84 13 Vital Signs 1. Define important words in this chapter 2. Discuss the relationship of vital signs to health and well-being 3. Identify factors that affect body temperature 4. List guidelines for taking body temperature 5. Explain pulse and respirations 6. List guidelines for taking pulse and respirations 7. Identify factors that affect blood pressure 8. List guidelines for taking blood pressure 9. Describe guidelines for pain management Supplemental Tools transparency 13-1 ranges for adult vital signs handout 13-1 thermometer worksheet handout 13-2 blood pressure worksheet chapter 13: exam Assignments textbook reading, pp. 220-241 workbook exercises, pp. 73-77 Overview of Teaching Strategies This chapter explains many more of the hands on procedures the NA will be doing for residents. There are many procedures for the students to learn in this chapter. Some of the procedures are performed daily by NAs and are general to all types of residents. The largest amount of time for this chapter should be devoted to demonstration and return demonstration of the vital sign procedures until they are completely comfortable with the techniques. The vital signs procedures should be practiced in a lab setting so that students have a chance to perform them on each other. The last part of the chapter focuses on pain management. It is important to emphasize to students to take residents complaints of pain seriously. Remind them to be empathetic and to remember that nobody likes to be in pain. If you use pain scales at your facility or school, bring them in to show the students. 1. Define important words in this chapter textbook pp. 220-221 workbook p. Pronounce and define each of the key terms listed in the Learning Objective on pages 220-221. 2. Discuss the relationship of vital signs to health and well-being textbook p. 221 workbook p. 73 Pronounce and define the following key term: Vital signs Review what vital signs consist of: Taking temperature Counting pulse Counting rate of respirations Taking blood pressure Observing and reporting pain level Discuss the fact that vital signs are often the first indication that a person is ill.
85 Display Transparency 13-1 ranges for adult vital signs Use the transparency to emphasize ranges as you go over each of the vital signs in the following learning objectives. 3. Identify factors that affect body temperature textbook pp. 222-223 workbook pp. 73-74 Discuss the following factors that affect body temperature: Age Amount of exercise Circadian rhythm Stress Illness Environment Pronounce and define the following key term: Hypothermia Review signs of hypothermia: Shivering Numbness Quick and shallow breathing Slow movements Mild confusion Changes in mental status Pale and cyanotic skin 4. List guidelines for taking body temperature textbook pp. 223-230 workbook p. 74 Thermometers Fahrenheit Celsius Discuss the four main sites for measuring temperature: Mouth Rectum Armpit Ear Review the points about different types of thermometers: Mercury-free thermometers can be used to take an oral, rectal, or axillary temperature. Mercury-free thermometers are usually green for oral thermometers and red for rectal. Digital thermometers are commonly used for oral, rectal, and axillary temps. They register temperature within two to 60 seconds. Digital thermometers require a sheath to cover the probe. Electronic thermometers are commonly used for oral, rectal, and axillary temps. They register temperature within two to 60 seconds. Electronic thermometers require a probe cover that must be discarded after a single use. Disposable thermometers can be used to take oral or axillary temps. Disposable thermometers are used once and disposed of. They do not require a disposable sheath. Tympanic thermometers are fast and accurate. Temporal artery thermometers are moved across the forehead and are non-invasive. Review when not to take an oral temperature on a person. Do not take oral temperatures on a person who is unconscious, using oxygen, confused or disoriented, paralyzed, has facial trauma, likely to have a seizure, has a nasogastric or orogastric tube, younger than six years old, has sores, redness, swelling, or pain in her mouth, or has an injury to the face or neck. Demonstration Demonstrate the procedure: Measuring and recording oral temperature. Include all of the numbered steps in your demonstration. Have the students return the demonstration.
86 Review these points about rectal, tympanic, and axillary temperatures: Rectal temperatures: Rectal temperatures are most accurate. NA must explain what he will do before starting. Be reassuring. NA must hold onto the thermometer at all times. Gloves must be worn. Thermometer must be lubricated for this procedure. The privacy of the resident is important. Thermometer must be held the entire time it is in the rectum. Tympanic temperatures: The tip will only go into the ear 1/4 to 1/2 inch. Axillary temperatures: Axillary temperatures are not as accurate as other sites. Axillary area must be clean and dry. Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: Measuring and recording rectal temperature Measuring and recording tympanic temperature Measuring and recording axillary temperature Have the students return the demonstrations. Distribute Handout 13-1 thermometer worksheet Distribute handout and have students fill in the correct temperature reading in each of the blanks. Go over answers and discuss any questions the students may have. 5. Explain pulse and respirations textbook pp. 230-231 workbook pp. 74-75 BPM Tachycardia Bradycardia Dilate Respiration Inspiration Expiration Discuss the following factors that affect pulse rate: Age Sex Exercise Stress Hemorrhage Medications Fever and illness Pronounce, define, and discuss the different types of respirations: Apnea Dyspnea Eupnea Orthopnea Tachypnea Cheyne-Stokes respiration 6. List guidelines for taking pulse and respirations textbook pp. 231-234 workbook p. 75 Radial pulse Stethoscope Review the following points about the pulse rate: Pulse is the number of heartbeats per minute. Normal rate is 60-100 beats per minute for adults. Observe for the overall pattern of the pulse and the quality or type of the pulse.
