Certified Nursing Assistant Easy and Fun Tutorial Part Twenty-Four **********Vital Signs from a movie on vital signs (continued)
Fever is a higher than normal temperature. For an electronic temperature take the reading at the end of the line near the end of the bulb.
For an axillary temperature reading put the bulb end of the thermometer in the center of the armpit or axilla and leave in place for 10 minutes.
There is a normal 0.5 to 1 degree lower for the axillary temperature so you must note which method was used.
When you measure the oral temperature the blue tip is the oral probe. If the person is on oxygen you must take the temperature axillary because the oxygen cools the body's temperature.
With an electronic thermometer you turn the thermometer on and put the sheath on and then ask them to close their mouth around the probe but don't bite it.
Then when the reading is obtained ask the person to open their mouth and then read the thermometer and dispose of the sheath.
With a glass thermometer you leave it in the person's mouth for three to five minutes and record the person's name, time and temperature into the patient's record.
If the temperature is above or below normal you must report it to the nurse immediately.
********Rectal temperature
For a rectal temperature is the person has hemorrhoids then there may be some rectal bleeding. For some heart conditions you may want to take a rectal temperature.
You need a thermometer with a rectal probe and some Vaseline. Lower the working side of the bed and lower the head of the bed and ask the person to lie on their side in Sims position.
Fan fold the top to just the person's hips and put on gloves. Open the lubricant pack to get the gel out and expose the patient's buttocks.
Cover the probe with a sheath and lubricate the probe and then use one hand to raise the person's buttocks. Insert the probe one inch or less into an adult's rectum and insert ½ inch in children.
Now you must hold the probe in place until the device signals. Wipe the lubrication from the person's anus and adjust their bedclothes. Remove the bed sheet and place the instrument on charge and note the name and the temperature in the notepad.
*****Radial pulse rate
To determine the radial pulse rate place your fingers gently over an artery that runs close to the skin.
In adults the rate is normally 60-100 beats per minute. Observe the pulse rhythm and the pattern of pulses and pauses between them. The pulse amplitude is equal to the force or quality of the pulse.
To take the radial pulse you need a watch with a second hand and you rest the arm comfortably and then locate the pulse and use the second hand to reach 12 or 6 and begin counting the pulse. Count for 60 seconds.
The respiratory rate equals the number of respirations per minute.
The respiratory rate should be greater than 20 breaths per minute.
Watch with the second hand on the 12 or 6 and count each rise and fall as one respiration. Do this for 60 minutes. Put the person's name, time, respiratory rate, rhythm or quality down on your notepad.
*******Measure blood pressure
Blood pressure is the force against the arterial walls of a person.
Systolic 100-140 mm Hg
Diastolic 60-90 mm Hg
You need alcohol wipes, a stethoscope, a spygmomanometer, and note whether the person is sitting or lying down. You want to make sure that the person is level with the heart and the arm is facing up.
You want to take the blood pressure on the person's bare skin and use alcohol to clean the ear pieces, the diaphragm and the bulb. Now squeeze the air out of the cuff and put it close to the elbow as in one inch over the elbow.
Now place the stethoscope earpieces in your ears and with one hand hold the bulb and squeeze the bulb slowly and with one hand take the pulse and when you are no longer able to hear the heart sounds turn the valve counterclockwise so that you lock it and when you listen to the Korotkoff sounds note the systolic and diastolic pressure and clean the stethoscope with alcohol wipes and record the name, time and blood pressure reading.
“The sounds heard during measurement of blood pressure are not the same as the heart sounds 'lub' and 'dub' that are due to the closing of the hearts valves.
If a stethoscope is placed over the brachial artery in the antecubital fossa in a normal person (without arterial disease), no sound should be audible. As the heart beats, these pulses are transmitted smoothly via laminar (non-turbulent) blood flow throughout the arteries and no sound is produced.”
“Also, if the cuff of a sphygmomanometer is placed around a patient's upper arm and inflated to a pressure above the patient's systolic blood pressure, there will be no sound audible.
This is because the pressure in the cuff is high enough such that it completely occludes the blood flow. It is similar to a flexible tube or pipe with fluid in it that is being pinched shut.”
“If the pressure is dropped to a level equal to that of the patient's systolic blood pressure, the first Korotkoff sound will be heard.
As the pressure in the cuff is the same as the pressure produced by the heart, some blood will be able to pass through the upper arm when the pressure in the artery rises during systole.
This blood flows in spurts as the pressure in the artery rises above the pressure in the cuff and then drops back down beyond the cuffed region, resulting in turbulence that results in audible sound.”
“As the pressure in the cuff is allowed to fall further, thumping sounds continue to be heard as long as the pressure in the cuff is between the systolic and diastolic pressures, as the arterial pressure keeps on rising above and dropping back below the pressure in the cuff.”
”Eventually, as the pressure in the cuff drops further, the sounds change in quality, then become muted, then disappear altogether.
As the pressure in the cuff drops below the diastolic blood pressure, the cuff no longer provides any restriction to blood flow allowing the blood flow to become smooth again with no turbulence and thus produce no further audible sound.
The first Korotkoff sound time averaged is a reliable pressure marker of Systole of the heart. The fourth Korotkoff sound time averaged is a reliable pressure marker of Diastole of the heart. ” From http://en.wikipedia.org/wiki/Korotkoff_sounds
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