AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of performing the steps to completing vital signs.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given the five elements of the nursing care process and a set of simulated vital
signs on a patient by correctly responding to written, oral, and experiential
assessment measures .
TEACHING POINTS
1. Identify the normal adult parameters for
temperature, pulse, respirations, and blood
pressure
2. Identify factors that may affect temperature
3.
4.
5.
6.
Describe patient teaching related to vital signs
7.
Describe nursing interventions for abnormal
vital signs
Identify factors that may affect pulse rate
Identify factors that may influence respiratory
rate
Identify factors that may affect blood pressure
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Instructional Time: 72
Reference(s):
ISBN 0-323-01727-4
Foundations of Nursing, 4th Edition
01 Jan 2003
Minutes
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
When admitting a client to a health care setting, there are several
measurements that the Practical Nurse makes in his/her assessment in order to
establish a data base for each client. Included in the measurements are the
client's vital signs: temperature, pulse, respirations, and blood pressure. There
are normal values established for all of these and it is important for you to
remember that specific nursing interventions are based on the accurate
collection of this data. During the next two hours, we will introduce you to the
knowledge required to obtain these measurements and considerations related to
variations in vital signs.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Identify the normal adult parameters for temperature, pulse, respirations, and blood
pressure
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Normal temperature - Temperature variation from 97º F to 99.6º F (36.1º C to 37.5ºC) are considered
to be within normal range
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
b. Normal heart rate 60-100 beats per minute
(1) Tachycardia if greater than 100 beats per minute
(2) Braycardia if less than 60 beats per minute
c. Normal respiratory rate 12-20 breaths per minute
(1) Tachypnea if greater than 20 breaths per minute
(2) Bradypnea if less than 12 breaths per minute
d. Normal blood pressure
(1) Systolic blood pressure 100-120 mm Hg
(2) Diastolic blood pressure 70-80 mm Hg
e. Remember to record the method used to obtain signs
(1) Oral/Tympanic/rectal temp
(2) Monitor/ manual
(3) Arm/thigh cuff
Knowledge Lesson:
Question:
Answer:
Question:
Answer:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
Your patient has a heart rate of 113. What is the term for this condition?
Tachycardia
A respiratory rate of 27 breaths per minute is considered what?
Tachypnea
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Identify factors that may affect temperature
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
Minutes
a. Factors affecting temperature
(1) In response to disease or illness
(a) Termed pyrexia, febrile, or hyperthermia
(b) A body defense to destroy invading bacteria
(c) Classified as constant, intermittent, and remittent
(d) Signs and symptoms of elevated temperature
1) Thirst
2) Anorexia
3) Flushed, warm skin
4) Irritability
5) Glassy eyes/photophobia
6) Headache
7) Elevated pulse and respiratory rates
8) Restlessness or excessive sleepiness
9) Increased perspiration
10) Disorientation, progressing to convulsions
(2) Age
(a) Temperature regulation unstable in infancy
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(b) Normal range commonly lowers in older adults
(c) With aging, sensitivity to temp extremes develops
(3) Exercise
(a) Can increase body temperature
(b) Can raise as high as 103.2 o
(4) Hormonal influences
(a) Women generally have greater variations in temp than men
(b) Hormone changes during ovulation and menopause cause temp variations
(5) Diurnal variations
(a) Temperatures vary throughout the day
(b) Lowest reading occurs between 0100 and 0400
(c) Usually peaks between 1600 and 1800
(6) Stress
(a) Physical or emotional stress may raise body temperature
(b) Anxiety may raise body temperature
(7) Environment
(a) Extremes can raise or lower body temperature
(b) Depend on
1) Extent of exposure
2) Air humidity
3) Presence of convection currents
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(8) Ingestion of hot and cold liquids
(9) Smoking
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
List three factors that will raise body temperature
Exercise, stress, warm environment
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Identify factors that may affect pulse rate
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Factors affecting heart rate
(1) Age
(a) Pulse rate decreases from infancy through adulthood
(b) In older adults, rate may be > 80 beats per minute 2o meds or weak heart
(2) Exercise
(a) Short term exercise increases heart rate
(b) Long term exercise strengthens heart muscle
(c) Results in lower than normal rate at rest and quicker return after exercise
(3) Fever, heat
(a) Both increase pulse rate because of increased metabolic rate
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(b) Hypothermia will decrease pulse rate
(4) Acute pain, anxiety will increase rate 2o sympathetic stimulation
(5) Unrelieved severe pain, chronic pain will decrease rate 2o parasympathetic stimulation
