Radial and Apical Pulse – Vital Signs (Nursing)

by Samantha Rhea, MSN, RN

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00:00 Let's take a look of how we obtain a radial pulse. This is going to be the most common method of how we obtain a pulse from a patient. So if you take a look at this image here, we've got the client's palm facing up. Now, we're going to place the pad of our index finger in either 2 or 3 fingers between the client's wrist bone and the tendon on the thumb side of their hand. So if you take a look at that image, if you think about thumb side, that will give you a good reminder for the direction of where you want to place your fingers. Now, we're going to apply light pressure until you can feel the client's heartbeat. This is a really important point here that we do not press to the point where you can press the client's artery and restrict blood flow. Also, if we compress too hard, we may no longer be able to feel that client's pulse. Another little tip here, many times when you go to palpate a pulse, sometimes students will put their fingers kind of here. If you will do it more flat, that will help you find and palpate that pulse a little bit better. Now, once we find that pulse, you can use the second hand of your watch or a clock and you can count how many times you feel the pulse in 30 seconds and then just multiply by 2. This is going to calculate the number of beats per minute, BPM, or the heart rate, HR. So when you document you may see BPM as beat per minute or HR for heart rate. It's the same thing. Then, we're going to document the pulse rate. Just to note that if you're palpating a patient's pulse and the rhythm is not regular, key point that you want to count for a full minute. This makes a lot of sense.

01:51 Right? Because if it's going tik, tik, tik, tik, tik, tik and then it's irregular, then if we don't count for a full minute we're not going to get an accurate pulse rate. Let's take a look today of how we take a radial pulse for our patient. So this is one of the most common methods in the way that we obtain a heart rate. It's noninvasive and the access to the patient's radial pulse is much easier and very easy to find for nursing students. This is something that you can practice at home either with the peer or a family member just to get a little practice with this, but this is a common assessment that we're going to use. So when I take a radial pulse, I'm going to have my client's palm here facing up. So, it's just whatever you're comfortable with but I usually take my index finger and until you get used to finding that pulse, you can either use 2 or 3 fingers. Now, here's where we place it. Always remember that you're going to do this between the wrist bone and the tendon of the patient's arm. And it's going to be on the thumb side. So it's a very easy cheat to remember thumb side for radial pulse. So when I go ahead and obtain my radial pulse, I'm going to take 2 or 3 fingers and if you're having a little trouble finding the pulse you may start with 3. Once you get used to that, just 2 would work as well. So once I find my pulse, here is the key on this that many times as nursing students or when you're new to this skill that may happen. You want to make sure you apply light pressure until you feel the patient's pulse or their heartbeat. What we don't want to see as you're pressing really hard to the point where you're compressing the artery and you're constricting blood flow to the hand. Also, we may compress the artery so hard that we can't find that pulse anymore.

03:47 The other thing I do see nursing students do is when they go to palpate or feel the heartbeat, I see them take their fingers here instead of flat. So it's really ideal to do flat so we have light compression and even pressure around that artery. So once I found my patient's pulse, I'm going to take my second hand on my watch. It's also really helpful if you've got a clock in the wall when you're taking this as well. So I'm going to take my second hand of my watch. I'm going to find a starting point and I've got to wait until I can feel the patient's pulse. Now, once I feel that patient's pulse, I'll pick a little starting point on my second hand on my watch and then I'm going to count for 30 seconds. So what we're doing here is feeling and we're looking at our watch all at the same time. So I'm going to do this for at least 30 seconds and then multiply by 2 to get your beats per minute.

04:45 Now again, we can actually do this for a full minute if the patient's heart rate is irregular.

04:53 So that's a great tip for you as well. And of course, you want to make sure you document the results. Let's take a look of how we obtain an apical pulse. When you hear this term, we are talking about obtaining a heart rate from listening to the patient's heartbeat.

05:14 So first of all, we need to start with our stethoscope or what we call our ears to listen to that patient's heart. Here's the tricky part for the nursing student. We have to find the apex of the heart. This is at about the midclavicular line. So if you ever hear that term, really just think about where is our patient's clavicle, where is about the midportion and move down. Then we can palpate and feel about the 4th or 5th intercostal space meaning those little ridges between the patient's ribs and take a listen with our stethoscope.

05:49 We'll place our stethoscope over this area on our patient's chest. Now, we should be able to hear that heartbeat. Now once you do that, you should hear each lub dub, lub dub, every lub dub is counted as one beat. Now, when we're talking about this, we could hear that lub dub and you want to use that second hand on your watch or look at a clock and count how many lub dubs, again counting as one, for a full 30 seconds and then multiply that by 2. That's going to give our beats per minute or otherwise known as our heart rate.

