Do you take vitals on babies who are sleeping?

wish_me_luck, BSN, RN · Sep 29, 2012

That is up to your policy at your hospital. Ask the staff and also look in the policy and procedure manual.

allnurses Guide · Sep 29, 2012

Yes. You need to get an order to skip vitals due to the baby sleeping. I totally sympathize! Especially when they've been fussy for hours.

umcRN, BSN, RN · Sep 29, 2012

Yup. I work in an ICU so we're a bit more strict with that but on our step down they still do vitals q4, the techs can try to cluster them to when their awake but it doesn't always work that way and they have to be done, especially on a cardiac unit (I work cardiac ICU so its a cardiac step down)

anon456, BSN, RN · Sep 29, 2012

Yes we still do. They are there because they require nursing care. I also listen to breath sounds and feel pulses. If the family refuses I notify the MD and chart it. Its my license and baby's health if I miss something.

turnforthenurse, MSN, NP · Sep 29, 2012

Yes you still do. If anything, I think it's easier to get a HR and RR on a sleeping baby than a crying, fussy one.

KelRN215, BSN, RN · Sep 29, 2012

For pediatric oncology, depending on what chemo they're on, you may have to change their diapers as frequently as q 2hrs anyway. And yes, you still need to do vitals on them when they're sleeping... babies, toddlers, pre-schoolers, school-aged kids and teenagers. They all get vitals overnight. ESPECIALLY in oncology, we need to know if they're spiking fevers. If there's a family that's been in for a long time and refuses overnight vitals, the nurse should tell you this at the start of the shift. Babies in the hospital rarely sleep through the night. When I worked in the hospital, we (nurses) also woke them up at a minimum of q 4hrs for neuro checks.

CP2013 · Sep 30, 2012

In some hospitals, you continue to do pulse, respirations, and temperature every 4 hours, and BP at 0800 along with TPR.

Depends on your facility and sometimes on the child as well. But TPR q4h, and BP-TPR every 0800.

rn/writer, RN · Sep 30, 2012

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.

Pediatric Critical Care Columnist · Oct 1, 2012

I wholeheartedly second everything that Miranda has said. Especially the part about choices. They have NO choice about having the vitals done so don't suggest they do. They DO have a choice about what order they're done in, which arm is used, whether their stuffy is assessed first and that kind of thing. It's more than possible to get vitals on sleeping kids; what I really resist is doing oral care on my intubated and sleeping kiddies in the PICU - they don't sleep through that and then they need more sedation. For that I wait until they wake up on their own.

Katie71275 · Oct 5, 2012

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, BSN, RN · Oct 5, 2012

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.