Vital Sign Failer.

unicoRNurse · Sep 21, 2012

Your school's skills lab should have all the instruments on which you need to practice. Our skills lab is staffed during all open hours with lab instructors who are really helpful in terms of providing little tips (like keep your non-dominant hand under the patient's elbow and your thumb on your stethoscope while taking blood pressure -- keeps the patient from bending her arm) or helping you out if you are doing something wrong. Practice on all the different types of sphygmos, thermometers, etc. in the lab, because you will have to be able to use whatever kind your facility has. Also, practice taking pulses on different people. We aren't allowed to have non-students in our lab (which stinks, but I can understand why they have that policy), so in addition to lab practice I spent $35 on a sphygmo and practiced outside the lab on my husband, parents, friends, etc.

I imagine you get a second try, so practice as much as you can between now and then, seek help from instructors or strong classmates, and go pass your VS return demo. Good luck!

rubato, ASN, RN · Sep 21, 2012

Going to the lab more was going to be my suggestion as well. You cannot do it until you've practiced it to death. And, yes, check offs are stressful and you fumble more, but go and get the expert advice you need in the lab.

lifelearningrn, BSN, RN · Sep 21, 2012

Many people fail their vital check offs-- I failed the blood pressure reading!! Are y'all using old mercury thermometers or are you having trouble with the mechanism of the electric ones? Those old thermometers are hard to read sometimes-- and I can't imagine using them in practice very often, if ever.

Tarabara · Sep 22, 2012

My friend and I did our vital signs check off together and she couldnt feel my brachial pulse and started crying...now 2 years later we're both RNs doing well and we still laugh about it! Its such a hilarious memory now and a great reminder of where we came from. We all have to start from the beginning, you'll get it and then one day look back and laugh as well.

libby11 · Sep 22, 2012

I agree that you need to spend more time in the lab. We were required to document that we practiced each skill so many times in the lab on campus before we got the opportunity to attempt to check off.

I'm not sure what your campus is like, but if there is not an open lab, or a way to make an appointment with an instructor to practice skills (who is an RN, not student); then you need to go straight to the dean.

Also, my advice in response to this is directly below: "Part of me feels like it’s completely my fault and the other part wonders if the instructors (we have 4 just for this one class for my health practicum 1. I wonder if the fact we are cramming everything into 6 weeks for all the basic nursing things is what is effecting this too and if all schools do this; or is it just me) should have helped more."

At this point... does it matter whose fault it is? If you determined whose fault it was, would it make the situation any better? Focus not on the failure and the fault, but focusing on what you can do today & this week, to move FORWARD. Also, your attitude will play into whether or not you pass, so punch a pillow, cry, or eat a whole box of cookies, get it out of your system. Take a long, hot shower, go for a run, do some yoga, write in a journal, rock out to your favorite tunes, whatever you do to 'start over' or 'reset.' Then take a long, hard look in the mirror, dig deep and tell yourself that you are smart, confident, and skilled. You will study and practice to the best of your abilities. You will smile and be positive. You will PASS your skills checkoffs.

Let us know how it goes. We are all cheering for you!

(Oh yeah, and get this! I failed my CNA exam... because I couldn't count a pulse... the test you take to be licensed by the state, the one that costs $125 to take, the test you have to pay again to re-test... yeah. it sucked. I cried... but I retook it and passed and got a CNA job and will be ready to take the NCLEX in a year, hopefully anyway)

Swellz · Sep 28, 2012

We were required to take 25 vital signs by a certain day as homework. I found it helped me a lot to practice on everyone. I seriously went up and down my street knocking on doors (of neighbors I knew, ok, it's not that weird I swear lol) and taking vital signs.

You will get through this. It was probably more test anxiety than anything else!

Stephalump · Sep 28, 2012

So I feel like a failer. I cant believe I failed my check offs for vital signs. I practiced for it and everything. I messed up reading the thermometer and got it confused with the scale. I kept miss reading it and the instructor even rolled their eyes at one point (that just really made me sad and depressed). Then I got to the pulse rate. I would feel the pulse, then once I started time it felt weaker and weaker, then gone. I tried pressing lightly and I tried pressing a little hard. Still I had about a 13 pulse difference than my instructor. Then after that failer I tried the blood pressure. The student would collapse her arm after I kept straightening it and push the cuff down off the one inch margin I tried to leave between the dip where your elbow forms and the cuff. I tried to take to listen to the brachial pulse the first time and got no sound. I felt where her pulse was but I think her arm moved again after I found it. I got a second try. At this point I was just depressed and felt really hopeless. I read the line wrong for systolic pressure.
I just dont know what to do, I read my book, and I practiced. I wish our instructors would have walked us through as a class and not just show us an example once and thats it. I dont know anyone to ask for advice or help me practice it right. I just feel like I never even practiced it right the first time after all my practicing. It depresses and embarrasses me more to know the instructor rolled her eyes at me when I tried to make sense of the thermometer. I feel like I dont even want to go back. I really want to be a nurse but it makes me question if Im even cut out for it. Part of me feels like its completely my fault and the other part wonders if the instructors (we have 4 just for this one class for my health practicum 1. I wonder if the fact we are cramming everything into 6 weeks for all the basic nursing things is what is effecting this too and if all schools do this; or is it just me) should have helped more.
I just dont know anymore. I guess Im hoping to find helpful advice and examples of exactly how a good pulse rate should feel like and maybe a refresher how to read the thermometers with four lines in between each number. I just really want to get this right and try to find enough confidents to return to class this Monday.

