Stumped on a question pls help!

JustBeachyNurse, LPN · Jan 25, 2016

Who cares if he has an apical pulse if there is potential vascular compromise. Absent radial plus on right side after right shoulder surgery is emergent and may require a return to the OR ASAP.

natmanzo · Jan 25, 2016

Oh!! I guess it makes sense now. So because there is a risk for a blood clot you're going to want to check all sites?

guest769224 · Jan 25, 2016

You're performing a complete assessment to check and compare all pulse sites to that of the R radial. There is no indication the HR needs to be checked, as the other options list.

JustBeachyNurse, LPN · Jan 25, 2016

Yes. You are focusing on an issue lost/absent peripheral pulse in a limb that had surgical intervention. It's to compare also R v L. Not necessarily a clot but the artery could be compromised from the procedure, edema, compression etc. you were given an abnormal finding urgent in nature. You also need to assess cap refill, color, perfusion, pain, sensation,

natmanzo · Jan 25, 2016

Yes. You are focusing on an issue lost/absent peripheral pulse in a limb that had surgical intervention. It's to compare also R v L. Not necessarily a clot but the artery could be compromised from the procedure, edema, compression etc. you were given an abnormal finding urgent in nature. You also need to assess cap refill, color, perfusion, pain, sensation,

thank you so much! A lot of people in my class were confused by this as well. So let's say that there was no surgery. That he was just there for a routine check up. Would you just check the apical?

Editorial Team / Admin · Jan 25, 2016

thank you so much! A lot of people in my class were confused by this as well. So let's say that there was no surgery. That he was just there for a routine check up. Would you just check the apical?

Not necessarily. Yes, vitals are routine for an outpatient physical exam. However, is this radial pulse absence something new? What else is going on?

It's not the heart rate you need to be concerned about with the question from the book. It's an assessment- what is different, and why is it different? What interventions are needed? In this case, the patient's limb truly is at risk. Vascular flow is compromised, which is evident from the decreased/absent radial pulse. That vascular flow needs restored ASAP, and this is a finding the surgeon needs to be notified about immediately.

%D#2 · Jan 25, 2016

It's not apical pulse because this is not a matter of the heart per say, it's a matter of circulation getting to the affected arm. So to be honest I would have picked either 2 or 4.. Maybe I'd do 3 after to bilateral hands to compare 02 perfusion to arms and hands. But Ya wanna compare pulses because if they are not equal then blood is not being properly circulated

springchick1, ADN, RN · Jan 25, 2016

4. You need to assess all the pulses, especially in the upper extremities. There is no radial pulse but what about a brachial pulse? That's why 4 is the most correct.

JustBeachyNurse, LPN · Jan 25, 2016

thank you so much! A lot of people in my class were confused by this as well. So let's say that there was no surgery. That he was just there for a routine check up. Would you just check the apical?

Nope. The problem to focus on is absent radial pulse not absent heart rate

mrsboots87 · Jan 25, 2016

I was going through the questions in my potter and perry book and I got stumped on a question. So here it is: a pt returns to your post op unit following surgery on his right rotator cuff. The LPN reports she had difficulty finding his rt radial pulse. What is your best response?
1) assess pts apical pulse to optain HR
2) obtain HR from right and left radial sites
3) obtain HR using oximeter probe
4) perform a complete assessment of all pulses.
i chose 1 because it seemed like the most logical but the book says 4. When you can't find radial you check the apical by listening with your stethoscope. 4 is if they have problems with the peripheral vascular right?

One thing may help you in the future is not to focus on the vital sign you are assessing and getting that vital sign. You need to ask yourself "why am I doing this?" We don't assess the pulse just to get a number. There is a reason. In this case, the patient had a recent shoulder surgery. Assessing the pules distal to the surgical site will give information about blood flow to that limb. It's not for a medication or to assess cardiac. It is part of the vascular assessment of that limb.

If you are unsure of what exactly you are doing something for while testing, then use testing strategies. For one, why do we assess apical pulse to obtain the HR - to give a medication that is HR dependent usually. For two, why do you want the HR from both the L and R radial sites - we don't, because again you are not assessing HR at all. You are assessing the pulse. But this answer is at least closer to what you are looking for. For three, why would we obtain HR with a pulse ox - well for all kind of reason, but none have to do with this question because again, it is not the HR you want, but the pulse. Then you get to four, assessing all pulses. Ding. You want to compare all pulses to the one you can't find. Maybe multiple pulses are not palpable. You would want to follow up with that, but at least you are assessing the right thing.

AN

other test strategy is to find that which is different. Many times, if one answer sticks out like a sore thumb, it is likely correct. The first 3 answers address different way to obtain a HR. They are all similar. But 4 is different then the other 3. Because it is the correct answer.