(6) Medications can either raise or lower rate
(7) Hemorrhage will increase rate 2o sympathetic stimulation
(8) Postural changes
(a) Lying down initially decreases rate
(b) Standing or sitting increases rate
(9) Metabolism can cause changes in pulse rate
(10) Pulmonary conditions increase rate because they cause poor oxygenation
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
List three factors that will affect heart rate
Pain, fever, exercise
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Identify factors that may influence respiratory rate
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Factors affecting respiratory rate
(1) Conditions that alter the rate and depth of respiration
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(a) Lung tissue disease
(b) Reduced red blood cell levels
(c) Chest pain
(d) Kidney diseases
(e) Febrile disease
(f) Diseases of the heart
(g) Chronic lung disease alters the normal stimulus for ventilation
(2) Stress will likely cause an increase in rate and depth
(3) Fever can cause an abnormally rapid rate of breathing
(4) Age
(a) Lung capacity increases and respiratory rate gradually decreases with growth from infancy to
adulthood
(b) Lung capacity and depth of respiration decrease and rate increases with older adults
(5) Gender; men have greater lung capacity than women
(6) Body position
(a) Straight, erect posture promotes full chest expansion
(b) Slumped or stooped position impairs ventilation
(7) Medications may increase or decrease the rate and depth of respirations
(8) Exercise increases the rate and depth of respirations
(9) Acute pain increases the rate and depth 2o sympathetic stimulation
(10) Smoking long term changes the lungs' airways, resulting in increased respiratory rate
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(11) Brain stem injury impairs the respiratory center and inhibits respiratory rate and rhythm
Knowledge Lesson:
Question:
Answer:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
How does age affect respiratory rate?
With growth from infancy to adulthood, the lungs' capacity increases and
respiratory rate gradually declines. With older adults, lung capacity and depth
of respiration decrease, and respiratory rate increases
In a skill lesson, provide practice and watch students perform a skill.
5. Teaching Point: Identify factors that may affect blood pressure
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Factors affecting blood pressure
(1) Disease or illness
(a) Hemorrhage lowers blood pressure
(b) Acute pain increases blood pressure
(c) End-stage Renal Disease increases blood pressure
(d) Primary essential hypertension increases blood pressure
(e) General anesthesia lowers blood pressure
(f) Exercise increases blood pressure
(g) Postural change lowers blood pressure
(h) Smoking increases blood pressure
(2) Age causes a variation in normal blood pressure; gradual increase with age
(3) Anxiety, fear, pain, and emotional distress may increase blood pressure 2o increased heart rate and
increased peripheral vascular resistance
(4) Medications can either lower or increase blood pressure
(5) Hormones
(a) Variations in blood pressure may be manifested as a person ages because of hormonal alterations
(b) Pregnancy may cause mild to severe elevations in blood pressure
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(6) Diurnal variations include a lower blood pressure in the morning, rising throughout the day,
peaking in the late afternoon or evening and lowering at night
(7) Race
(a) Rate of hypertension is higher in urban African-Americans than in European Americans
(b) Hypertension related deaths also higher among African-Americans
(c) This is believed to be genetically and environmentally related
(8) Gender
(a) No clinically significant difference in blood pressure levels between boys and girls
(b) After puberty, males tend to have higher blood pressure readings
(c) After menopause, women tend to have higher blood pressure readings than men of similar age
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
How does smoking cause alterations in blood pressure?
Smoking causes vasoconstriction therefore increasing blood pressure
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
6. Teaching Point: Describe patient teaching related to vital signs
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Patient teaching related to vital signs
(1) Demonstrate on self or family member
(2) Explain rationale
(3) No temperature after smoking or eating hot/cold foods
(4) Use caution in recommending aspirin in patients whose condition contraindicates their use
(5) Use fingertips, not thumb to assess pulse
1
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(6) Use gentle pressure to assess pulse
(7) Use watch with second hand
(8) Deep breathing and coughing exercises
(9) Count respiratory rate when patient is unaware of being observed
(10) Notify physician if unusual fluctuations occur
(11) Risks of hypertension
(12) Patients with hypertension should learn more about B/P values and treatment
(13) Take B/P at same time using same arm in same position after rest period
(14) Proper cuff and stethoscope position, size and pressure
(15) Positioning and selection of arm site are causes of inaccurate readings
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Aspirin is contraindicated in what medical conditions?
