11 Sep 30, '12
by rn/writer Guide
Here are some tips for taking vitals on a sleeping child. I've learned them from my own practice and from taking care of my kids and other family members.
Speak to the child first. Don't just ambush them with your touch. They need to feel safe in their beds and know that any intrusion into their space will come with warning signs, or they'll never really relax.
Tell them what you're going to do before you do it. Even the pre-verbal kids can take this in on some level.
Touch them gently before doing the procedure. Stroke their hair or an arm and talk to them. If they open their eyes, show them the stethoscope or thermometer.
DON'T ask them if it's okay to take their temp or B/P? This implies a choice which they really don't have, and it sets up both child and nurse to be unhappy. If you ask and the child says no, then what?
DON'T say you want to TAKE their temp or B/P or pulse. Kids learn pretty early that taking something from them leaves a hole where that something used to be. Instead, say you need to check their temp, etc.
Give choices they actually do have. Right or left arm for B/P. If only one arm is suitable, ask if they want the B/P first or last.
Let them listen use the stethoscope to listen to their own heartbeats. Then transfer the earpieces to yourself.
When you are done, thank the child for helping you to help them get better.
Even if the child doesn't fully awaken, keep talking gently and narrate what you're doing. Thank them when you're finished.
Try to coordinate with the interruptions caused by other disciplines. RT has to check some of the same vitals before and after a treatment. Ask parents to call you if the child gets up to use the bathroom or wakes for some other reason. If you have scheduled meds or the likelihood of prn meds, do your vitals with these things. Use some common sense.
Vitals at three hours or five hours isn't the end of the world with a kid who is fairly stable. You can also do a preliminary check and (with a soft word) touch the skin, listen to the respirations, get a reading on the depth of sleep, and so on.
I have seen nurses who do a beautiful job of taking nighttime vitals with a minimum of disruption and others whose lack of courtesy and skill have upset kids and parents alike. I admire the former and wish the later would get a clue.
Last edit by rn/writer on Sep 30, '12