What happen to taking Vital Signs???

Home Health Columnist / Guide · Aug 24, 2005

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.

:yeahthat:

Especially when I was charge and the ONLY nurse on nights with 26 patients + 2 aides. Also manually titrated those IV rates as pumps yet to be invented--glass IV bottles to boot.

Less than 5 minute eyeball knew what was going on with each patient-about 1/1/2 hrs did first rounds.

I still today take apical pulse, rarely radial as can get so much more info: lungs, able to sit up, pain on movement, skin color, see if they can follow directions, dizziness, exchange plesantries, etc.

Could see if call bell in reach, IV bag almost empty, trash overflowing, suction canister needing emptying.

"Can I get you anything while i"m here" I used in the 80's before it became a buzz word and saw result of it decreasing call bell.

Same reason I liked making walking rounds with staff who were leaving: nurses with repeatedly trashy rooms, empty IV's NOT tolerated.

student4ever · Aug 24, 2005

The thing that makes me mad is that at my ER, EVERYONE uses the dynamap (or as we call it, the datascope), and until the last week of my training as a tech, I was never taught HOW to do a manual BP, and that only happened b/c we had a Pt whose BP was too high for the datascope or cardiac monitor to pick up the BP. Since I'm not into the clinical portion of nursing school yet, I hadn't been taught before, and had NO experience, I was just expected to know already. Thank goodness for the kind nurse who took time out of her busyness with 5 critical patients (she got someone else to cover her patients while she taught me) And we techs are not ALLOWED to carry our own stethescopes because then we're "trying to represent ourselves as nurses." That's a bunch of BS in my book. If we have to take a manual BP, we have to get a nurse to unlock the cabinet in the med room that has the manual BP cuffs, and use a disposable steth that are kept for isolation Pts, which then drives up the cost for the hospital, and they hurt my ears terribly. I want so badly to learn the skill of manual BPs, but I can't at work - so this week I'm going to buy a manual BP cuff and a steth of my own so I can practice on my family and friends. They don't know it yet, cause I don't want them to run away before I get started!!! It's silly though, how much we rely on technology to do our jobs for us. Yes, it is nice when I'm covering about 15 patients with Qhr vitals to have the datascope, and just go from room to room, taking temp and asking about pain levels, etc. while the BP is taking, but I still count pulse and resps manually no matter what. The resps the machine gets are rediculously high most times, because they count every second, rather than by going total of a minute or whatever. If a pt. breathes twice in 2 seconds, it says they are at 60 resps a min.... not exactly what the doc likes to see. So then the docs just generally throw out whatever resps are charted, and tend not to care about anything we chart because they don't see it as accurate. Which for the most part is true. It's disheartening to see how many medical professionals are forgoing the manual way of taking vital signs, examining patients, etc. because of technology. Every day I see patients getting unneccessary medical tests which are expensive (ex. repeated US and CT and MRI for frequent flyers who report belly pain or knee pain in an attempt to get narcs), and it's getting out of hand. I know the docs have to cover their butts because of insurance, but it's getting outrageous. We only have 1 doc who actually relies on his findings from physical exam, and rarely sends people for testing unless it's absolutely warranted. But what makes me maddest is when we are not TAUGHT how to do things manually because "we have machines to do that for us now." Um, sorry, but machines are not critically thinking, sentient beings - at least not at this point in time! Please don't use them to replace good old fashioned nursing practice - there's a reason I'm going into nursing - and it's not so I can use all kinds of cool equipment!!!!

Cute_CNA, CNA · Aug 24, 2005

Like others have said, retraining is a good idea.

When I first started doing blood pressures, I had anxiety about whether or not I'd be able to hear anything. So I took a friend's stethoscope and sphygmometer (sp?) home with me, and practiced taking BPs repeatedly on my poor husband.

With time, I've become a lot more comfortable doing it. Maybe it has to do with people not practicing enough, and therefore are afraid to do it, for fear of looking incompetant. Just a thought.

Of course, they may also be just plain lazy.

chadash · Aug 24, 2005

I worked with some fellow aides in LTC who would guess at bps, because they could not hear them...

These were folks who had been doing the work along time, and it was just plane too embarrassing for them to admit they needed training. The nurse alway commented that it took twice as long for me to get my vitals than it did the other girls. Oh well.

