Do you take vitals on babies who are sleeping? - page 2

by chariot, ASN, RN | 7,899 Views | 23 Comments

I'm a new nursing assistant in the float team. We get sent everywhere including the peds floor. I know we take vitals every 4 hours on patients in the adult floors. As for the pediatric floors like pediatric oncology, do we... Read More


  1. 1
    Im a nursing student, but a nurse tech on the ped's floor. We do take vitals on sleeping pts...in fact they are easier when they are asleep! I do everything before the BP cuff. So 1st thing I do is count the respirations b/c have you ever actually counted resp. on a moving screaming 1 yr old? Then I move to temp, and then the BP cuff. I always put the BP cuff on the calf and that's usually pretty easy and some even sleep through it
    wooh likes this.
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    Quote from Katie71275
    Im a nursing student, but a nurse tech on the ped's floor. We do take vitals on sleeping pts...in fact they are easier when they are asleep! I do everything before the BP cuff. So 1st thing I do is count the respirations b/c have you ever actually counted resp. on a moving screaming 1 yr old? Then I move to temp, and then the BP cuff. I always put the BP cuff on the calf and that's usually pretty easy and some even sleep through it
    I actually do BP before T, as it's easier to get a temp on the baby if they wake during the BP than to get a BP if they wake during the temp.
    I try to use some common sense though. If it's a baby on day 9 of 10 days of antibiotics for meningitis, that's eating/drinking/peeing and stable? I'll be willing to skip one of the three sets we do over a 12 hour shift. If it's a baby that's been fussy and obviously miserable and they've JUST fallen asleep? I'll let them sleep for a while and go back later when they're less likely to wake up.

    It's kind of an art getting vitals on a sleeping kid. Like with a sleeping adult, you don't grab their arm to throw the BP cuff on, you gently touch their arm so they aren't scared awake. Same with the babies. I'll gently touch them before doing anything. Sneak the cuff on. If they start to stir, gently pat their chest/stroke their head. Unless they're needing a diaper change/hungry and were about to wake anyway, they pretty much always go back to sleep.
    tryingtohaveitall and rn/writer like this.
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    This...depends on which department you work in.

    I used to work in a facility where every baby was on a monitor, unless it was well-baby nursery.

    When the babies were on a monitor, we DID NOT wake them up for vitals...they were already on a monitor, so we just wrote them down off the monitor. We did our listening and temperatures during times when the baby was awake. It always translated to "roughly" Q4 vitals. So the baby was assessed very often. You cannot get obsessive about, "Oh, it's 2:00 a.m., time for vitals!!!" No, we did it around the baby's schedule.

    Now, with well-baby nursery, where they are not on vitals...they are also, being fed every 2 to 3 hours. We had the parents to call us when the baby was awake around the time that vitals were to be taken.

    This is called "consolidation of care". It is to NO BENEFIT to keep waking a sick or sleeping infant just because you didn't get there when the baby is awake. Most units have smaller assignments in peds, well-baby and the NICU, so it is VERY possible to work around the baby's schedule.
    rn/writer likes this.
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    Absolutely you take vital signs on a sleeping patient.

    Sometimes a sleeping patient can be a sign of deterioration. My last six months have been spent in paediatric neurology/neurosurgery and it's absolutely critical to wake these children for the hourly, second hourly or fourth hourly vital signs and neuro obs.
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    We take vitals as they are ordered - Q2 (Gah, hope not), Q4, or Q8. I will say that I think we over monitor sometimes, however. A kid that is in the hospital as a feeder/grower... do we really need to be shoving a thermometer up their bum every 4 hours?

    But to answer the question, they are done as they are ordered. A parent can (and they do!) refuse anything - and they often do. We are based around "family centered care", which sometimes I also think we take too far (but that's a different thread, perhaps. LOL). If a patient refuses, we chart it.
  6. 1
    Quote from ~PedsRN~
    We take vitals as they are ordered - Q2 (Gah, hope not), Q4, or Q8. I will say that I think we over monitor sometimes, however. A kid that is in the hospital as a feeder/grower... do we really need to be shoving a thermometer up their bum every 4 hours?

    But to answer the question, they are done as they are ordered. A parent can (and they do!) refuse anything - and they often do. We are based around "family centered care", which sometimes I also think we take too far (but that's a different thread, perhaps. LOL). If a patient refuses, we chart it.
    We take axillary temps on newborns. We might take a rectal temp if the axillary temp is really low after several tries, but this happens so rarely that I can't remember the last time I took one.

    Rectal temps carry a only a small risk when done by a professional, but many docs do not want parents attempting this at home. To that end (pun intended), they'd rather not have parents even see a rectal temp being taken.

    Of course, this could be different with a critically ill child in a PICU. But even it our NICU, I have never seen a rectal temp being taken.
    nursel56 likes this.
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    Quote from rn/writer
    Of course, this could be different with a critically ill child in a PICU. But even it our NICU, I have never seen a rectal temp being taken.
    In our PICU if we're that concerned about a kid's temp that we're doing rectal temps, we'll put in either a rectal or esophageal probe to monitor it continuously. The probes are not much different from an NG - soft and flexible - so they're an obvious choice for us. Obvious contraindications for rectal temps in any child would be things like lower GI and ano-rectal (for imperforate anus, for example) surgery, perineal burns and thrombocytopenia. Axillary temps can be difficult to obtain accurately if the kiddie is very scrawny (no flesh to press together!) but I've sometimes used the inguinal fold instead on those ones. I don't recommend tympanic temps on any child because the thermometer must be positioned JUST SO to accurately bounce off the eardrum and that's usually impossible in a conscious child.
    NRSKarenRN and KelRN215 like this.
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    Thanks for the explanation, Jan. I thought as much. A continuous soft probe would be much less hazardous and traumatic than a rigid thermometer. Sad to think of little ones so scrawny you can't do axillary temps, although I do see this sometimes in 36-weekers. I'll keep that inguinal option in mind.
    Last edit by rn/writer on Oct 22, '12
  9. 0
    I agree about the rectal temps... I've only done rectal temps a handful of times in 5 years as a pediatric nurse. In the oncology population, it was against policy to do rectal temps on them. Occasionally, if you got a temp of 34 degrees Celcius axillary on a patient who wasn't known to be baseline low (I saw many patients with severe brain injuries from birth whose baseline temps were in the 34-35 degree range), then you'd do a rectal temp. I vaguely remember one patient who was going to need to have an LP if he spiked again and had a temp of 39.2 axillary using the disposable thermometer when the CNA checked him. When I rechecked it, he was 38 something but lower than 38.5. 38.5 was the cutoff to take action and it was a significant discrepancy between the 2 thermometers so we did a rectal temp. He ended up getting the LP.

    I also agree about the tympanics. When I worked in neurosurgery, I spent years trying to get people to stop taking tympanic temps on post-op cranis. You could seriously get a tympanic temp of 39.2 reported by the CNA and go recheck the kid and find that his oral temp is a perfect 37. You could also have a temp of 39 in one ear and a temp of 34 in the other. I just don't trust those thermometers.
  10. 0
    It is our policy that all children under the age of one have rectal temps. We are a large children's hospital, and our floor is one of high acuity. I often use "nursing judgement".


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