Assessing for Apical-Radial Pulse Deficit

pt 2

5. Nurse 2 palpates the radial pulse and assesses rate, rhythm, and quality. 6. Nurse 2 says "Start" when ready to begin and "Stop" when finished. Both nurses count the pulse simultaneously for 1 full minute. Count simultaneously to ensure accuracy. Counting for 1 full minute is necessary for an accurate assessment of any discrepancies that may exist between the two sites.

pt 3

7. To obtain pulse deficit, subtract the radial rate from the apical rate. Apical Rate - Radial Rate = Pulse Deficit Atrial and ventricular dysrhythmias may cause beats that do not perfuse, so although you hear an apical heartbeat, you do not feel a peripheral pulse. The pulse deficit is the number of heartbeats that do not perfuse.

Pre-Procedure Assessment

Determine why assessment of pulse deficit is indicated. Conditions that require assessment of pulse deficit include digitalis therapy, blood loss, cardiac or respiratory disease, and other conditions that affect oxygenation status. Assess factors that may alter the pulse, such as activity and medications. Obtain another nurse to assist with the procedure.

Documentation

Document the apical-radial pulse deficit. Sample documentation MM/DD/YYYY 0900 Apical-radial pulse deficit is 4 beats/min. ——————— Jon Albertson, RN

Evaluation

Identify the presence of an apical-radial pulse deficit, and compare to previous findings. Assess other measures of cardiopulmonary status to identify a decline in the patient's condition. Look for trends. The presence of any apical-radial pulse deficit is abnormal.

Delegation

Instead of delegating measurement of an apical-radial pulse to a NAP, you would most likely ask the NAP to assist you in this procedure because it is best performed by two persons working together.

Procedure pt 1

Procedure Steps 1. Wipe the stethoscope with a 70% alcohol or benzalkonium chloride wipe before and after examining the patient. Cleaning can reduce the bacterial count by up to 100% and prevent the transmission of microbes. 2. Expose the left side of the patient's chest, minimizing patient exposure. Prevents distortion of sound from the patient's gown rubbing on the stethoscope and protects privacy. 3. Place the watch so that the second hand is visible to both nurses (if two nurses are performing the procedure). Using one watch increases accuracy of counts. 4. Nurse 1 palpates the 5th intercostal space at the midclavicular line for the apical pulse and holds the diaphragm of the stethoscope in place, using firm pressure. Aids in hearing high-pitched sounds and ensures good contact between the diaphragm of the stethoscope and the skin.

Equipment

Watch or clock with a second hand or second readout Procedure gloves, if indicated Stethoscope Alcohol or other antiseptic wipes to clean the stethoscope

What if?

What if ... *There is not another nurse available to assist?* Hold the stethoscope in place with the one hand while palpating the radial pulse with the hand wearing the watch. Even if you cannot manage to count both rates, you should be able to feel any differences between the apical and radial pulses. *There has been an increase in pulse deficit since the last measurement?* An increase in pulse deficit means that the patient's cardiac output has decreased.