I'm not in the library anymore. Those Apple Macs drive me up the wall! I hate the mice and I hate the Caps Lock button because it keeps sticking!! Grr...
It's great to be back on my beautiful Dell Inspiron Q15R!
In this post I'll be covering clinical skills. In particular I'll be talking about Vital signs and how to take them! Enjoy!
Vital Signs (TPR)
Respiration Rate
Before taking a patients breathing rate (BR), they must have been relaxed for at least five minutes, not talking. The BR must be taken over one minute to ensure that we do not miss anything out. One breath is counted as one rise and fall of the chest.
It may also help to look at the abdominals as well as observing the depth of breathing.
If both sides of the chest do not rise (both sides moving is known as bi-lateral movement), for instance, the patient could be suffering from a collasped lung.
It is also important to observe and see whether breathing is...
* regular
* through the nose or mouth
* loud/quiet
* Allowing them to speak
* laboured
Pulse
When measuring a persons pulse, we are taking note of the number of times their heart is beating in a minute (BPM). The blood in the artery is at high pressure, this makes it easy to record pulse.
Where we can take pulse...
* Radial artery - Wrist - choosen as the 'easiest' to take because it does not restrict a patient of personal space
* Carotid artery - Neck - Big vessel that is closest so your heart
* Pedal artery - Foot - Choosen if the patient has a compliant that might compromise circulation in the leg or foot
* Femoral artery - Inner thigh
* Popliteal artery - Behind the knee
* Brachial artery - In crook of arm, Other side of the elbow
* Temporal artery - Temples at the side of the head
Small childrens radial arteries are smaller and therefore harder to find so a more accurate way of taking their pulse would be to use a stethoscope on the apex of the heart (just under the breast).
Technique
* When taking pulse, use two fingers (preferably the two middle fingers; not your thumb or index finger as, of course, you have a pulse which can give off inaccurate readings). Using two fingers instead of say, one, widens the surface area meaning you will get a more accurate reading.
* Push down gently for a few moments before counting
* What helps me to remember where to find the radial pulse, is that you will most likely find a pulse on your wrist in line with your thumb.
* Also, what helps me find the brachial pulse is that this pulse will be found on the side of the arm opposite the thumb!
* If you are not sure or get the reading wrong, don't guess. Do it again!
* If you cannot find the pulse, try the other arm or drop the arm so that it is haning down freely. This increases bloodflow.
* Also some people suffer from heightened anxiety before their blood pressure is taken. This is known as White Coat Syndrome (my nana says that she has this!!) which is fear of going to the doctors/to the hospital, basically!
* Bradycardia is a term meaning a HR under 60 BPM
* Tachycardia is a term meaning a HR over 100 (meaning that something has changed in their physiology. For instance, they may be losing a lot of blood so their body is trying to compensate for the lost blood and therefore increases HR).
* A normal HR would be approx. 60-100 BPM.
Temperature
Temperature is a good sign of infection as there are many metabolic functions going on in the body that affect temperature.
Normal body tempertature is approx. 37-36.5 degrees celcius. (Childrens might be slightly different).
It's important to recognise that you should know the internal (core) temperature instead of the external termperature.
A temporal reader can be used to take temperature by running the device from the middle of the head to the hairline at the temple and then to behind the ear.
A digital thermometer can also be used or even a Tympanic Thermometer.
Before taking temperaturecheck whether the patient is wearing a lot of clothes, has just had a hot bath, a hot drink or is covered with a lot of bed sheets as all these factors can contribute to higher temperature.
Terminology
Pyrexia is the term used to describe high temperature. A pyrexial (hyperthermic) patient would have a temperature above 38 degrees celcius. In the same way, hypothermia is low core temperature. A person is apyexial if they have normal core temperature.
Something else I found interesting is that if someone does not show the symptoms of a complaint (and therefore will not be treated) is said to be asymptomatic. Something else a little bit random I found interesting - any term ending in 'itis' such as 'bronchitis' describes an inflammation of something. E.g. bronchitis is an inflammation of the main air passages into the lungs.
Blood Pressure
When measuring blood pressure, it is important to remember that you are actually measuring the pressure of blood coming out of the heart. Also the patients may actually be aware of their own BP as they probably take it themselves at home if they have hypertension.
BP is measured in mmHg, by a sphygmomanometer.
A normal BP is considered to be 100/70. Hypertension is high BP is is said to be pressures similar to 140/80, for instance. However, always remember when taking TPRs that what is considered 'normal' may not be 'normal' for your patient. Everyone is different.
Blood pressures are made up of two different pressures. Systolic and Diastolic. Systolic pressure is pressure when the heart is contracting. Diastolic is pressure of the blood in the arteries when the heart is at rest between beats. So, in a BP of 100/70, a patients systolic pressure would be 100 and their diastolic would be 70. When measuring BP using a sphygmomanometer, you can refer to the little numbered gauge to find the systolic and diastolic pressure.
Technique
* Tell the patient to fully relax
* The rubber bladder inside the sphygmomanometer should cover 80% of their arm circumference.
* As well as a sphygmomanometer you will also need a stethoscope in order to find the systolic and distolic pressures.
* Inflate the cuff, listening carefully using the stethoscope. When you do not hear the pulse, or the pulse has seemingly stopped, record this as the systolic pressure. (Refer to the little gauge to record the number). Then slowly release the air, listening again for the pulse to stop. This is the diastolic pressure.
* Make sure that you document what arm you took the BP from.
Oxygen Saturation
02 saturation is the amount of oxygen carried in the blood.
'Normal' oxygen saturation woud be aprrox. 94-99. 02 saturation can easily be taken from the finger by a oximeter (which also can record your HR).
Oxygen saturation can be improved by regularly changing position.
Another random little note: pain is also seen as a vital sign as it indicates that a patient is conscious enough to recognise pain and that they still have feeling in an area.
Thats all folks!! Hope you liked this post! Thanks for reading!
Emily
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