What happen to taking Vital Signs???

Nurses General Nursing

Published

Sorry, but I must vent.

I am at a hospital, that has a BP cuff and a stethoscope in EVERY room.

So why is it that no one can possibly get vital signs without access to a dynamap???

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When I was a tech, I worked in a facility that did not have access to dynamaps on the MS floor, and we did VS manually...ALL of them. But it seems that the techs at the facilities that have been at, are physically and or mentally incapable of taking a manual BP. They have little tiff fights over who gets to use the dynamap first.

If the machine cannot get a reading, they keep trying to again until it does. And if it just will not read, they are completely mystified as to what to do.(a clue...if the patient has Afib or an arrythmia..the machine may not be able to read or may give an incorrect reading)

They get a totally absurd result but don't recheck it manually.

They spend 30 minutes trying to find the dynamap....they could have been finished with vitals if they did them manually by the time that they find it.

I have given up on the "I need a set of VS, stat."..because they would go running for the machine..it is faster to do it myself.

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The other night of my patients needed to be on the dynamap for two hours as he was having serious issues. I ask the tech for a set of VS on another patient getting blood. I find that he didn't do it...because he couldn't find the machine. Of course, he didn't let me know either. Thankfully, both patients were fine.

Really, how hard is it to do a manual BP? Especially when EVERY single room has access to the equipment.

Do any of y'all have problems with this issue?

I too am a PCA and nursing student. I would love to have more experience doing manual BP's on my floor but during my first week on the job, one of the nurses told me that I should not bring my stethoscope to work as they wouldn't want anyone to confuse me with a nurse. Needless to say, I have not been doing many manual BPs.

I love my job as a PCA. I love the patient contact I have gotten on the job and wouldn't trade it for anything.

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Specializes in Obstetrics, M/S, Psych.
I too am a PCA and nursing student. I would love to have more experience doing manual BP's on my floor but during my first week on the job, one of the nurses told me that I should not bring my stethoscope to work as they wouldn't want anyone to confuse me with a nurse. Needless to say, I have not been doing many manual BPs.

I love my job as a PCA. I love the patient contact I have gotten on the job and wouldn't trade it for anything.

That nurse gave you bad advice. Bring your stethoscope and practice, practice! Glad you are enjoying patient care. That's awesome!

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Personally I like doing my own BPs manually. For awhile our NM had the techs doing the q4h vitals and the nurses covering the bedpans, ice etc runs so the techs wouldn't be bothered. Tell me did that make any sense?

Thinking about VITAL signs. You can lean over to get the BP...watch the chest rise and fall, count the resps, leave the cuff on uninflated and raise the stet to listen to heart sounds. Undo the cuff have the patient sit up (if able) catch the resp sounds, and in less than 5 minutes you have done a quick eyeball assessment. You then say what can I get you "right now" before I check the rest of my patients. Usually there's nothing they want, and on you go. I'd certainly rather know something VITAL is wrong rather than wait on a tech. Almost all our techs are RN/LPN students and they understand technique, but everyone needs reminding not to get lazy.

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Specializes in Utilization Management.

Our techs use dinamaps and most of the time, no problem.

I did have a problem not too long ago with a tech who was always coming to tell me about patients with high BPs, and then getting upset with me when I waited to retake them. I suspected she was doing something wrong, so I asked her to tell me more.

She claimed that the patient's BP was 210/100, "and I'm sure because I took it three times." I had to explain to her that taking a BP three times within five minutes on the same arm, whether manual or dinamap, will certainly drive the BP higher. Not to mention the potential bruising that can occur on frail 90-year-old arms from the cuff inflation.

I then demonstrated taking a manual BP on the patient and I got a far lower number. Yes, it was high, but no, it didn't warrant the prn Vasotec IVP she had ordered.

It really is up to us as RNs to re-educate our coworkers when we find gaps in their knowledge base. Hopefully we won't realize that there is a gap when we're busy with a patient's crisis.

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Personally I like doing my own BPs manually. For awhile our NM had the techs doing the q4h vitals and the nurses covering the bedpans, ice etc runs so the techs wouldn't be bothered. Tell me did that make any sense?

Thinking about VITAL signs. You can lean over to get the BP...watch the chest rise and fall, count the resps, leave the cuff on uninflated and raise the stet to listen to heart sounds. Undo the cuff have the patient sit up (if able) catch the resp sounds, and in less than 5 minutes you have done a quick eyeball assessment. You then say what can I get you "right now" before I check the rest of my patients. Usually there's nothing they want, and on you go. I'd certainly rather know something VITAL is wrong rather than wait on a tech. Almost all our techs are RN/LPN students and they understand technique, but everyone needs reminding not to get lazy.

I couldn't agree more! This is just what I was saying in my post. As an RN, I will want to make sure I get accurate readings as my butt is on the line if something (God forbids) goes wrong.

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Specializes in Nursing assistant.

