Assessing Vital Signs.m4v
So today, we're going to talk about assessing vital signs. I'm going to just tell you what I would
do for a lot of them, but the blood pressure I will actually take so we can demo that.
You want to make sure that you've checked the orders for how often you need to take vital signs.
You want to explain to the patient what you're going to do. And I think it's very important that
you let the patient and the family know what their vital signs are after you take them.
You always want to assess pain, because pain can impact all of the vital signs, and that is
oftentimes considered an additional vital sign. But again, go by what your book says and what
your lecture notes say.
So I, again, would have the patient's bed in the lowest position. And then I would raise it to an
appropriate working condition to do this. You want to make sure that the patient's arm is at heart
level and that the legs are straight and their legs are not crossed.
If they're sitting in a chair, you want to make sure that the feet are on the floor and, again, that
the legs are not crossed. You want to make sure that you're taking the blood pressure in an arm
not on a side where a patient's had a mastectomy, has a PICC line, a fistula, anything like that. So
you want to double-check all of those different things.
So I'm going to introduce myself to the patient. Hello, Mr. Smith. I'm Barb. I'm your registered
nurse for this shift. And can you tell me your full name and your date of birth? Thank you.
So, Mr. Smith, I'm going to go ahead and take your vital signs today. We'll just see how you're
doing. So for your pain, on a scale of zero to 10, with zero being no pain at all and 10 being the
worst pain you've ever felt, what would you say your pain is? And so the patient says that it's a
three. So my next statement should be, and are you comfortable at that level?
So I'm going to make sure that I have my stethoscope, I have a pulse oximeter, and I have three
different kinds of thermometers here. And I have an oral thermometer on the wall. So you will
learn how to use all of those when you're in the lab.
So what I like to do first is I like to take a temperature first and get the patient used to what I'm
going to be doing. So for a tympanic-- this is one kind-- you put the probe on the end. And for an
adult, you lift the ear up and back, and you place this into the ear canal. And again, you will learn
how to do that when you come into lab. It will make a little bit more sense. For a child, you're
going to pull down, but for an adult, you pull up and back.
You want to make sure that the patient hasn't been laying on that ear, had a hat on over that ear,
or had a fan blowing on that ear. That can impact your tympanic.
The next, we have two different kinds of temporal. One goes right here on the temple. The other
one scans across. And so these are both considered temporal thermometers. The last one is the
oral, which you're going to put a probe on and put it underneath the patient's tongue and take that
temperature. Most of the thermometers have a Mode button on the side where you can change it
to centigrade or Fahrenheit. So you can do that also.
So I have my stethoscope. I've also brought in alcohol swabs, because I like to clean the part of
the stethoscope that's going be touching my patient. I'd like to clean that with alcohol. Regardless
of what it says in the manuals, I've had this for a long time, and it's never been hurt. When you
guys are using each other's stethoscopes, make sure that you clean the earpieces before you put it
in.
So I have that ready. The next thing I like to do is to check the pulse ox, so I'm going to put that
on. And remember that you need to go by what your lecture notes say or your book says as to the
appropriate level of oxygen saturation.
Then I would take a radial pulse, which is right here. So I'm going to take a radial pulse, and that
you can normally count for 30 seconds, unless it's irregular. If it's irregular, you're going to take
it for 60 seconds.
The next, I'm going to take my stethoscope. And some people when they're taking the radial also
like to count the respiration, so that's appropriate too. So I'm going to put my stethoscope in, and
for the apical, this is going to be fifth intercostal space, midclavicular. And so if the person has
breast tissue or is larger, you want to raise that breast tissue up with the back of your hand. And
then this, you're going to count for a full 60 seconds. And this is the time I normally am counting
respirations after I've counted the apical.
So you've done that, and then you've told the patient again what that is. There are some
medications that you need to take an apical pulse before administering. Then I can pull down my
patient's gown, and I'm going to take the blood pressure. I'm going to put this side rail down on
this side after I raise the bed up a little bit more.
And I'm actually going to put this patient's arm just up just a little bit so you can see what I'm
doing. So you want to make sure that you have the right size cuff, and you will notice on this
there's a place where you put the arrow for the brachial. So you feel where the brachial pulse is
at, you put the cuff on so that that arrow is pointing right there. And refer to your book for proper
size of the blood pressure cuff. That can impact it. You never want your stethoscope to be up
underneath the cuff. It needs to be right below.
So one of the ways that you can check to see what the systolic is-- and we want you to do this in
lab-- is you can feel the radial, and you pump up the cuff until you no longer feel the radial pulse.
And that gives you a ballpark of what the systolic is. So that's the way you do that. We do want
you to do that. Then you totally release the air.
So I have a money-back guarantee in the lab, and I've never had to pay up on it. So if you've
never done this before and you're very frustrated, please come see Jennifer or myself, and I will
help you with that.
And one of the things you sometimes have to do, because this has multiple pieces, is learn what
you're listening to. So sometimes to have someone else pump up the cuff, someone else to do all
of that, and you just put your stethoscope on and listen helps to train your ears for what you're
listening for. So don't get frustrated if you can't hear this right away. It just takes a lot of practice.
Also I want to mention the stethoscope, it goes in like this so that the pieces are pointing toward
your ear. That's really important so that you can hear. My stethoscope has a floating diaphragm,
just so you know that. So mine between the diaphragm and the bell is just pressure.
So I want to make sure that this is heart level. And what I'm going to do is I'm going to put my
stethoscope-- and not let the patient's arm drop-- and you want to hold the stethoscope firmly
against the patient's skin so that you don't hear the outside noise. And that's usually one of the
mistakes or one of the frustrations that students have is that they hear a lot of other sounds.
So I'm going to pump this up to about 20 to 30 above what I got for their approximated systolic
pressure. I'm going to pump this up, and because this is a mannequin, this may not show up like
it should. So I would pump it up, and I'm going to say that the approximated was 120, so I'm
going to pump it up to 140.
I'm then going to slowly release this valve. So it's righty tighty, lefty loosey, if you can't
remember. So twisting it to the right tightens it and to the left loosens it. Then I'm going to
slowly deflate about two to three millimeters going down smoothly. The first sound I hear is the
systolic, and when I don't hear any more sounds, that's the diastolic. But you want to make sure
that you're listening carefully.
And when you are complete, you want to go ahead and deflate the cuff completely, because we
don't want patients' eyes bugging out, and then you want to clean your stethoscope before you go
to the next patient. You want to remove the cuff, and you want to wash your hands.
You want to document all of your vital signs. It is a good idea too to document which arm you
took the blood pressure in, which arm you took the radial pulse in, what kind of thermometer you
used, all of those things in your documentation. And if there's anything outside the expected
parameters, then you want to notify the provider of what those are.
That's it.