Vital Signs - what's your routine??

R2ndof7 · Jul 22, 2008

I can't give any different advise than what has already been offered - all good! We have automatic machines in every room at my hospital, and provided that they cooperate, my routine usually involves getting the temperature first, but after I have applied the BP cuff and pulse oximetry probe. Then, especially if it is a talkative patient, I very pointedly tell them that I am going to start their BP. Usually this will keep them quiet for the time being. That way I can check their resps and get a more accurate BP since they're not talking. I have had those patients that seem to do everything possible (not deliberately, of course) to interfere with me getting a solid idea of their RR. Oh my. I have not hesitated in some cases to stand outside their door, hoping that they will not sense me watching them, and count them from out there. If they catch me...I can't make too many apologies! :)

As long as their breathing is regular, I take it for 30 seconds and double it. This changes, of course, if I need to double check an abnormal result (high or low) or if their respirations are irregular. Then I count for a full 60. I have known some to multiply the resps in 15 seconds by 4 for a really fast result, but this is a little too quick of a method for me. I know some nurses who have it ingrained in them to always count for 60. Then the pulse assessment comes in handy. My CNA instructor would do pulse for the first 30, then RR in the last 30 seconds of the minute. All of those little tricks!

As for the time, I think that as long as you do not find yourself suffering extremely by the time expenditure at the beginning of the shift, you should not worry about hurrying through VS rounds. The beginning of the shift is the vital time (no pun intended) for me to make that initial bonding with my patients where I assure them that I am there for them and would like to take care of any continuing needs that often times the previous shift was not able to handle in last minute rushes. The elderly ladies, often times with UTIs, let me know as soon as I come in the room that they need to use the restroom. Better now than later, like when dinner trays have just been delivered and Mr. Jones needs to be fed, or when I am listening to another patient talk. The interruption of my phone ringing has not ceased to strike me as rude, so I can't imagine what the patient feels.

With experience, though, I have become less hesitant to politely indicate that I am unable to chat at the moment (given that what they're communicating is not directy related to patient care), but will be back to check on them and see how they're doing. I do love to listen to stories, especially those from the beloved geriatric patients. The more brisk VS pace is necessary if I forsee a particularly busy night (ie. frequent bathroom calls, multiple complete baths, incontinent patients), or if I am getting a new admission shortly. Assuring the patient of my availability and willingness to help seems to temper that rapid entrance and exit as I try to get those out of the way. I've certainly mellowed in how much I stress about getting things done in a certain amount of time or right away.

Focus on building a good relationship with your patients if possible and let that take care of any awkwardness you may feel! I haven't known anyone to get upset because they thought I was taking too much time with them (unless they're trying to sleep). Neglect is what leaves a negative impression of the hospital with them (if that is the setting in which you work).

crazyNursingStudent1 · Jul 24, 2008

when i come on shift i usually do vitals i have 8 pts unless im short a tech and then i have more it usually takes me about 30 min at the most to do vitals. i use a dynamap too. I usually guess at the resps unless i see that the pt. is breathing different than normal or having apnea then i will stop and count them. I usually ask them if they need anything and then once i am done with vitals then i will get everything at once

mzjennx, BSN, RN · Jul 25, 2008

If your luck and have automatic BP machine, it does it all for you BP and HR. I just would take the temp, then RR afterwards. And if the patient has a Foley or needs assitance to the bathroom, or pericare I will help them at that time.

If no automatic machine then I would do BP first, then HR afterwards.

mzjennx, BSN, RN · Jul 25, 2008

when i come on shift i usually do vitals i have 8 pts unless im short a tech and then i have more it usually takes me about 30 min at the most to do vitals. i use a dynamap too. I usually guess at the resps unless i see that the pt. is breathing different than normal or having apnea then i will stop and count them. I usually ask them if they need anything and then once i am done with vitals then i will get everything at once

GUESSS? I guess... but take the time if your not too busy. I know how it feels to be busy. I was the only CNA working for a 24 bed until in which all patients needed their routine VS. It was dreadful to do and I use to guess before. But the RN will know. Not everyone has the same 20 RR. 10 second is all you need to look at a patient's chest and then x6 and you got your rate per minute. You can do this while your taking the temp.

Besides if you misreport the vital signs, it could be detrimental for the patient so take the time to look at the inhalation and exhalation of the patient even if it means 10-15 seconds of your time. Good luck!

mzjennx, BSN, RN · Jul 25, 2008

yes take note of this. if its irregular you should count the whole minute. and if your not sure, check with the RN or the previous CNA. you should of got report about the patient with the abnormal VS.