Vitals question

Specialties School

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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?

Specializes in ICU/community health/school nursing.
But honestly look into your facility's written protocol. There has to be one.

A lot of times we don't have one in a school setting. We're going on nursing judgment and experience. Very few people NEED a full set. But I mostly take a full set of vitals in a kid where I have no idea what's going on, and I hope that the vitals point me in a direction. Usually they point me in the direction of water, rest, back you go!

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Specializes in Cardiology, School Nursing, General.
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.

I shall!

Off topic: Is your name based on the last airbender? Because it is, I love it!

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Specializes in critical care ICU.
I shall!

Off topic: Is your name based on the last airbender? Because it is, I love it!

Yes it is. Because Katara and Aang are the best couple ever. :D

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Specializes in critical care ICU.
A lot of times we don't have one in a school setting. We're going on nursing judgment and experience. Very few people NEED a full set. But I mostly take a full set of vitals in a kid where I have no idea what's going on, and I hope that the vitals point me in a direction. Usually they point me in the direction of water, rest, back you go!

True. BP would probably be a bit excessive for 99% of cases, especially in children with no significant health history. I think I recall when I was using the nurses office in middle school to skip class (yes I did...) I only had my temperature checked. Though one time was legit, I had a 103 fever lol.

Maybe only BP/pulse/O2 if the kid is lightheaded or showing changes in level of consciousness.

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Specializes in Cardiology, School Nursing, General.
Yes it is. Because Katara and Aang are the best couple ever. :D

SO TRUE!

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Specializes in Cardiology, School Nursing, General.
True. BP would probably be a bit excessive for 99% of cases, especially in children with no significant health history. I think I recall when I was using the nurses office in middle school to skip class (yes I did...) I only had my temperature checked. Though one time was legit, I had a 103 fever lol.

Maybe only BP/pulse/O2 if the kid is lightheaded or showing changes in level of consciousness.

That's what I mainly do. I am checking temps now more (Thanks to some users here!) for every visit unless it's something else not pertaining to any sickness (Like a cut or leg hurting), but that's it.

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Specializes in School Nurse.
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.

I believe Old Dude said it best. You are hooked into this position with little guidance and supervision for significantly less pay. When something goes wrong, bam you are out. If you are not practicing under an RN or MD - run! Find out what credentials the "School Health Manager" has, if they do not have an RN or MD the entire district could be non-compliant with TEA (I am definitely not an expert here though).

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Specializes in Pediatric Critical Care.
I am trained in EVERYTHING. Basically l know how to listen to heart rhythms, breath sounds, BP, Pulse Oximeter, temp, manual pulse, etc.

I can do all this, but I'm not sure when to do this, or when I'm over reacting on something.

This is my big concern for you, Amethya: You have been trained in all of these tasks, but aren't sure when to do them or what to do with the information (i.e. when is over-reacting). You shouldn't be deciding either of those things.

Based on what you have said in past threads, your school probably has not provided you with the policies that they should have, but the fact is that they should. For example, there should be a protocol of what to do when a child complains of a stomach ache: what questions to ask the child, which vitals to take, what ranges for these vitals are acceptable, what triggers a call to a nurse/doctor/911, if you should offer water/rest room/ice pack, etc.

You should be working under clearly outlined written protocols, and with appropriate people to call for back-up. It is really unfair to you (and these kids) that you haven't been provided with the tools to do your job.

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Any of you guys use flow sheets? I do occupational health and we utilize a flow sheet...person comes in with a headache, pull out that flow sheet and follow it step by step....Have that for like 27 very common issues, pretty much covers the body head to toe.....makes it very easy to follow and makes sure you don't miss anything. takes away a lot of the confusion and covers ur butt. As well it states what meds we can provide, based on protocols/orders from our Dr.

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Specializes in Cardiology, School Nursing, General.
This is my big concern for you, Amethya: You have been trained in all of these tasks, but aren't sure when to do them or what to do with the information (i.e. when is over-reacting). You shouldn't be deciding either of those things.

Based on what you have said in past threads, your school probably has not provided you with the policies that they should have, but the fact is that they should. For example, there should be a protocol of what to do when a child complains of a stomach ache: what questions to ask the child, which vitals to take, what ranges for these vitals are acceptable, what triggers a call to a nurse/doctor/911, if you should offer water/rest room/ice pack, etc.

You should be working under clearly outlined written protocols, and with appropriate people to call for back-up. It is really unfair to you (and these kids) that you haven't been provided with the tools to do your job.

Actually I have a binder that tells me what to do for things like that, but doesn't say for vitals. I do know what ranges vitals are acceptable though. The only thing is when to use them, but I got an idea now thanks to an RN that works in my district. She explained to me what to do and I did email my school health manager and she explained which protocols to follow what.

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Specializes in Peds,Geri-Psych,Acute Care Rehab.

I'm an LPN and I wouldn't feel comfortable "assessing" or auscultating heart sounds in a peds student (those little guys just go bad so fast), I am also wondering if you need to clarify your scope of practice because when I was in medical assisting school I never learned to auscultate cardiac sounds, or rhythms, can you identify where to listen (M,T,A,P) Ebbs point ect. Not to mention I went thru a two year diploma program with all hospital experience and feel comfortable identifying sinus rhythm/predetermined/diagnosed murmurs and that is about it! Know your scope and be careful....

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Specializes in Peds,Geri-Psych,Acute Care Rehab.

Wish I had been trained in "EVERYTHING" in nursing school, If I had a dollar for every time as a new grad I though "I was not taught that in school" I would be a very rich woman XD

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