UM Review RN, ASN, RN · Aug 24, 2005

sphygmometer (sp?)

Close~ it's "sphygmomanometer".

JasmineG · Aug 24, 2005

When I was in clinicals all of the students would wait in line for the machine, it would take about an hour just to get vitals in the morning. I finally just started using the wall system in the pts. room. My instructor thought I was falsifying my vitals, because I always had all of my vital done and charted before everyone else and because she didnt see me roaming in the hall with the rest of the students waiting for the one machine. So I had to explain that I was using the BP cuff in the pts room. Well, I guess I opened a can of worms, because from that moment forward, everyone had to use the pts BP cuff. Needless to say, I was not the most popular person for a while, but the vitals were done and charted in a timely manner. :rolleyes:

There were 5 thermometers and 3 pulse ox machines on the floor, so it just didnt make sense waiting an hour before starting pt care :twocents:

Cute_CNA, CNA · Aug 24, 2005

Close~ it's "sphygmomanometer".

Thanks. Why couldn't they have given it a more simple name?!

caroladybelle, BSN, RN · Aug 24, 2005

Thanks. Why couldn't they have given it a more simple name?!

Because it's a medical device...therefore it can't be simple

Just like anything that one cannot find the cause to is "Idiopathic". Hair loss is alopecia.

If they can't name it a big word, theycan't charge as much for it.

allele, LPN · Aug 24, 2005

I have to admit, this is a serious pet peeve of mine. I ALWAYS get at LEAST one set of vitals with a manual cuff on every patient. I actually use manual cuffs about 95% of the time (really), only exception being someone who needs frequent vitals....in which case I start with a manual pressure to make sure the machine results compare well, or if I just can't find a manual cuff. (I'd give anything to have one in every room!!). Anyway, there are actually RN's on my unit that rely on the dynamaps, and if the numbers don't look good, they don't even double check with their own ears!! They COULD be wrong!! I just couldn't call a doctor to tell them that my patient has a pressure in the 70's without hearing if for myself. Once we had a patient sent to us from another unit (my unit is surgical telemetry) because the heart rate was in the 30's. In report the transferring nurse said the aide got the vitals, and the heart rate was taken from the oximeter. I received the patient and their heart rate was actually double what the oximeter was reading. I called the nurse and asked if she had taken an apical pulse. I wasn't trying to "catch" her in doing something wrong, I wanted to know if the patient's heart rate was REALLY in the 30's at some point. She hadn't. She totally relied on what the aide told her as far as vitals. Like I said, it's a pet peeve. I see the automatic equipment as a great convenience when appropriate, but I do see it taking over where the nurses should be doing their own assessments sometimes. It's a shame.

GrnHonu99, RN · Aug 24, 2005

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?

Im a NS and we have to do all of ours manually. We call the "VS"s a nurse on a stick...we arent allowed to use them except for pulse ox and temp.

RN and Mommy · Aug 24, 2005

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???
-------------------------------------------------------------------------
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.
-------------------------------------------------------------------------
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 would like to address this from the view of the Nursing Assistant. I currently work at a hospital where we have only 3 dynamaps for 6 Nursing Assistants to use. I agree whole heartedly with you. I don't think a lot of the NAs know how to take a manual blood pressure. I will use the dynamap to take routine VS on patients and if I do get a reading that is not what the patient has been running I will recheck manually. For surgical patients and patients who are recieving blood I always check them manually because I don't always trust the dynamaps. Some of the NA's I work with actually "hide" the dynamaps! As for the NA you were working with who didn't check the BP, that's a huge problem! Even if the patient was fine in the end. What if he wasn't??????

A Nursing Assistant and Nursing Student (May 2006!!!)

BackOff · Aug 24, 2005

At my hospital we have both kinds of machines. I am the CNA so when I am taking vitals on 29 patients (As is the case most days) I use the dynamap. If I have isolation patients I do manual. If I cannot get a pressure on a patient, or if the reading is way high or low, I immediately do manual and report BOTH to the RN immediately. I think at my hospital the reason for using the machine is mostly because of time and it has everything on it, pulse ox, thermometer and BP so it's much faster. I do know how to take manual BP's though and do so every shift with at least a handful of patients.

You are wonderful. I would have loved to have you working with me. I have had some wonderful CNA's and many many terrible ones. Working with someone like you is a Godsend. Keep up your standards.