Vitals question

  1. There's a post here and some people were commenting on vitals and how they do it. What's your method? I basically just check temps if it's something related to fevers, like colds or headaches, or if the child says they feel "hot". I'm not sure of full vitals though, when do you do these? I do hear chests if the child says their chest hurts and such, but I'm not sure what else I can do for vitals.

    How do you guys do it?
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  2. 48 Comments

  3. by   OhioBPH
    Are you trained to listen to breath sounds? I am not, so if I have someone I am worried about I call the district RN. I just get temps, sometimes a pulse. Occasionally I'll get a pulse-ox to reassure a student that they are getting enough air on rare occasion (frequent fliers). If I get a pulse it's often to report it to EMS when they arrive.

    Unless you have an order with protocol for what to do, I would not obtain the vital.
  4. by   ruby_jane
    What does your certification allow you to do and what have you been trained to do?

    My unlicensed clinic aide has been trained to take temp, use the BP "machine", and use a pulse oximiter. She does not count respirations. She doesn't take a manual pulse. She does not auscultate breath sounds and cannot differentiate heart rhythm...although she knows that over 100 means something needs to be done.

    She only does this when I am away from the office (as in, she'll start and I usually double check). If there was no nurse here, she is instructed to call EMS.
  5. by   WineRN
    I'm not sure of what your scope includes A, so like Ohio said above, I would get that clarified before doing a full set of vitals.

    Every visit is different for me, except everyone gets a temp check. I probably listen to breath and bowel sounds more than needed, but I feel like lately a lot of my "stomach aches" are actually just a side effect from excessive coughing or just hunger. I take BPs for dizziness, first time headaches. Neuro checks for head injuries. The ones who stump me (non FFs with odd symptoms) get a head to toe.
  6. by   Amethya
    I am trained in EVERYTHING. Basically l know how to listen to heart rhythms, breath sounds, BP, Pulse Oximeter, temp, manual pulse, etc.

    *If you are in Houston,Texas and in need of a Medical Aide for you school, PM me btw.*

    I can do all this, but I'm not sure when to do this, or when I'm over reacting on something.

    I only do vitals if there's an emergency or something is going on. But if the child has chest pains or anything like that I do hear their chest. I don't use my pulse oximeter much, because it seems to act up sometimes and I can get a better reading doing respiration counts myself.

    Here's an example:

    I had a student who came to me because she felt dizzy. I checked her vitals, basically heart rhythm, respiration, BP, pulse oximeter, manual pulse. Was sent home. She was fine in that, and later I learned this girl was lying just to get out of class, but I did my protocol.

    I had a student who came with chest pains, has a history of heart issues. Heart rate was good, heart rhythm sounded good, respiration, BP and oximeter said he was fine. Mother just asked him to rest for a while and he felt better after a rest.

    I just a student come in because a nasal congestion and cough, checked temp, normal. (98.3). Informed mother, went home.

    Abdominal is something I was taught but I'm not good at, so I just go by asking where does their stomach hurt. (Below belly button (if female poss. cramps) or around belly button, possibly needs to go to the restroom. Above belly button, possibly hungry or ate something that doesn't work for them, get a drink of water. Nothing works, I inform parents anyways to ask them to see what they would they want to do with them.
  7. by   OhioBPH
    I would review your scope. Here in Ohio anything I do is delegated to me, which means a physician or nurse tells me what to do, and what to do with the results. So if I listen to heart rhythm and it is off, do I have protocol for what to do? My RN and organization do not want me doing these things. It is not delegated, so I do not. None of my procedures indicate more than a temp check, really.
  8. by   Amethya
    Quote from OhioBPH
    I would review your scope. Here in Ohio anything I do is delegated to me, which means a physician or nurse tells me what to do, and what to do with the results. So if I listen to heart rhythm and it is off, do I have protocol for what to do? My RN and organization do not want me doing these things. It is not delegated, so I do not. None of my procedures indicate more than a temp check, really.
    Here in Texas I can do anything a nurse can do as long as I was trained or taught and I'm under supervision of a RN, NP or MD, or given permission to do so. I can't diagnose obviously, but I can do vitals and such, and that's it.

    That's all I do basically, vitals, inform parents and if the parents want to take them home or not, that's their responsibility.
  9. by   tining
    Quote from Amethya
    I am trained in EVERYTHING. Basically l know how to listen to heart rhythms, breath sounds, BP, Pulse Oximeter, temp, manual pulse, etc.

    I only do vitals if there's an emergency or something is going on. But if the child has chest pains or anything like that I do hear their chest. I don't use my pulse oximeter much, because it seems to act up sometimes and I can get a better reading doing respiration counts myself.

    Here's an example:

    I had a student who came to me because she felt dizzy. I checked her vitals, basically heart rhythm, respiration, BP, pulse oximeter, manual pulse. Was sent home. She was fine in that, and later I learned this girl was lying just to get out of class, but I did my protocol.

