470 The Nursing Assistant Copyright Goodheart-Willcox Co., Inc. Rationale Apical pulse is usually taken if you want more information than a radial pulse can provide or if it is not possible to take a radial pulse. A pulse outside the normal range may indicate a health issue, medical disease, or condition. Preparation 1. Ask the licensed nursing staff how this procedure fits into the plan of care, if there are doctor’s orders for the procedure, if there are any special instructions or precautions, and if the resident can be moved into the positions required for this procedure. 2. Wash your hands or use hand sanitizer before entering the room. 3. Knock before entering the room. 4. Introduce yourself using your full name and title. Explain that you work with the licensed nursing staff and will be providing care. 5. Greet the resident and ask the resident to state his full name, if able. Then check the resident’s identification bracelet. 6. Use Mr., Mrs., or Ms. and the last name when conversing. 7. Explain the procedure in simple terms, even if the resident is not able to communicate or is disoriented. Ask permission to perform the procedure. 8. Bring the necessary equipment into the room. Place the following items in an accessible location: • a stethoscope • antiseptic wipes • a watch or clock with a second hand (not a digital watch) • pen and pad, form, or digital device for recording the pulse rate The Procedure 9. Provide privacy by closing the curtains, using a screen, or closing the door to the room. 10. If the resident is in bed, lock the bed wheels and then raise the bed to hip level. 11. Ensure safety during the procedure. If the resident is in a bed with side rails, raise and secure the rails on the opposite side of the bed from where you will be working. Lower the rail on the side you are working. 12. Have the resident sit or lie down. 13. Clean the earpieces and diaphragm of the stethoscope with an antiseptic wipe. 14. Warm the diaphragm of the stethoscope by rubbing it in the palms of your hands. 15. Place the earpieces of the stethoscope in your ears. 16. Uncover the left side of the resident’s chest. Avoid any overexposure. 17. Place the diaphragm of the stethoscope on the left side of the chest, under the breast, or just below the left nipple (Figure 18.21). Figure 18.21 Best Practice If the heartbeat is difficult to hear, have the resident turn slightly to the left or sit upright. 18. Note the position of the second hand on your watch. Count the heartbeats for one full minute. Note the rhythm and quality. 19. Cover the resident’s chest. 20. Record the pulse on a pad, on a form, or in the electronic record. 21. If the resident is in bed, check to be sure the bed wheels are locked. Then reposition the resident and lower the bed. 22. Follow the plan of care to determine if the side rails should be raised or lowered. Measuring an Apical Pulse Procedure