Audio quality is not the best – recorded on the carotid artery.

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Normally, the pulse rate matches the apical pulse. There are a few conditions in which the apical pulse could be higher the palpable pulse in the radial or carotid artery. Basically it would be secondary to a heart beat that does not lead to enough cardiac output to produce a palpable pulse in the arteries. This can occur with premature atrial or ventricular heart beats and also with atrial fibrillation. The technical term is a pulse deficit. The more likely explanation is error or just a variation in the heart rate. Remember that heart rate varies from second to second. If you listened for a minute at the apex and then you felt the pulse for a minute, you may get a slightly different reading. The most accurate way to determine the true heart rate is to listen with your stethoscope at the apex of the heart for 1 minute. This is especially important in people with atrial fibrillation, because they have a known pulse deficit. If you just palpated their pulse, then you would not get an accurate ventricular rate.

Normal heart rate is 50-100. Therefore both of these values are within normal limits. I suspect the differences are secondary to error and nothing to worry about. Good luck.

Yes, an apical pulse is heard with a stethoscope placed over the apex of the heart, and is an accepted pulse measurement. It differs from an arterial pulse and is not considered as one of the accepted arterial pulse points in that it does not measure pulse being palpated where an artery passes over a bone, but rather is listened for directly over the heart.

What is the threshold for radial/apical pulse deficit being a problem. Please include a reference to where I can find your answer in publication (preferably on the web)

A pulse deficit is the difference between the apical vs. radial pulse. A pulse deficit greater than 4 might indicate some physiological problem.

Find it at: (see in page 40)
http://legacy.bluegrass.kctcs.edu/fileadmin/files_biology/LAB_4.pdf

I received an unexpected scholarship and have decided that I would like to get a new stethoscope for nursing clinicals. I’m currently using a $10 sprague from allheart but the tube rub makes it very difficult to listen for low frequency sounds. I also have trouble hearing the apical pulse on COPD patients. I’ve had the opportunity to use an instructors Littman Cardiology III and was very happy when I was able to find the apical on a barreled chested patient. No one with a sprague had been successful with the same patient.
I’ve been trying to do some research to see what’s out there but it’s hard to find reviews for anything other then Littman. ANY first hand reviews or suggestions would be appreciated. My budget is $200 and I need a stethoscope with a bell and diaphragm so it can do double duty on peds.
I’m not concerned with my stethoscope walking away. I’ve had the same sprague since the beginning and it NEVER leaves my side.

I’ve used the Harvey Elite, and am quite happy with it’s performance. It would be comparable to a Cardiology II. Here is a link to the specs for it. This will give you an idea of what it looks like, what comes with it, and an idea of a general price. Obviously, if you shop around, you could probably find a better price.

http://www.steeles.com/catalog/harvey.html

It does well in the back of a noisy squad. I can’t imagine a controlled clinical environment being more noisy than that..

Edit: while I’m thinking about it, try to select one with shorter tubing (or trim the tubing down)- between 15 and 20 inches. This helps to cut down on extraneous sound, and provides better sound transmission. Tubing less than 15 inches tends to be uncomfortable, as you will always be leaning over and stretching to listen to heart and lung sounds.

Apical, Brachial, Pedal, Radial My answer is Brachial
Question 2: If you have an infant with CHF and takes 1.25oz formula in 20 minutes and the doctor ordered 2oz of formula q3H the best action for the nurse to take is: Continue feeding slowly, stop the feeding and request a gavage feeding PRN, burp the unfant and try to stimulate sucking, ask mom to feed the infant when she arrives. I believe to continue feeding slowly allowing as much time as infant needs to finish

Digoxin blocks the AV node, decreasing the heart rate. If your heart rate is already too slow (less than 60 beats a minute), the medication can decrease the heart rate to a dangerous level.

Pulse: Apical

Burp and try to stimulate sucking

You need to check not only the heart rate, but also rhythm and quality of pulse. In case there is irregular beats where there were none or if heart rate falls below 60, consult doctor.

