Vitals question

[Amethya]

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?

[Amethya]

A lot of littles with strep throat will only present with a stomachache (and temp of course). You do you, boo, but I might suggest getting a temps on those stomachaches, if nothing else, at least if one comes back truly sick the parent can't throw it in your face "Well, she told you she had a stomachache and you didn't even check her temp, then she got home and was 101!" You know those types. If you check the temp you could say with certainty that they were fever free in your care.

I get it, I'll do this now. Thanks for the advice!

[Amethya]

Nail polish and artificial nails are the biggest problem in accuracy of a pulse ox

She didn't though, so I'm confused on my pulse ox.

[tining, BSN, RN]

I was wondering where you got trained in "EVERYTHING."

I purposefully stayed away from what I have stated in other threads.

I am hopeful that you find a position that suits your needs to allow your growth in the medical field or other pursuits.

[Amethya]

I was wondering where you got trained in "EVERYTHING."

I purposefully stayed away from what I have stated in other threads.

I am hopeful that you find a position that suits your needs to allow your growth in the medical field or other pursuits.

I went to school, where else? That's where I got trained in vital signs, especially what I spoke about. In Texas, if an MD wants to train me in IV placement and such, I can as long as I was trained. It's weird I know. So if at school they taught me how to do vital signs and how to interpret them, then I can do.

Thank you for doing so.

And I really hope I do too.

[BSN16]

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.

why cant she count a resp rate? seems odd to me

[Amethya]

why cant she count a resp rate? seems odd to me

I find that odd too. That's one of the main things we are taught at school.

[Julius Seizure]

A couple of things, just because I am concerned that there may be a few inaccuracies in your knowledge. As a disclaimer, this is meant to be informational, not contentious.

(1) I'm not sure that nurses (even APRNs) can delegate to medical assistants. I am pretty sure that is only something that only physicians do. I don't think nursing scope of practice allows for it.

(2) While MA practice is pretty unregulated in Texas, I don't think that you are allowed to independently interpret vitals. The standard, according to my google-research, is that MAs can be delegated tasks "that do not involve the exercise of independent medical judgment." You can do any task that you have been trained on and the physician has delegated to you...but you can't interpret. There needs to be protocols (written ones!) that you follow. No diagnosing, as has already been stated, but also not independent clinical assessments/interpretations.

(3) If you aren't getting a reliable heart rate reading on your pulse ox, I would be hesitant to trust the oxygen reading. Pulse oximetry works by the light "seeing" the pulsating flow of blood through the arteries. If it isn't reading that pulsating flow right, it isn't working. I suggest that you don't rely on the one that you currently have.

Here are some mostly Texas-specific sources that I found:

Medical Assistant Scopes of Practice

Can I Delegate This?

Texas Medical Association

American Association of Medical Assistants

[Amethya]

Thank you for the information.

Exactly what you said, I mainly just get the information and give it to the right source. I don't diagnose and such, so there's not much of an issue there. But I understand everyones concern.

As for the oximeter, I might have to get a new one, but I'm just not sure if it's just the machine or it's the student in question.

[OhioBPH]

Exactly what you said, I mainly just get the information and give it to the right source. I don't diagnose and such, so there's not much of an issue there.

I want to remind you that I am a medical assistant, granted in another state, but have been working for seven years under this title. Just some thoughts based on my experience.

First, a physician I worked for once told me that if you don't need the vital or don't know what to do with it, don't get it.

Second, you may be trained to do everything from weights to IVs, but unless the person who delegates to you, whether it be a nurse or physician, has said "I want you to get the following vitals, in the following scenarios" don't. The person delegating to you in this role is the person who's license is on the line, it it for them to decide what they want you to do and how or when you should do it.

Third, if they do delegate to you more than temps, you need to have guidance from them on what is a normal range, and what to do if it is out of that range. For example, I have written protocol signed off by student's physician, and reviewed by the district RN, instructing me when to check blood glucose and what to do if it is out of range. Who to call, how much glucose to give, and how to follow up and document these events. So if my RN asked me to start counting RR on all coughs I would need to know what she considers out of range and what to do with that information.

Once you get into interpreting information on your own, you get into the realm of assessment. Unfortunately, it is not within our scope to make assessments based on our own judgement, we just make decisions based on the guidelines handed down to us.

Do not be afraid to tell people that you cannot do something based on your credentials. You need to know what your supervisor's credentials are as well. If you find that they are not an LPN or RN, find out who their supervisor is and go up and up. If you are not working under a physician or nurse, honestly you should be looking for a new job anywhere. You would be working out of your scope otherwise.

I understand that you do not have good support in your position, and that sucks. But in that case, you may want to do less, not more. And if less is not acceptable, and the reasoning above falls on deaf ears, walk away from that job knowing it is a career killer.

[OhioBPH]

I just spent some time reviewing the Texas nursing board's regulations on nursing delegation, and it is similar to my experience here in Ohio.

[Amethya]

I want to remind you that I am a medical assistant, granted in another state, but have been working for seven years under this title. Just some thoughts based on my experience.

First, a physician I worked for once told me that if you don't need the vital or don't know what to do with it, don't get it.

Second, you may be trained to do everything from weights to IVs, but unless the person who delegates to you, whether it be a nurse or physician, has said "I want you to get the following vitals, in the following scenarios" don't. The person delegating to you in this role is the person who's license is on the line, it it for them to decide what they want you to do and how or when you should do it.

Third, if they do delegate to you more than temps, you need to have guidance from them on what is a normal range, and what to do if it is out of that range. For example, I have written protocol signed off by student's physician, and reviewed by the district RN, instructing me when to check blood glucose and what to do if it is out of range. Who to call, how much glucose to give, and how to follow up and document these events. So if my RN asked me to start counting RR on all coughs I would need to know what she considers out of range and what to do with that information.

Once you get into interpreting information on your own, you get into the realm of assessment. Unfortunately, it is not within our scope to make assessments based on our own judgement, we just make decisions based on the guidelines handed down to us.

Do not be afraid to tell people that you cannot do something based on your credentials. You need to know what your supervisor's credentials are as well. If you find that they are not an LPN or RN, find out who their supervisor is and go up and up. If you are not working under a physician or nurse, honestly you should be looking for a new job anywhere. You would be working out of your scope otherwise.

I understand that you do not have good support in your position, and that sucks. But in that case, you may want to do less, not more. And if less is not acceptable, and the reasoning above falls on deaf ears, walk away from that job knowing it is a career killer.

Thank you for the information!

[kataraang, BSN]

Scope of practice is a very important topic and it is good to be discussed in this thread. I am not trying to be smart or anything, but why not just take a full set of vitals? It only takes a minute. That eliminates the confusion of what should you be measuring for what symptom. But honestly look into your facility's written protocol. There has to be one.