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ASSESSMENT
OF APEX BEAT
LEARNING OUTCOME
At the end one hour lecture, the students must
be able to:
1. Define apex beat.
2. List the variation of heart beat by age.
3. State the purpose of assessment of apex beat.
4. State the location of assessment of apex beat.
5. State the factor affecting for heart beat.

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LEARNING OUTCOME
5. Explains the nursing management in
assessment of apex beat.
6. Demonstrate the technique of assessment of
apex beat
7. Appreciate the knowledge of assessment of
apex beat.

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DEFINITION
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VARIATIONS OF HEART BEAT BY AGE
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AGE HEAR T RATE AVERAGE (BPM)
Newborn 130 (80-180)
1 year 120 (80-140)
5-8 years 100 (75-120)
10 years 70 (50-90)
Teen 75 (50-90)
Adult 80 (60-100)
Older adult 70 (60-100)
PURPOSE
To obtain the heart rate of newborns, infants, and
children 2 to 3 years old or of an adult with an irregular
peripheral pulse
To establish baseline data for subsequent evaluation
To determine whether the cardiac rate is within normal
range and the rhythm is regular
To monitor clients with cardiac, pulmonary, or renal
disease and those receiving medication to improve heart
action.
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FACTOR
AFFECTING
HEART
BEAT
AGE
GENDER
EXERCISE
FEVER
MEDICATION HYPOVOLEMIA
STRESS
POSITION
CHANGES
PATHOLOGY
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FACTOR
AFFECTING
HEART BEAT
AGE
AGE
LOCATION
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RIGHT
LEFT
INTERCOSTAL SPACE
MID-CLAVICULAR LINE
5
TH
intercostal space
1 cm medial to the
mid-clavicular line
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PURPOSE
To obtain the heart rate of newborns, infants, and
children 2 to 3 years old or of an adult with an irregular
peripheral pulse
To establish baseline data for subsequent evaluation
To determine whether the cardiac rate is within normal
range and the rhythm is regular
To monitor clients with cardiac, pulmonary, or renal
disease and those receiving medication to improve heart
action.
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ASSESSMENT
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ACTION RATIONALE
1. Patient condition


To know the reason for any abnormalities
2. Clinical sign of cardiovascular
alterations (dyspnea, pallor, cyanosis)
3. Factors that may alter heart rate
(medication)
4. Know the previous heart rate before
the actual procedure
As a data baseline
5. Environment Provide adequate work space
PLANNING
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Watch with a second hand or
indicator
Stethoscope
Antiseptic wipe
IMPLEMENTATION
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ACTION RATIONALE
1. Greet client and introduce self. Explain
to the client regarding the procedure.
Get the client cooperate and to reduce
patient anxiety.
2. Perform hand hygiene. To minimize the organism transmission.
3. Provide for client privacy. Maintain the client self-image
4. Use antiseptic wipes to clean the
earpieces and diaphragm.
The diaphragm needs to be cleaned and
disinfected, to minimize the organism
transmission.
5. Standing on the side of the client Avoid expose other part in order to
maintain the privacy of the client.
IMPLEMENTATION
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ACTION RATIONALE
6. Locate the apical pulse by:
Slide your index finger just to the left of
the sternum, and palpate the second
intercostal space.
Place your middle or next finger in the
third intercostal space. Continue
palpating downward until you locate the
fifth intercostal space.
Move your index finger laterally along
the fifth intercostal space toward the
mid-clavicle line (MCL).




To obtain the accurate result
7. Place the diaphragm of the
stethoscope over the apical impulse and
listen for the normal heart sounds
To listen to heart sounds
IMPLEMENTATION
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ACTION RATIONALE
8. Count the heartbeats for 1 minute Provide a more accurate assessment
9. Comfort the client Ensure comfort
10. Inform the client result
11. Document in the client record As a documentation
EVALUATION
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ACTION RATIONALE
1. Relate the result to baseline data and
health status
Detect early abnormalities
2. Report to the primary provider any
abnormal findings.
Early treatment, to prevent further
complication.
DEMONSTRATION
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CONCLUSION
1. Define apex beat.
2. List the variation of heart beat by age.
3. State the purpose of assessment of apex beat.
4. State the location of assessment of apex beat.
5. State the factor affecting for heart beat.
5. Explains the nursing management in assessment of
apex beat.
6. Demonstrate the technique of assessment of apex beat
7. Appreciate the knowledge of assessment of apex beat.

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REFERENCES
Berman, A., Snyder, S. J., Kozier, B., & Erb, G. (2008). Kozier & Erbs
Fundamental of nursing: Concepts, process and practice (8
th
ed.). New
Jersey: Prentice Hall.

Rasnah Abd. Rahman & Salizar Mohamed Ludin (2005). Prosedur
kejururawatan menggunakan proses kejururawatan.
Selangor,Malaysia:Prentice Hall

Warkman, B., & Bennett, C, L. (2003). Key nursing skills. London: Whurr
Publisher.
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THANK YOU.
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