Questions about counting apical pulse

[Amcanarn]

My health assessment course doesn't begin until January, but I was wondering how skills, such as counting pulse, are graded? If you don't count pulse exactly as is are points taken off? I'm already practicing with my stethoscope, since I'm in an accelerated program. I wasn't expecting it to be so tough. I have the Littmann Cardiology III steth, and hearing doesn't seem to be much of a problem. It's just keeping up with counting.

[LadyFree28, BSN, LPN, RN]

In my health assessment course, we were graded on a focused assessment; not just a specific part of the assessment. It's not just the general assessment pieces in fundamentals, like apical, lung sounds, bowel sounds it's learning how, for example: to listen for fremitus in the respiratory assessment; how palpate the lymph nodes and thyroid in the ENT assessment; whether you can feel the spleen or able to palate the liver in a GI assessment; in the neuro assessment how specific cranial nerves are tested; reflex testing for the musculoskeletal system to determine whether it's neuro based.

It's much deeper, focused, and complete.

[LoriRNCM, ADN, ASN, RN]

Apical is a one minute count. In that nickel sized area mid clavicle line below left breast. Practice on someone and you will know where to find it.

[rubato, ASN, RN]

All of our skills were pass/fail. No points taken off, just had to retest. I think we were allowed 2 or so beats off from our instructor.

[Caribbean Character]

We were taught it is mid clavicle at the 5th intercostal space (above the left nipple). It was pass/fail and we had to be within 2 beats of the instructor's count.

[i♥words]

All of our skills were pass/fail. No points taken off, just had to retest. I think we were allowed 2 or so beats off from our instructor.

The skills at my school are pass/fail as well. We aren't told how "off" we can be, but from what I've heard, most of the instructors allow a couple of chances to complete a skill correctly.

[Amcanarn]

Thanks guys! I like to know about what to expect ahead of time. I'll try to get lots of practice. I'm worried about counting the apical pulse on an infant, ahhh... their little hearts go so fast!

[akulahawkRN, ADN, RN, EMT-P]

Usually the heart generates two distinctly different tones. When you listen to the heart, listen for the tones produced by that heart and pick one. Then count that specific tone for one minute. Something that's a little more advanced is to listen to the apical pulse and feel the radial pulse. I count the apical pulse and keep a mental track of how many of those beats were "dropped" at the radial pulse site. I might hear 83 apical pulse beats and note that 4 radial pulses were dropped in that same minute for a pulse rate of 79.

As to counting really fast beats, I just count to 10 and use my fingers to note how many 10 counts were heard. So if I heard 146 beats, that's 14 counts of 10 on my fingers plus another 6. Easy-peasy! About the only time I have trouble counting beats is if it's >200 beats/min.