I was working for a home health agency, actually hospice, and was being observed by an RN ( I am an aide). The RN took the pt pulse and BP with an electronic cuff. I took it manually. I Kept getting a pulse of about 68, and she kept telling me, no that is wrong, and eventually she told me it was 120. She never just reached over and felt the pts. pulse. The pt had a tremor in her arm. Her pulse was hard to feel, but I took it several times and got 68, sometimes 70. After the RN left, the patients spouse said to me, her pulse is never 120! Well, I know that it could have been elevated, but, darn it, though I did not pass my pulse taking in that evaluation, I could not for the life of me get 120. That made me wonder, am I that bad at counting, or are those darn electronic cuffs sometimes goofy?

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Specializes in ER, ICU, Infusion, peds, informatics.
i was working for a home health agency, actually hospice, and was being observed by an rn ( i am an aide). the rn took the pt pulse and bp with an electronic cuff. i took it manually. i kept getting a pulse of about 68, and she kept telling me, no that is wrong, and eventually she told me it was 120. she never just reached over and felt the pts. pulse. the pt had a tremor in her arm. her pulse was hard to feel, but i took it several times and got 68, sometimes 70. after the rn left, the patients spouse said to me, her pulse is never 120! well, i know that it could have been elevated, but, darn it, though i did not pass my pulse taking in that evaluation, i could not for the life of me get 120. that made me wonder, am i that bad at counting, or are those darn electronic cuffs sometimes goofy?

yes, mechanical bp cuffs can easily pick up "twitching" and interpert it as the pulse. this will mess up not only the pulse, but the bp, as well. even if you use an electronic cuff to get the vs, you should always at least palpate the pulse for a few moments, so you can get a feel for how fast/slow it is, and whether or not the pulse rate the electornic cuff gave you makes sense or not.

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Specializes in Obstetrics, M/S, Psych.
I was working for a home health agency, actually hospice, and was being observed by an RN ( I am an aide). The RN took the pt pulse and BP with an electronic cuff. I took it manually. I Kept getting a pulse of about 68, and she kept telling me, no that is wrong, and eventually she told me it was 120. She never just reached over and felt the pts. pulse. The pt had a tremor in her arm. Her pulse was hard to feel, but I took it several times and got 68, sometimes 70. After the RN left, the patients spouse said to me, her pulse is never 120! Well, I know that it could have been elevated, but, darn it, though I did not pass my pulse taking in that evaluation, I could not for the life of me get 120. That made me wonder, am I that bad at counting, or are those darn electronic cuffs sometimes goofy?

The nurse should have palpated the pulse. If she was going by just that one reading from the electronic B/P cuff and you got several by palpation that were around 70, I'd say that yours were right. The monitor reading very well could have been altered by the patients' tremor.

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I want to comment on the post above. I am a student also and exposed myself to the used of manual bp taking. but i have a problem of it. Sometimes i can not hear the exact systolic and diastolic for my patient during our hospital exposure. especially you are caring for 2 pt. i hate doing it and repeating to pt. soemtimes its too painful for the patient to feel because of repeated procedure. I guess it's better to use an automated bp . however if the hospital your working with, does not have one its really disgusting and a problem anyway. If i were to ask,I would prefer to use the operated one, but how can i have one if its forbidden to use in the practice of nursing while you are still a student. I wish when i work i would use the automated one..... Gud luck and pray for better health care facility in my country philippines.

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Specializes in IMC, ICU, Telemetry.

As a student, our school's clinical policy is to do manual vitals - which I prefer to do (force of habit since EMS days). The problem I've run into at the last two clinical sites I've been to, there are no manual BP cuffs - each pt is given their own disposable dynamap BP cuff (which I applaud for infection control purposes). Some rooms had been equipped with a wall mounted sphygmomanometer, but 9 times out of 10, it didn't work - leak in the bladder or hand pump broken/missing. Or it was completely removed from the wall. :rolleyes: When I asked staff where I could find a manual handheld, was told they didn't have any (or looked at me like I was crazy), just the disposable dynamap cuffs. I could resort to carrying my own - but concerned about spreading cooties (more so than I was in the field). And I don't have the pocket space :lol2:

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I want to comment on the post above. I am a student also and exposed myself to the used of manual bp taking. but i have a problem of it. Sometimes i can not hear the exact systolic and diastolic for my patient during our hospital exposure. especially you are caring for 2 pt. i hate doing it and repeating to pt. soemtimes its too painful for the patient to feel because of repeated procedure. I guess it's better to use an automated bp . however if the hospital your working with, does not have one its really disgusting and a problem anyway. If i were to ask,I would prefer to use the operated one, but how can i have one if its forbidden to use in the practice of nursing while you are still a student. I wish when i work i would use the automated one..... Gud luck and pray for better health care facility in my country philippines.

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Right, but there are people out there that are not confidant in their skills especially new CNA's/Techs. Lord knows how many new CNA's I've orientated who've looked at me and said "Um...142 over 96?" because all they've ever learned is "Normal blood pressure is 120 over 80..." They get thrown into a situation where there is no "normal", most of the time patient's base line is nowhere near "normal" so they think they themselves are wrong. What do they do? They grab the BP stand and rely on that so much so they never gain confidance in themselves.

You also have to remember that the schooling for CNA's/Techs is so short that they don't have months of clinical (like nurses do) on the general public. It's generally a few weeks, you practice on (relatively) healthy classmates, take your test and hit the floor.

:chuckle :chuckle

I actually mean't I was more confident taking them myself manually than relying on a dynamap. You've brought up some good points though.

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