Help with vitals...tips, tricks, anything???Please

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HI all,

I Just started LPN school this week and I need a little advice from the pros on this wonderful site...:bow::bow:

Can anyone offer any tips for taking vitals....

I have no problem finding pulses except sometimes the brachial, I am doing well with bp, however, sometimes I have trouble with technique. Sometimes I feel like an elephant in a china shop, I want to be able to progress through full set of vitals without the awkwardness. If anyone has any tips as far as body positioning, both mine and the patient, tips for trying to take respirations, which is sometimes difficult, sometimes it's not easy to see the rise and fall, is there a certain way I should be standing. I'm just trying find any little info that might help out any. I know I will get better with practice, and I have been, we were required to a full set on all 37 of our classmates. We have to test on this next week and I would appreciate any advice. Thanks.:):)

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Specializes in Psych.

Practice on everyone and anyone that will let you :) And feel confident when you are doing it. Attitude has a lot to do with everything.

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Respirations are easier to see if you watch the stomach rather than the chest. Watching the area of the collar bones works too, if they are visible. Watch the shoulder if someone is lying on their side.

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Specializes in Psych, Maternity, ER, Ortho.

One of my instructors said it might be helpful to take the pulse with the pt's hand on their chest, then once you are done counting pulse you can look and feel their breathing without making them aware of it.

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Specializes in Infusion.

linnaete, that's exactly how we learned for CNA certification. Continue to hold onto the wrist after taking the pulse so you can watch the rise and fall of the stomach or chest or collar bone.

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Great ideas, thanks so much!

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Specializes in Trauma ICU.

If you're having trouble finding a pulse, you don't need to keep poking around your patient with two fingers looking for it. Sometimes I grasp the back of the wrist with all four of my fingers to feel something. The larger the surface area the better chance I have of finding it right?

It goes the same way for a brachial pulse. And once you find the brachial you've got a good place for a landmark with bp.

I habitually stand to the left side of the patient when doing vitals (on an ambulance you can't exactly fit on the right side because the stretcher is usually up against a wall) so I end up doing the same thing everywhere. Habits are good to get into. Obviously you need to be flexible should something happen but if it helps you from fumbling through things and you're efficient- who cares?

Good luck with everything :)

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Specializes in Step-down, cardiac.

I am so glad you asked this! I feel totally ridiculous fumbling around with the stethoscope and BP cuff and the pressure valve for it--I end up dropping it on the patient's bed half the time, or not lining it up correctly and having to take it off and re-place it on their arm. My husband bought me a stethoscope and cuff for my birthday, and that has made SUCH a difference! I take his vitals pretty much every day, and in just a week or so, it has gotten so much easier. I'm getting used to wrapping the cuff correctly the first time, and sliding on my stethoscope without having to put down the BP squeezy thing (what is that thing's name? :) ). Practice really does make perfect!

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Finding the brachial artery is easier if you tell the patient to let their arm just go limp. Support their elbow with one of your hands and use the fingertips of the other hand to find the pulse. The straighter their arm is, the more the pulse seems to "pop" out. If there is any bend, it becomes much more difficult to find.

For resps, you can sometimes watch the movement of wrinkles in their shirt.

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Specializes in Management, Emergency, Psych, Med Surg.

Practice on your family... practice finding all pulses, even the femoral, pedal. Check your pulse and respirations by placing your stethoscope on the patients chest. You can count the pulse first and then the respiratory rate.

When you have a patient who has a very high or very low blood pressure, check it in both arms. If you use any type of automatic blood pressure device, do not depend on those readings if the blood pressure is too high or low.

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Specializes in Level 3 Neonatal Intensive Care Unit.

To count respirations on my patient, I always do that along with my respiratory assessment. So while I assess the lung sounds, I also assess the respiratory rate. The person who mentioned the automatic machines aren't the best is correct - if I ever get a crazy reading, I always always always do a manual bp. You can always make coversation, too, during the times that you don't need to be counting or listening. You'd be surprised how much the patients actually appreciate someone wanting to talk and listen! But be careful- I went in to do a blood sugar today actually and started small talk and couldn't get out of the room! :)

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I was so glad to read your post, OP. I am starting NS next week, and I am all worked up over vitals which is the first thing we do. I can never find my own brachial pulse!!! I think the above info about letting the arm go limp will help me. Don't even get me going on the popliteal...

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