Risk of Reye's syndrome, aspirin allergy, bleeding tendencies and gastric
ulcers
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
7. Teaching Point: Describe nursing interventions for abnormal vital signs
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson
Skill Lesson
Learning Support:
a. Nursing interventions for an abnormal body temp
(1) Repeat measurement; if indicated select another site
(2) Remove/reduce external coverings
(3) Keep clothing and bed linens dry
(4) Administer medication as ordered
(5) Limit physical activity; increase frequency of rest periods
2
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(6) Increase/encourage oral fluid intake
(7) Assess for possible site of localized infection
(8) Encourage oral hygiene
(9) If subnormal temperature, cover with blankets, eliminate drafts, encourage warm fluids
b. Nursing interventions for an abnormal pulse
(1) Perform complete assessment of all peripheral pulses
(2) Observe for symptoms associated with altered tissue perfusion
(3) Observe for factors associated with a decrease in cardiac output
(4) If pulse is above normal, assess for related data
(a) Pain
(b) Fear
(c) Anxiety
(d) Recent exercise
(e) Low blood pressure
(f) Elevated temperature
(g) Inadequate oxygenation
(5) Observe for other symptoms
(a) Dyspnea
(b) Fatigue
(c) Chest pain
(d) Orthopnea
(e) Syncope
(f) Cyanosis
(g) Pallor of skin
(6) If pulse is below normal
3
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(a) Assess apical pulse
(b) Observe for factors related to medications
(7) If pulse is weak or irregular
(a) Assess apical pulse for pulse deficit
(b) Pulse deficit exists if apical pulse count and simultaneous radial pulse count differ by more than
two
c. Nursing interventions for abnormal respirations
(1) Occasional periods of apnea is a symptom of underlying disease
(2) Assess in position of greatest comfort
(3) Respiratory rate less than 12 or greater than 20 may require immediate intervention
(4) Assess for adequate oxygenation
(5) Observe for obstructed airway or stertorous respirations
(6) Observe for related signs and symptoms
(a) Cyanotic nailbeds, lips, or mucous membranes
(b) Restlessness
(c) Irritability
(d) Confusion
(e) Dyspnea
(f) Shortness of breath
(g) Productive cough
(h) Abnormal breath sounds
(7) Consider possible effects of medications
(8) Assist to a supported sitting position
(9) Provide oxygen as ordered
d. Nursing interventions for an abnormal blood pressure
(1) Repeat assessment after eliminating extraneous noise
4
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(2) If you hear sounds immediately
(a) Release cuff pressure
(b) Wait 60 seconds
(c) Reinflate cuff 30 mm Hg higher than first attempt
(3) Patient seated or lying in quiet environment for at least 5 minutes
(4) Do not interchange cuff from machines of different manufacturers
(5) Prepare children for the squeezing feeling of the cuff
(6) Explain that machine may make audible alarm sounds
(7) If an abnormal pressure is obtained, measure pressure in the opposite arm
(8) Ask another nurse to assess readings
(9) If blood pressure is above normal, observe for related symptoms
(a) Headache
(b) Flushed face
(c) Epistaxis
(d) Fatigue in older patients
(10) Utilize appropriate size cuff
(11) Administer medications as ordered
(12) Compare your current reading with the patient's baseline
(13) If blood pressure is below normal, observe for related symptoms
(a) Weak, thready pulse
(b) Weakness
(c) Vertigo
(d) Confusion
(e) Pale, dusky, or cyanotic skin
(f) Cool, mottled skin
5
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
(14) Position in supine position and limit activity
(15) Increase rate of intravenous fluid
Knowledge Lesson:
Question:
Answer:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
List four related symptoms that might be seen in a patient with elevated blood
pressure
Headache, flushed face, epistaxis, and fatigue in older patients
In a skill lesson, provide practice and watch students perform a skill.
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
5.
6.
7.
8
9.
10.
Identify the normal adult parameters for temperature, pulse,
respirations, and blood pressure
Identify factors that may affect temperature
Identify factors that may affect pulse rate
Identify factors that may influence respiratory rate
Identify factors that may affect blood pressure
Describe patient teaching related to vital signs
Describe nursing interventions for abnormal vital signs
Closing Statement:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Re-motivating
Statement:
When admitting a client to a health care setting, there are several
measurements that the Practical Nurse makes in his/her assessment in order to
establish a data base for each client. Included in the measurements are the
client's vital signs: temperature, pulse, respirations, and blood pressure. There
are normal values established for all of these and it is important for you to
6
AFAMS Master Lesson Plan (MLP)
Nursing Program
Vital Signs
remember that specific nursing interventions are based on the accurate
collection of this data. During the next two hours, we will introduce you to the
knowledge required to obtain these measurements and considerations related to
variations in vital signs.
7