06:27 Now, here is a big tip. If the patient's heart rate is irregular, we want to make sure we count for a full minute to get an accurate heart rate. And once we have obtained this, we can document the pulse. Let's take a look of how we obtain an apical pulse. So if you guys remember, when you hear the word apical pulse, we're really just talking about taking what we call our ears or otherwise our stethoscope and listening to the patient's heartbeat to obtain a pulse rate. Now, this is the ideal method if you're going to give cardiac medications based on that pulse rate. So many times you may see a nurse again go for a radial pulse which is the easiest to obtain, but again if you're going to give medications apical pulse is preferred. So before we get started, we need to make sure we grab our stethoscope. Now, it's a great idea to find the patient's heart and make sure you can hear really well before you obtain this pulse. So a good marker and a place to do that is to find the apex of Brandon's heart here. So where we're going to start with this is find the midclavicular line which really when you hear that just means the clavicle in the middle here.

07:44 So I'm going to palpate around where I find Brandon's clavicle and go about the midsection and then after I find that I'm going to palpate down to about the 4th or 5th intercostal space on his chest. Now when you hear the word intercostal, all that means is the little groove you can feel between the patient's ribs. So once I found where I'm going to listen, I want to go ahead and place my stethoscope on the patient's chest. This is a great time to put in your ears and listen. So as you notice here just a little tip in something that I do is I close my eyes to make sure I find that heart rate first and hone in. Now, once I've done that we're going to listen for that lub dub, lub dub. Now remember that lub dub is one heartbeat. So once we've heard that lub dub, I want to take my second hand on my watch or if you're lucky to have a clock on the wall that makes it really convenient and then you're going to count this for a full 30 seconds and then multiply by 2. That's going to give us our beats per minute. Now here's a really important tip. As you know, many times you may have a patient with what we call atrial fibrillation or an irregular heart rate, if that's the case we want to ensure we count for a full minute to obtain an accurate reading.

09:10 Now, we can go ahead and document our pulse rate. Now, let's talk about the character of the pulse. If you remember there are different things we've got to consider. We've got to consider the rate. Is it bradycardic or tachycardic? Meaning too fast, too slow. What's the rhythm? Is it regular and on time? Kind of like a marching band. Or is it irregular and all over the place. What's the strength? Is it bounding? Is it diminished? And what's the quality? And remember when we're talking about equality, if I feel pulses in both extremities they should feel equal and about the same time. So just to know and we talked about apical pulse versus radial pulse earlier, but when we're getting an apical pulse from the chest of the heart using our stethoscope, we're only going to need our rate, so how fast is it going, and the rhythm. Also with the assessment of the radial pulse, this is what we're going to use, the rate, the rhythm, the strength, and the equality because we're looking at an extremity here. Now before measuring a pulse, review the client's baseline for comparison. If you guys remember earlier, people's pulse rate can vary quite a bit. If we're talking about that super ultra marathon runner, their pulse rate maybe lower than maybe yours or mine for example. So another really important note to talk about is if you did take an abnormal rate while palpating a peripheral pulse, the next step is to go to the heart directly to the source and assess the apical. The apical rate is the one we're going to use our stethoscope and listen to the patient's heart tones.

The lecture Radial and Apical Pulse – Vital Signs (Nursing) by Samantha Rhea, MSN, RN is from the course Vital Signs (Nursing).

Included Quiz Questions

1. By placing the pads of their index and third fingers between the client’s wrist bone and the tendon on the thumb side of their hand
2. By placing the pads of their little finger and ring finger between the client’s wrist bone and the tendon on the little finger side of their hand
3. By placing the pads of their little and ring fingers between the client’s wrist bone and the tendon on the thumb side of their hand
1. 60 seconds
2. 30 seconds
3. 120 seconds
4. 90 seconds
1. At the midclavicular line between the fourth and fifth intercostal space
2. At the midclavicular line between the third and fourth intercostal space
3. At the midclavicular line between the fifth and sixth intercostal space
4. At the midclavicular line between the second and third intercostal space
1. Listens for 30 seconds, counting each “Lub dub” as one beat, and then multiplying the number of beats by two
2. Listens for 30 seconds, counting each “Lub” as one beat and each “Dub” as one beat, and then multiplying the number of beats by two
3. Listens for 15 seconds, counting each “Lub dub” as one beat, and then multiplying the number of beats by four
4. Listens for 15 seconds, counting each “Lub” as one beat and each “Dub” as one beat, and then multiplying the number of beats by four
1. Apical
3. Brachial
4. Popliteal

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