CENTRAL LUZON DOCTORS’ HOSPITAL - EDUCATIONAL

INSTITUTION, INC
Romulo Highway, San Pablo, Tarlac City
Tel No. (045) 982-5019/982-5052/982-0264 Fax No. (045) 982-0780/982-2757

NURSING DEPARTMENT

CHECKLIST ON NURSING PROCEDURES (NCM _______)

___________Semester, A.Y. _____________

VITAL SIGNS
ASSESSING THE APICAL PULSE

Name of Student: Date:

RATING SCALE:
1 - NO
2 - YES
3 - MASTERED

GRADING SYSTEM: Raw Score / Total Score x 50 + 50

Performed

Preparation NO YES Mastered Comments

1. Assess:

● Clinical signs of cardiovascular alterations, other

than pulse rate, rhythm, or volume
● Factors that may alter pulse rate
2. Assemble equipment and supplies:

● Watch with a second hand or indicator

● Stethoscope
● Antiseptic wipes
● If using DUS, the transducer probe, obtain the
stethoscope headset, transmission gel, and
tissues/wipes
Procedure

1. Explain to the client what you are going to do, why it is

necessary, and how he can cooperate.

2. Wash hands and observe other appropriate infection

control procedures.

3. Provide for client privacy.

4. Position the client appropriately in a comfortable

supine position or a sitting position.
 ● Expose the area of the chest over the
apex of the heart.

5. Locate the apical impulse.

● Palpate the angle of Louis, located just below the

suprasternal notch and felt as a prominence.
● Slide your index finger just to the left of the
client's sternum, and palpate the second
intercostal space.
● Place your middle or ring finger in the third
intercostal space, and continue palpating
downward until you locate the fifth intercostal
space.
● Move your index finger laterally along the fifth
intercostal space towards the MCL. Normally, the
apical impulse is palpable at or just
medial to the MCL

6. Auscultate and count heartbeats.

● Use antiseptic wipes to clean the earpieces and

diaphragm of the stethoscope.
● Warm the diaphragm of the stethoscope by
holding it in the palm of the hand for a moment.
● Insert the earpieces of the stethoscope
into your ears in the direction of the ear or
slightly forward, to facilitate hearing.

● Tap your finger lightly on the diaphragm to be

sure it is the active side of the head.
● Place the diaphragm of the stethoscope over the
apical impulse and listen for the normal S1 and
S2 heart sounds.
● If the rhythm is regular, count the heartbeats for
30 seconds and multiply by 2. If the rhythm is
irregular, count the beats for 60
seconds.

7. Assess the rhythm and the strength of the heartbeat.

● Assess the rhythm of the heartbeat by

noting the pattern of intervals between the

beats

● Assess the strengths (volume) of the Heartbeat.

8. Documentation

RAW SCORE -
-
TOTAL SCORE

FINAL GRADE -