I have had a lot of stress lately and I have had panic attacks before. I have noticed that for the past 3 nights, I have woken up with my heart pounding out of my chest, but the crazy thing is, I check my apical pulse and its normal :/ My breathing rate is normal, I’m not sure what is causing this crazy fast pace heart rate feeling in my chest. Its not when I’m completely asleep, just about 30 minutes after laying down. I’m not really thinking about anything but is it possible that I am still thinking about things in the back of my mind that are stressing me out?

Maybe That can be the reason or it can be something else I’m no doctor but you maybe should consider going to see one

Earlier today, a disoriented woman who was BARELY conscious was rushed into our clinic. She was having difficulty of breathing. I helped his son remove her bag, loosened her belt. Made sure that her airway was patent. She was breathing — with marked difficulty. I Checked her BP- 160/100, while the doctor assessed her apical pulse, listened to her breath sounds.

Suddenly, the patient’s son asked for water.. he told us that his mother needs to DRINK water. His mother was gasping for air… Then I told that it wasn’t a nice idea to make her mother drink water cos she’s having difficulty of breathing.. the water could get into her lungs — aspiration.

A student nurse (maybe she was confused) gave the son a bottle of drinking water. The other nurse warned him, about the risk aspiration if he gives his mom water. I was the one who was nearest to the patient– so I grabbed the bottle of water on top of the desk, to prevent him from giving her water to drink… HE YANKED my arm away — the force was strong enough to PUSH ME AWAY. He yelled at me "I know how to CURE my mom, I am her SON". Then he let her mom drink some water.

I was regally pissed off. I just told him, "if that water gets into your mom’s airway or lungs, NONE of us nurses can be blamed. Nobody in here is liable to what your are doing to your mother… and"

I haven’t finished my statement yet when his mother began gagging — water went out of her nose.

Then the patient’s son started BLAMING the policemen for arresting his brother for "driving without a license" and driving an unregistered vehicle. He told us that it was the policeman’s fault why his mother got an "attack".

The doctor was annoyed at him too, the doctor made a referral and told him to bring his mom to the hospital — for further evaluation. The son refused he told us he didn’t have money to bring his mom to the hospital.

If you were me, what would you do? Would you do the same thing?
@krazegurl — That’s the thing the son doesn’t have a background in health sciences… and he had the nerves to yell at me and push me away.

I don’t see the necessity of "pushing the nurse away."

I have worked in several hospitals where i have encountered these type of people. When i was younger i was a housekeeper at a rural hospital in my hometown and i would see nurses have to deal with these jerks and i always felt for them in these situations. I have noticed the best way to handle these people is to treat them like angry customers or small children, distracting them with a different topic or trying to make them feel like your doing what they want in a round about kind of way is the best way to deal with them. A little butt kissing helps sometimes as well. Even though you know in your heart and mind that you know better then they do on how to care for their loved one you can’t ever appear that way or seem arrogant or cocky at all, most family members take it the wrong way. Especially if any of the family members have a health care backgroud, that makes it even worse.

PS: For furture reference anytime a family member is combative or is interfering with treatment of a patient call the police, do not hesitate. This woman could expire because you guys are busy trying to fight off a crazy family member and are too distracted to notice. The hospital i work for currently is huge and has their own police force, they are frequently called to the ER to restrain unruly family members and combative patients. And as for the answer before mine i know we can sedate combative patients but we are not allowed to do anything to family memebrs unless they request medical help. So just jumping an unruly family member and giving him a sedative is NOT allowed, you’ll find your butt in court being sued and your licences suspended for that kinda crap.

a. afterload
b. the difference between the apical and radial pulses
c. the ability of the heart to increase cardiac output when needed
d. the extra blood remaining in the heart after contraction

c. the ability of the heart to increase cardiac output when needed

Cardiac output can increase upto 6 times. Part of it is due to increase in heart rate while the rest is due to increase in stroke volume. (cardiac output = heart rate x stroke volume).

Her vital sign is following. BP 140/70,Apical pulse 84, slightly irregular and she has a pacemarker, R 18. She is still slightly disoriented. slight edema is found ,but al althe systems are WNL Based on the history, the assessment and the medications you suspect that the following (Name 2)occured. Give your rationale.
What happened to her? I am not sure.
She is on Lasix and blood thinner. Sh recently had a heart sugery nd has a pac maker. She is diabetic.

Well what is the history and medications she takes, you have not given enough information to answer the question