STUDENT: ________________________________________________________________
DATE: _________________________
INSTRUCTOR: _____________________________________________________________
DATE: _________________________
PROCEDURE PERFORMANCE CHECKLIST
Skill 31-2 Assessing the Radial and Apical Pulses
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Comments
1. Determine need to assess radial or apical pulse.
2. Assess for factors that influence pulse rate.
3. Determine previous baseline apical rate
(if available) from client’s record.
4. Explain that pulse or heart rate is to be
assessed. Encourage client to relax and
not speak.
5. Perform hand hygiene.
6. Provide privacy.
7. Obtain pulse measurement:
A. Radial pulse:
(1) Assist client to supine or sitting
position.
(2) If client is supine, place client’s
forearm straight alongside the body or
across lower chest or upper abdomen
with wrist extended straight. If client
is sitting, bend client’s elbow 90 degrees
and support his or her lower arm on a
chair or on your arm. Slightly flex
client’s wrist, with palm down.
(3) Place tips of first two fingers of hand
over groove along radial or thumb
side of client’s inner wrist.
(4) Lightly compress against client’s
radius, obliterate pulse initially, then
relax pressure.
(5) Determine strength of pulse.
(6) After pulse can be felt regularly, look
at watch’s second hand and begin to
count rate.
(7) If pulse is regular, count rate for
30 seconds and multiply total by 2.
(8) If pulse is irregular, count rate for
60 seconds. Assess frequency and
pattern of irregularity.
B. Apical pulse:
(1) Assist client to supine or sitting
position. Expose client’s sternum
and left side of chest.
(2) Locate anatomical landmarks to
identify the point of maximal
impulse.
Continued
Copyright © 2005 by Mosby, Inc. All rights reserved.
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Comments
(3) Place diaphragm of stethoscope in
palm of your hand for 5 to 10 seconds.
(4) Place diaphragm of stethoscope over
point of maximal impulse at the fifth
intercostal space at the left
midclavicular line and auscultate for
normal S1 and S2 heart sounds.
(5) When S1 and S2 are heard with
regularity, look at watch’s second
hand and begin to count rate.
(6) If apical rate is regular, count for
30 seconds and multiply by 2.
(7) If rate is irregular or client is receiving
cardiovascular medication, count for
60 seconds.
(8) Note regularity of any dysrhythmia.
(9) Replace client’s gown and bed linen.
(10) Assist client in returning to a
comfortable position.
(11) Clean earpieces and diaphragm of
stethoscope with alcohol swab as
needed.
Perform hand hygiene.
Discuss findings with client as needed.
Compare readings with client’s previous
baseline and/or acceptable range of heart
rate for client’s age group.
Compare peripheral pulse rate with apical
rate and note discrepancy.
Compare radial pulse equality and note
discrepancy.
Correlate pulse rate with data obtained from
blood pressure and related signs and symptoms.
Record pulse rate with assessment site and
report abnormal findings.
Copyright © 2005 by Mosby, Inc. All rights reserved.