You’re preparing to administer a cardiac medication to Mr. Henderson, but before you do, you need to verify his heart rate. Instead of checking his wrist, you grab your stethoscope to listen directly to his chest for the apical pulse. This isn’t just a routine step; it is the most accurate way to ensure his heart is ready for that medication.
What is Apical Pulse?
The apical pulse (A-pi-kul) is the heartbeat heard at the apex of the heart, typically located at the fifth intercostal space on the left side of the chest, mid-clavicular line. Unlike a radial pulse taken at the wrist, this vital sign involves listening directly to the heart valves closing using a stethoscope. This measurement provides a clear, direct assessment of cardiac function.
Why Apical Pulse Matters in Your Daily Care
This is considered the “gold standard” for measuring heart rate because it detects rhythm irregularities that a wrist pulse might miss. Certain medications, such as Digoxin, can dangerously slow the heart rate. If you rely on a wrist pulse and miss a weak beat, you could administer a drug that causes cardiac arrest. Monitoring the apical pulse ensures resident safety and prevents medication errors that can be life-threatening.
What You’ll See During Your Shift
You will primarily check this during the “check before take” protocol for specific cardiac drugs or if a resident reports dizziness. You will place the stethoscope diaphragm over the landmark, listen for the “lub-dub,” and count.
“Nurse, I assessed Mr. Henderson’s apical pulse for one full minute before his Digoxin. It is 48 beats per minute and regular. That is below his parameter of 60, so I held the medication and notified you immediately.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Counting the apical pulse for only 15 or 30 seconds and multiplying. While this is acceptable for a healthy radial pulse, it risks missing irregularities or rate drops in the apical rate.
Pro Tip: Always count the apical pulse for a full 60 seconds (1 minute). This ensures you catch every single “lub-dub” and detect even slight irregularities (arrhythmias) that shorter intervals might miss.
Memory Aid for Apical Pulse
Think “Apical = Apex = Accuracy.” It is taken at the very tip (apex) of the heart to get the most accurate reading possible.
State Test Connection
This is a critical skill in the CNA clinical skills exam (Prometric/Pearson VUE). You will be graded on finding the correct landmark (PMI), using the stethoscope properly, and counting for a full minute.
Related Care Concepts
Monitoring the apical pulse connects directly to medication administration (specifically holding cardiac meds), arrhythmias (detecting irregular rhythms), and vital signs. It is also closely linked to blood pressure monitoring, as these two vitals often go hand-in-hand during cardiac assessments.
Quick Reference
✓ Landmark: 5th intercostal space, mid-clavicular line (left side) ✓ When to report: Rate below 60 or above 100, irregular rhythms, or skipped beats ✓ Care reminders: • Use the diaphragm of the stethoscope for a clear sound • Count for a full 60 seconds • Warm up the stethoscope with your hands before placing it on the resident’s skin • Check before administering specific cardiac medications like Digoxin
Listening to the heart directly takes a few extra moments, but it is often the most important minute you spend with a resident to protect their wellbeing.