the heart sounds.
Make sure you can see your watch while you are counting. I either put my arm over them so they dont go anywhere, or right above their head. Its hard when they are squiming/crying but do your best, and if you need to do it again, its ok. If mom/dad questions it, just tell them how babys squim and wiggle and you want to get a proper heart rate.
When you count- I try not to listen to anything else, but i do look at the baby and make a few 'shhhh' sounds or "hellooo sweetie"..the eye contact helps as they can get mesmerized almost by it.
Counting itself: 1 2 3 4 5 6 7 8 9 10
2 2 3 4 5 6 7 8 9 10
3 2 3 4 5 6 7 8 9 10
By saying the first number (ie 3 for 30 beats) it can help you to keep track.
you will hear the lung sounds, and its the best way to count respirations! Ignore them when you listen to the apical, and ignore the apical when you listen to lung sounds. I promise its not as hard as it sounds.
I find it hard to count resps on a squirmy infant whose going all over the place, so if you take them when you listen for the apical, it works great and everything is done in that one step instead of 2.
I also recommend when mom and dad go out of the room- hop on it there and just practice!! Practice makes perfect, and you'll soon get it :)
Good luck :)
And dont worry about not being prepared for the NICU- if this is what you want to do, a hospital will train you for it. you are getting infant experience now, and thats great! You're also getting experience at working with staff, family members, etc. See how much you've done so far! Bet ya you dont realize how much you know/have done.

Good technique, MeghanRN. I also tap my index finger to keep up with the rapid heart rate. Cocentrate on the tapping and it helps to keep you accurate.

ZASHAGALKA, RN · Nov 9, 2005

I use a pulse oximeter as a double check.

~faith,

Timothy.

bethin · Nov 10, 2005

Thanks guys for your suggestions. I think I'll practice on my nieces--they're the queens of squirming. All of your ideas sound great. It never even crossed my mind to double check with a pulse oximeter. Thanks again!

bethin

prmenrs, RN · Nov 11, 2005

Get an infant or peds stethescope, so the business end isn't so big, you're picking up bowel sounds, too. Try to catch the baby sleeping, and sneak that stethescope under their shirts. Just tell mom and dad "this is harder than it looks!" but don't try to make them leave the room. Baby may cry harder, or they might not want to leave the baby. Also, they might be able to soothe the baby easier than you.

If the baby is active and playing, forget it, come back later. Ask Mom to let you know when the child is asleep. It may be easier to take your watch off and hold it so you can see it. I don't really like to wear watches, so I'm always craning my head to see the clock on the wall. Don't forget to wash your hands more when babies are around!

walkingrock, ADN · Mar 6, 2006

I agree you aren't likely to hear murmurs or irregular rhythms in 6 or 15 seconds, however, you can take a HR for several short sessions, and then listen at length at heart sounds. Most likely, if you can hear the murmurs or irregular rhythms, you have already mastered listening to and counting the HR. It is definitely an experience thing!!

kitty29 · Mar 7, 2006

Gosh I've never had a problem!

Tiny1Nisolet · Mar 7, 2006

Try soothing the infant while you listen. Talk to the baby but still listen to the heart sounds.
Make sure you can see your watch while you are counting. I either put my arm over them so they dont go anywhere, or right above their head. Its hard when they are squiming/crying but do your best, and if you need to do it again, its ok. If mom/dad questions it, just tell them how babys squim and wiggle and you want to get a proper heart rate.
When you count- I try not to listen to anything else, but i do look at the baby and make a few 'shhhh' sounds or "hellooo sweetie"..the eye contact helps as they can get mesmerized almost by it.
Counting itself: 1 2 3 4 5 6 7 8 9 10
2 2 3 4 5 6 7 8 9 10
3 2 3 4 5 6 7 8 9 10
By saying the first number (ie 3 for 30 beats) it can help you to keep track.
Yep, that's the way I do it as well. I have tried counting the heart rate various ways, but I have found this to be the best for me. Keep practicing and you will get it, dont worry!

prmenrs, RN · Mar 7, 2006

When I'm first trying to "isolate" the heart sounds, I often close my eyes till I "get" it, then find the clock to count. I only have to count the HR when I'm doing newborns; in the NICU, I'm just listening for murmurs. Use the monitor for the HR--make it easy, if possible!