infants apical pulse

[onduty23]

i am having a hard time taking newborns apical pulses. i start ok but then i get fuster around 15 secs in and lose my count because there heart rate is so fast. i am asking for help from experience ob nurses on trick of the trade. this is my only vital sign i struggle with.

[walkingrock, ADN]

I also shut my eyes to listen to murmurs. Another trick is to take a 6-sec HR and multiply by 10. I do this all the time. One should be aware of how regular or how "normal" the HR is at that time though, might take several different 6-sec rates and average them. I make an effort to take the HR without disturbing the infant as much as possible, preferably while sleeping, placing the stethescope over a t-shirt. Once they start crying it isn't possible to get an accurate HR. Can hold a pacifier in their mouth to calm though and then take it. Yes, it is preferable to take a 1-min HR, however in reality, I don't see that happening. It is especially difficult with an infant that may get squirmy and fussy during that long 1 min. In the NICU we have the luxury of seeing the HR on a monitor for comparison with the auscultated HR.

[elizabells, BSN, RN]

The other day I saw a doc (in NBN) tap his finger on the side of the bassinet and have the nurse count his taps. Gives you fewer things to try to focus on at once, I suppose.

[msittig]

Thanks for the tips! I start my OB rotation tomorrow and appreciate the help! I will def. use the 15sec rule!

[Justhere, BSN, RN]

When I'm doing infant heartrates, the other nurses tell me I bob my head. So I started paying more attention and I do I nod my head with every heartbeat. Usually will count for 15 secs x by 4. but continue to listen afterwards for anything abnormal.

[johj]

I manage an OB unit. The nurses there are expected to listen for one full minute when doing VS on newborns. That way they can assess for murmurs. I agree that closing your eyes can work, or tapping your finger. Tapping your finger is also a good practice to get into because when doing resuscitation, it is good to let others who are assisting count what the heartbeat is by looking at your finger. That helps them to know whether they need to continue or change their interventions.

Good Luck!!!!

[elizabells, BSN, RN]

What scares me is that some docs discharge babies home sometimes at

We just lost a baby in our NICU who had been born at an outside hosp, sent home from their WBN and brought into the ER a couple of days later acting really sick - turns out the baby had hypoplastic left heart. They rushed her down to us but they couldn't get her off bypass after the Norwood. How HLHS gets missed like that is beyond me, but hey, it was my first day as a nurse today, so I suppose it's possible.

[poodlehead]

worked in the nursery 12 yrs. toe tapping is great or use your index finger and move it up and down with each beat. The finger method, If you tend to a baby at a C-Section and you are working with another nurse and/or the neonatologist, it's a way of them knowing the rate as well.