    Abdominal is something I was taught but I'm not good at, so I just go by asking where does their stomach hurt. (Below belly button (if female poss. cramps) or around belly button, possibly needs to go to the restroom. Above belly button, possibly hungry or ate something that doesn't work for them, get a drink of water. Nothing works, I inform parents anyways to ask them to see what they would they want to do with them.
    A pulse ox checks the oxygenation of a patient and in no way could you ever "get a better reading doing respiration counts myself" A pulse ox will also check heart rates and does not do "respiration counts." Maybe that is why you are not utilizing this tool well.

    Heart rhythms are different from heart rates or the pulse and we auscultate those.

    Abdomens have 4 quadrants that Nurses auscultate.

    You have an RN that supervises you and trained you?
    Last edit by tining on Jan 19
  10. by   OyWithThePoodles
    I haven't read other posts so forgive me if I am repeating.

    I check temps for any stomachache, earache, headache, sore throat, or just blah.

    O2: Feelings of SOA, persistent cough, dizziness (just as a CYA)

    HR: same as O2 because of the pulse ox

    BP: True feelings of dizziness or a student just doesn't look right. Feelings of being hot all of a sudden, and occasionally if there's a really bad headache with flushed face but no fever.

    RR: Asthma kiddos if they are struggling or my anxiety kids.
  11. by   Amethya
    Quote from tining
    A pulse ox checks the oxygenation of a patient and in no way could you ever "get a better reading doing respiration counts myself" A pulse ox will also check heart rates and does not do "respiration counts." Maybe that is why you are not utilizing this tool well.

    Heart rhythms are different from heart rates or the pulse and we auscultate those.
    I'm sorry. I mis wrote that. I meant to say the heart rate not the respirations. I know it doesn't do respiration, that's my mistake. I meant the pulse. The pulse ox is old and sometimes I think it doesn't work with pulse, as well with ox. When I used it before it sometimes would say the student had 114 of pulse, but when I did it manually it would be 94. I do use it for pulse ox, but I have to squeeze it for it read well.

    I might have to get a new one or change the batteries I believe.

    Heart rhythms I know it's different from heart rates and pulse, but I do listen to them to if the child says their chest hurts.

    Sorry for writing it wrong, I wasn't paying attention what I was writing.
  12. by   Amethya
    Quote from OyWithThePoodles
    I haven't read other posts so forgive me if I am repeating.

    I check temps for any stomachache, earache, headache, sore throat, or just blah.

    O2: Feelings of SOA, persistent cough, dizziness (just as a CYA)

    HR: same as O2 because of the pulse ox

    BP: True feelings of dizziness or a student just doesn't look right. Feelings of being hot all of a sudden, and occasionally if there's a really bad headache with flushed face but no fever.

    RR: Asthma kiddos if they are struggling or my anxiety kids.
    No this is what I was looking for as an answer. I do temps like you, but not for stomach aches, unless the student looks really bad.
  13. by   OhioBPH
    Quote from Amethya
    I do temps like you, but not for stomach aches, unless the student looks really bad.
    Why not a temp on a stomach ache? Thats one of the few things I always get a temp on. Sorethroat, stoamch ache. Temp temp.
  14. by   LikeTheDeadSea
    Quote from Amethya

    I can do all this, but I'm not sure when to do this, or when I'm over reacting on something
    .

    I only do vitals if there's an emergency or something is going on. But if the child has chest pains or anything like that I do hear their chest. I don't use my pulse oximeter much, because it seems to act up sometimes and I can get a better reading doing respiration counts myself.

    In my state, MAs can be delegated to take vital information, but cannot interpret the numbers. They are given guidelines for when to get a staff member for immediate assessment/interpretation. From some responses, it looks like your job is "Take vitals, call parent and let them interpret what you find," but a staff member is not nearby for follow-up.
    If I was a district RN in this scenario, I'd be very nervous related to my license with how much is being delegated, especially with the increase of chronic conditions in the school setting. The Pulse Ox / Respiration Rate statement is a good example of assessment tools to help narrow an issue - but although they compliment each other, they are not interchangeable and doing both is necessary to narrow down certain issues. If I got an abnormal number for either, I'd definitely want to know the other. Based on this, I'd request a WRITTEN policy/guideline for what vitals should be done for what symptoms. In a hospital you would be told which ones and at what frequency, so I feel like it is reasonable to request this as protection for both you and the nurse.

    Best of luck in your job hunt! Hoping you get somewhere with more supports!

    EDIT addition: Saw you clarify the pulse ox/ respiration error above (Thank you!) - I'm not removing it from my post because I think it is a good example that I'm sure is a decently common error among people. I remember really needing to focus when learning about the differences and if I was charge over people, how do I know they're not looking at it that way?
    Last edit by LikeTheDeadSea on Jan 19 : Reason: OP clarified in comments above

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