87 Review the following points about respirations: Do the counting immediately after taking the pulse. Do not let the resident know you are counting breaths. Normal rate is 12-20 breaths per minute. Observe for the overall pattern of the respirations and the quality or type of breathing Demonstration Demonstrate the procedure: Measuring and recording radial pulse and counting and recording respirations. Include all of the numbered steps in your demonstration. Have the students return the demonstration. Pronounce and define the following key term: Apical pulse Mention that the apical pulse is normally about the same as the radial pulse. Define the pulse deficit as being the difference between an apical pulse and another pulse. Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: Measuring and recording apical pulse Measuring and recording apical-radial pulse Have the students return the demonstrations. 7. Identify factors that affect blood pressure textbook pp. 234-235 workbook pp. 75-76 Pronounce and define the following terms: Systolic Diastolic Hypertension Hypotension Orthostatic hypotension Prehypertension Discuss the following factors that affect blood pressure: Age Exercise Stress Race Heredity Obesity/unhealthy diet Alcohol Tobacco products Time of day Illness 8. List guidelines for taking blood pressure textbook pp. 235-238 workbook p. 76 Sphygmomanometer Brachial pulse Discuss different types of sphygmomanometers: Aneroid Electronic Non-invasive blood pressure monitoring Review the following points about blood pressure: Brachial pulse is used. The cuff must first be completely deflated. Remind students not to take blood pressure when these situations exist: An intravenous line (IV) is present. An amputation has been performed. The cuff does not fit the arm properly. The arm has a cast. Burns or injuries are present. The arm is being used for dialysis. The arm or side has had recent trauma.
88 The arm or side is paralyzed due to stroke. The side has had a mastectomy (or any breast surgery). Review additional points about blood pressure: Observe for normal readings and the quality or type of sounds. One-step method does not include getting an estimated systolic before beginning. Two-step method does require getting an estimated systolic. Let students know which method they need to learn (one-step or two-step). It is not always easy to perfect the skill of hearing the first and last sounds of the BP. Students may have to do the procedure over and over again and have the instructor or another student check technique and results for correctness. Distribute Handout 13-2 blood pressure worksheet Distribute handout and have students fill in the correct temperature reading in each of the blanks. Go over answers and discuss any questions the students may have. Demonstrations Demonstrate each of the following procedures, including all of the numbered steps in your demonstration: Measuring and recording blood pressure (one-step method) Measuring and recording blood pressure (two-step method) Have the students return the demonstrations. Provide them with enough time to practice these important procedures on each other, until they feel comfortable doing them. Procedure checklists are located at the end of the 9. Describe guidelines for pain management textbook pp. 239-240 workbook pp. 76-77 Review the following points about pain: It is as important to monitor as vital signs. It is uncomfortable and an individual experience. Take complaints of pain seriously. Ask questions to get accurate information. Discuss signs and symptoms of pain to observe and report: Increased pulse, respirations, and blood pressure Sweating Nausea and vomiting Tightening the jaw Squeezing eyes shut Holding or guarding a body part Frowning Grinding teeth Increased restlessness Agitation or tension Change in behavior Crying Sighing Groaning Breathing heavily Difficulty moving or walking Use measures listed on p. 240 in textbook to reduce pain. Chapter Review Exam distribute chapter 13: exam (appendix c, pp. 315-317) Allow students enough time to finish the test. See Appendix D for answers to the chapter exams. Answers to Chapter Review in Textbook 1. The vital signs consist of body temperature, pulse, respirations, blood pressure, and pain level. 2. It is illegal and can cause harm to the resident. 3. Answers include: age, amount of exercise, circadian rhythm, stress, illness, and environment 4. Answers include: elevated temperature reading, headache, fatigue, muscle aches, and chills. Skin may feel warm and look flushed.
89 5. Oral, rectal, axillary, and tympanic 6. Rectal 7. Red 8. Answers include: a person who is unconscious; using oxygen; confused or disoriented; paralyzed; has facial trauma; likely to have a seizure; has a nasogastric or orogastric tube; younger than six years old; has sores, redness, swelling, or pain in her mouth; or has an injury to the face or neck 9. 10-20 minutes 10. The entire time it is in the rectum 11. ¼ to ½ inch 12. 60 to 100 beats per minute 13. 12 to 20 breaths per minute 14. Radial pulse 15. Because people tend to breathe more quickly if they know they are being observed 16. The apical pulse is on the left side of the chest, just below the nipple. side has had recent trauma; the arm or side is paralyzed due to stroke; or the side has had a mastectomy (or any breast surgery) 24. Answers include: resident s culture; resident may believe that pain is a normal part of aging; resident may fear addiction to pain medication; or resident may think that staff members are too busy to deal with his pain 25. Answers include: increased pulse, respirations, and blood pressure; sweating; nausea; vomiting; tightening the jaw; squeezing eyes shut; holding or guarding a body part; frowning; grinding teeth; increased restlessness; agitation or tension; change in behavior; crying; sighing; groaning; breathing heavily; and difficulty moving or walking 26. Answers include: Report complaints of pain or unrelieved pain promptly to the nurse. Check on the resident often and ask if the pain has been relieved. Offer back rubs frequently. Assist in frequent changes of position. Offer warm baths or showers. Encourage slow, deep breaths, if the resident has difficulty breathing. Always be patient, caring, gentle, and sympathetic. 17. The pulse deficit is the difference between an apical pulse and another pulse. 18. Systolic, and the normal range for systolic blood pressure for an adult is 100 119 mm Hg. Diastolic, and the normal range for diastolic blood pressure for an adult is 60 79 mm Hg. 19. A blood pressure reading of 140/90 is considered high. 20. Answers include: age, exercise, stress, race, heredity, obesity/unhealthy diet, alcohol, tobacco products, time of day, and illness 21. To make sure that the reading will not be falsely high or low. 22. Brachial 23. Answers include: an intravenous line (IV) is present; an amputation has been performed; the cuff does not fit the arm properly; the arm has a cast; burns or injuries are present; the arm is being used for dialysis; the arm or