vital signs

[hcan]

When an on call nurse goes to a home, is it essential that she get all the vital signs each visit, even if they do not apply to the present situation? Is this something that varies state to state?

[doodlemom]

I'm not an on call nurse but I do not get a bp every time I go to a pt's home - only when there's a need and during my assessment visits.

[leslie :-D]

it depends on what's going on with your pt.

even knowing there's nothing i can do about abn vs, it gives me a broader perspective and associated implications; esp when you can assess the variations from baseline.

leslie

[weetziebat]

We do BP, apical pulse and respirations unless the patient's condition is such that it would make them more uncomfortable. Personally, I've wondered about these since what are we going to do about abnormal vital signs? To me, it just seems something that keeps TPTB happy, rather than anything that accurately shows cause for a change in orders.

Maybe I'm just new, but I've seen excellent vital signs on folks hours away from death.

[EmptytheBoat]

Vital signs are tools to help determine the patient's overall condition

and may be helpful indicators of the the disease process. I need

all the help I may get, so if not too invasive, I get all of the

vital signs: temperature, pulse, B/P and respirations.

Thanks for your inquiry.

[river1951]

Not only are they valuable tools, they are another way we show our caring for the patient. I had a patient once tell me after I was listening to his lungs he now knew the difference between nurses and doctors; the nurse waited to move the stethescope til after you breathed! Interesting observation, however, I believe our caring for the patient is the most important part of any kind of nursing. My social worker once said she wished she had procedures to do to fill the empty spaces and make the patient and family comfortable enough to talk.:wink2:

[doodlemom]

This is interesting to learn everyones different opinions on this. I almost always listen to pt's lung, heart, and bowel sounds but only do a bp if I feel it is necessary or if it is my once a week assessment (I know the minimum regs are to do a full assessment every 14 days but it is our agency's recommendation that we do one every week.) If a patient is actively dying, I very rarely (if ever) do a BP so the patient will not have to be subjected to it.

[hcan]

I went to a patient's home this week at 5 am bc the pcg said the foley wasn't draining. I picked up the tubing from the mattress and 300 ml flowed out immediately. The pcg apologized and was deeply embarrassed that he had called me out, and vital signs were just not necessary. I wondered though, bc I've been told that vs need to be gotten with each visit. I personally don't agree--that visit being a case in point.

[doodlemom]

I'm pretty sure that there are no medicare or JCAHO requirements that VS be taken on each nursing visit - if they are, we are way out of compiance! The requirement at your agency must be handed down from your management. I agree that if you are going to the house to change a foley, there is no need to check VS.

[andyg]

Very interesting to see the various thought processes on this issue. It is not a requirement by JCAHO or Medicare to do VS. This would be more of what your agencies P & P manual had in it. My own thought process is that a lot of the time this will increase a family and patient's anxiety because then they are concerned with it being to high or to low. At the same time depending on the patient's phsyical status you can almost bet it will be pretty elevated (increased pain or discomfort or anxiety) or pretty low (patient actively dying) so it will almost always vary. If it is elevated or low the patient or family will want to know what you are going to do to "fix" it. I do agree there are many times by doing these assessments it does make both family and patient feel that they are not dead yet and that you are truly taking care of them. So I guess my feeling is it based on their current "needs" and is uniquely individualized on each visit as with every other aspect of Hospice care. Andyg

[Nurset1981]

We are required to take VS as they are ordered ie QD, QOD or what have you. When I'm on call and have to go out I always take a set just to be on the safe side. Plus it reassures me and the patient.

[Katillac, RN]

As a nurse who does a LOT of on call, I can say that it is rare that I do a B/P. I use as the guideline before any piece of assessment, "What am I going to do with the data?" and for the most part a B/P will not be helpful to me or the patient when I am doing an on call visit. Quite frankly, I think that doing frequent B/Ps keeps patients and families focused on these numbers as if they are some kind of magic. And sometimes focusing on the numbers is a way of not looking at what is happening to the patient. Which is OK if that's the way the patient and family want to do it, but I try to show that there is another way.

For me, it's like the old ICU adage, "Look at the person, not the machines."