Pediatric Vital Signs by Kate Oneill,RN

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Category: Education
     
 

Presentation Description

Review course for Student Nurses and Doctors on proper vital sign techniques.

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Presentation Transcript

Vital Signs Across the Ages : 

Vital Signs Across the Ages Kate O’Neill, RN, MSN Faculty Instructor 2010

Vital Signs……… : 

Vital Signs……… NOT just numbers… They have meaning They have IMPORTANT value Essential part of Nursing Assessment Be careful & ck policy when delegating to Non- RN’s - post cardiac cath - first set of VS with admits - post - op VS - administering blood products - frequent VS with sick or sedated patients

VS and Patient Fears : 

VS and Patient Fears Stranger Anxiety Fear of surroundings, equipment, pain Avoid words with mixed meaning - Going to “TAKE” pulse or “TAKE” your BP” - listen to your heart “BEATING” Concrete thoughts / fears - remove something from their body - take their blood - get a beating

Vital Signs - General Rules : 

Vital Signs - General Rules Review previous VS & monitor for trends Don’t use “0” for VS documentation Get VS at least Q 4 hrs in acute care Measure in this order: - RR, HR, Pain scale, Pox, , BP, Temp Repeat abnormal values Fear, pain & stress will HR, RR & BP

Vital Signs by Age : 

Vital Signs by Age

Respiratory Rate - Clinical Practice : 

Respiratory Rate - Clinical Practice Count RR FIRST, before any invasive exam Count for 1 full min, periodic breathers Use stethoscope for obtaining RR not just visual method Watch rise and fall of chest & listen Listen for Heart Sounds when done counting RR

Respiratory Rates : 

Respiratory Rates Assess child when sleeping or resting quietly RR will be elevated with crying / fever Pre-term: 40 – 60 Newborn: 30 – 40 Toddler: 25 School-age: 20 Adolescent: 16 Panic levels: < 10 or > 60

Obtaining Pulse Rates : 

Obtaining Pulse Rates Apical pulse for infants & toddler < 2 years Count for 1 full min with stethoscope Palpate radial artery while listening for HR HR increases with: - crying - anxiety - fever - pain

Apical Pulse Landmark : 

Apical Pulse Landmark In child younger than 7 years

Heart Sounds : 

Heart Sounds See table 6-5, Bowden & Greenberg text

Auscultating Heart Sounds : 

Auscultating Heart Sounds Positioning Patient

Temperature Measurement : 

Temperature Measurement Obtain accurate Temp on ALL children Rectal route for children < 2 years of age, never tympanic Rectal Temp: only when absolutely necessary Use correct Celsius or Fahrenheit at facility

Celsius to Fahrenheit Conversion : 

Celsius to Fahrenheit Conversion Celsius ( C ) 37 degrees 38 degrees 39 degrees 40 degrees Fahrenheit ( F) 98 100 102 104

General Temperature Tips : 

General Temperature Tips Use of tympanic temp is controversial b/c Ear wax Ear infections Oral or tympanic temp > 5 to 6 yo Rectal temps - contraindicated in neonates, anal surgery, diarrhea, or rectal irritation. Check with hospital policy

Axillary Temps for Peds & Adults with Oral Difficulty : 

Axillary Temps for Peds & Adults with Oral Difficulty Whaley and Wong Position for taking axillary temperature.

Pulse Ox Measurement : 

Pulse Ox Measurement Indirect measure of arterial O2 on Hgb Capillary , Artery or Venous? Placement - warm fingers or toes, or infant hand - nail beds without color Normal Range 95-100%

Slide 17: 

Oxyhemoglobin Curve % Hgb Saturation Oxygen - Partial Pressure

Pulse ox : 30 - 60 - 90 Rule : 

Pulse ox : 30 - 60 - 90 Rule Pox Value Pox = 100% Pox = 90 % PaO2 Value PaO2 = 100 % PaO2 = 60 %

Blood Pressure Measures : 

Blood Pressure Measures obtain BP’s on ALL pts Q 8 hours or according to MD order Repeat BP if outside norms (too low/high) Obtain on leg if arm moving or contracted BP changes: late sign of hypotension

“70” BP Rule for Ages 1-10 yo : 

“70” BP Rule for Ages 1-10 yo Calculates low or minimum SYSTOLIC blood pressure in children Rule of 70: SBP = 70mm + 2 x (age in years) Johnny is 6 yo: SBP = 70 + (2 x 6) = 82

“90” BP Rule for Ages 1-10yo : 

“90” BP Rule for Ages 1-10yo Calculates nl Systolic BP in children Rule of 90: SBP = 90mm + 2 x (age in years) Johnny is 6 yo: SBP = 90 + (2 x 6) = 102 Using 70 & 90 rule = SBP range of Johnny = 82-102

Correct BP Cuff Size : 

Correct BP Cuff Size Width of BP cuff bladder: - 2/3 circumference of arm or leg Length should encircle 100% of the arm or leg without overlap Use Manufacturer scale on electronic cuffs

Blood Pressure Cuff : 

Blood Pressure Cuff Whaley and Wong

Orthostatic Vital Signs (OVS) : 

Orthostatic Vital Signs (OVS) Measures fluid volume deficit / dehydration Measure HR + BP at 3 min intervals - Lying - Sitting – Standing Quick Method: HR & BP sit & stand Mild OVS = HR increases by > 20 bpm, with no change in BP Mod – Severe OVS = HR & fall in BP

Slide 25: 

Probability of Dehydration HR and BP Change with Standing Orthostatic Vital Signs

Metabolic Fever Rule : 

Metabolic Fever Rule For every 1 degree rise Celsius in body temperature, there is a corresponding 10-12 % increase in BMR ( HR and RR)

Vital Sign Exercise : 

Vital Sign Exercise 5yo Jimmy is admitted to 4 South Hx: 3 days of fever, V & D Weight =20 kilos What is his circulating blood volume? MD orders 20 cc/kilo bolus IVF of NSS How much NSS do you administer? How much circ volume did you replace?

Jimmy’s 8am Vital Signs : 

Jimmy’s 8am Vital Signs

Jimmy’s 8am Vital Signs : 

Jimmy’s 8am Vital Signs

Vital Signs - Critical Thinking : 

Vital Signs - Critical Thinking Why is there a difference in values for Jimmy’s Vital Signs? - actual - calculated What could the difference be from? What causes an elevation in HR and RR above baseline?

Increase in VS above Baseline: : 

Increase in VS above Baseline: Respiratory distress (pneumonia) Sepsis Decompensation Crying Fever ( actual) Dehydration Stress Anxiety Pain

In Summary, VS are NOT Just Numbers : 

In Summary, VS are NOT Just Numbers Trend them Monitor them Analyze them Repeat them Document them

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