logging in or signing up Pediatric Vital Signs by Kate Oneill,RN kateoneill Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1614 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: March 22, 2010 This Presentation is Public Favorites: 3 Presentation Description Review course for Student Nurses and Doctors on proper vital sign techniques. Comments Posting comment... Premium member 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 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Pediatric Vital Signs by Kate Oneill,RN kateoneill Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1614 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: March 22, 2010 This Presentation is Public Favorites: 3 Presentation Description Review course for Student Nurses and Doctors on proper vital sign techniques. Comments Posting comment... Premium member 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