The Apical Pulse

I hope this is the first in a series of many: Nursing Student Bloopers.

This one isn’t MY blooper, however, as those occur, I will be certain to not waste my opportunity for humility and self-deprecation.

One of the first things you learn in nursing school is assessment, specifically vital signs. We had to prove that we could take a patient’s temperature, radial pulse, apical pulse, respiration rate, oxygen saturation, and blood pressure. As students, we are getting very bold in going up to others in the lab and saying, “I’m taking your blood pressure.” Or “Can I practice my assessment?” One girl came to me last week and asked the latter. “Sure.” I felt pretty good about my skils, so all I asked in return was that I practice taking her blood pressure.

Her specific problem was the apical pulse. “Hm, okay?” I thought.

I eventually won’t have to find an apical pulse this way, but to pass this assessment check-off, my class was told that we had to follow this method:

1. Working down from the collar bone, find the 5th intercostal space
2. Go to the mid-line between the sternum and scapula
3. Listen with Stethoscope.

For those of you without human anatomy:

Apical – apex of the heart, i.e. the base. I am to listen to the heart near its base to get a pulse. This is one thing a doctor or nurse is doing when he/she puts a stethoscope on your chest.

5th intercostal space – Intercostals are the muscles between your ribs. Start with your collarbone near your breastbone.  Go down to an empty space, find the first rib, the soft space below is the first intercostal space.

Mid-line between sternum and scapula – sternum is the breastbone. scapula is your shoulder blade. Think of an imaginary vertical line between those.

If you haven’t figured it out yet, females get felt-up with the method we were given in class. It’s okay. We’re nurses, we can handle it.

When my classmates talk about the apical pulse in practice, we usually say, “Alright, time to feel you up!”  So with my classmate, I helped her count my ribs to the 5th intercostal space, then over to the mid-line.

She kept her two fingers right there and said, “Shouldn’t I be feeling your pulse now?”

Me: “Um, you need to put your stethoscope there.”

There are multiple sites to ascertain a pulse on a human body, but I’m thankful that God didn’t place a pulsating artery directly underneath human breasts. Medical assessment are already awkward enough.