I'm curious t know what your instructor expects you to do now that you've failed. Did you ask for suggestions on how to improve? Obviously the key is PRACTICE, but do they have open lab? One on one help? Or are you supposed to buy your own thermometer and BP cuff and practice at home? Do you have friends in class oh have mastered those skills who can help? My nursing buddies have been absolutely invaluable to me. Always willing to lend a hand so no one gets left behind.

I know failing is a bummer and you have every right to be down in the dumps, but try to keep a little perspective. It's taking a TEMPERATURE. A pulse. A BP. It can be confusing at first, but once you figure it out, it's nothing. Easy peasy. Don't be taken down by it. I know you said you practiced, but if you still can't do it you didn't practice enough. So practice more. :)

akulahawkRN, ADN, RN, EMT-P · Sep 28, 2012

I know that failing the skills lab, in particular taking vital signs, seems like a pretty good downer right now. Taking vital signs is a really easy thing to do, once you understand how to do it. Over the last few years, I have done easily greater than 20,000 sets of vital signs. It is something that has become essentially second nature to me. That doesn't mean that I do not remember how it felt like when I first started taking vital signs.

When reading a temperature, make sure that the thermometer is in the correct mode: Fahrenheit or Celsius. Make sure that the tip of the thermometer is in the correct point in the mouth, under the arm, wherever you are taking it. Keep the thermometer in place until the reading is obtained. This is not hard, though testing environments can be intimidating. You can get through this.

Getting a blood pressure is equally a difficult thing at first. Probably the easiest way to find out where to place the stethoscope head is to palpate the brachial pulse. Have your subject straighten his or her arm out until it is straight. Place your fingers just medial to the biceps tendon. You should feel a little bit of a depression in there, just lateral from the head of the ulna. It is in that depression that you should find a brachial pulse. Palpate that distally, just past the crease in the elbow. It is there that you place the head of the stethoscope.Just make sure that you have the stethoscope rotated to the right position so that you hear from the diaphragm, rather than the Bell. Make a mental note of that location. You'll need it in a moment. Relocate the radial pulse at the wrist. Once you have felt it, inflate the cuff until you feel the pulse disappear. Deflate the cuff slowly, 1 – 2 mmHG per second, until you feel the pulse return. Make a note of that reading. Now is when you place the stethoscope head at that spot that you took note of earlier, at the brachial pulse that you palpated. Inflate the cuff just a little bit, to approximately 90 – 100 mmHg, you should start hearing the sounds, like a tap tap tap in your ears. Once you hear that, begin inflating the cuff to approximately 180 mmHg, at that point you should not hear the sounds anymore. Began deflating the cuff at 1 – 2 mmHg per second, and take note of when you 1st start hearing sounds in your ears. That is the systolic blood pressure, and it should be relatively close to the reading you got earlier when you felt that. Continue deflating until you hear the sounds disappear. That is the diastolic pressure. You are done with this particular task, write it down.

Taking a pulse is just as easy, if not easier. You want to acquire the radial pulse with your fingers. Probably the quickest, easiest way to find it is to mentally draw a line along the thumb, right where crosses the wrist bones is about where the radial pulse will be. Use 2 or 3 fingers to palpate that pulse. Once you have located use only enough pressure to feel the pulse beneath your fingertips. A lot of pressure will include the artery and prevent you from feeling the pulse. Next you find a watch or a clock with a sweeping secondhand, make a note of where the hand is on the clock or on your watch. Beginning counting, at 1 min., when the sweeping secondhand has returned to the position that it started from, that is the pulse. You want to count for one full minute because patients can have irregularly irregular pulses and it can be wildly different from minute to minute, even within the same minute, if you only count for 15 seconds or 30 seconds and multiply by 4 or by two respectively.

Counting respirations is also relatively easy. An easy way to do it, is to find the radial pulse, and pretend to take the pulse for 2 min. During one of those minutes, you count the pulse, and the other minutes you count the respirations. That is one full cycle in and out, I begin and end counting on inspiration. That is just simply what I do.

At that point, you have taken a full set of vital signs. I know I have said a lot in this post, but practice that a lot. Practice taking someone's holds. Practice taking someone's respirations. Practice getting a blood pressure from people that are willing to let you do it. If you have a thermometer practice with the darn thing! The thing is that you need to practice, and practice, and practice. It took me a long time to get to be as proficient as I am at it. After doing thousands of these things manually, I can get a set of vital signs often faster than a machine can. If you can, get vital signs the manual way, until you are good at getting it every time. Once you are there, then you can delegate some of that task to the machine.

If you are close enough to me, I would volunteer a few minutes of my time to give you some instruction on how to do it. Being that this is a worldwide forum, it is not likely that is the case. There are a lot of people that take vital signs were living. If you know someone who is an EMT, paramedic, working medical person of some sort, they should be able to help you learn how to do it. Just ask. The worst they can tell you is "I am sorry I don't have the time right now." Some of them might say "no" and that is okay. Just go ask someone else. Just don't be too much of a pest.

Good luck, the next time you take the skills exam, you'll do just fine! As you learn how to do it, and you become proficient at it, take a few minutes to teach someone else how to do it. Pass it on, pass it forward.

apedrique · Mar 7, 2015

I have the normal ranges down, but we have to state the abnormal ranges for each skill within the vitals. I keep getting all the information mixed up. What are the correct abnormal ranges for each. We also have to do a pain assessment at the beginning. Would that simply be, "Are you currently experiencing any pain?" or "On a scale of 0-10, are you currently experiencing any pain?"

My check off sheet also says, "Verify most recent health care provider's order," at the start of assessment. Any clue?