Vital signs are the observation of temperature, pulse, respiration, and blood pressure. Vital signs may be different in children those of adults or the elderly.
Purpose
The goal of obtaining a child's vital signs is to establish a baseline on admission and detect any abnormalities from the normal state.
Precautions
As there may be no prior knowledge of the patient's previous vital signs for comparison, it is important that the nurse be aware of the wide range of normal values that apply to children of different ages.
Description
Vital signs are recorded hourly to every four hours and as needed based on the patient's condition.
Temperature is recorded to check for pyrexia or monitor the degree of hypothermia. The body's normal temperature is 98.6°F (37°C). A fever is a body temperature two standard deviations greater than 98.6°F (37°C) taken orally, or 100.4°F (38°) taken rectally or above 102°F (38.9°C) for older children. Hypothermia is recognized by a temperature below 96°F (35.5°C).
The rate and rhythm of the pulse is checked to detect any abnormalities of the heart; the beat of the pulse is reflects the strength and tension of the beat against the arterial wall. The strength of the beat increases, for example, with fever; it is lowered by conditions such as shock and inter-cranial pressure.
Respirations are quiet, slow, and shallow when the child is asleep; the rapid, deeper and noisier respirations are heard during and after activity. Average rates of respiration:
infants, 34 to 40 per minute
children aged 1-5, 25 per minute
children older than 5, 16 to 20 per minute
Preparation
Have the child sitting or lying comfortably and ensure a calm environment. Ensure that the readings are taken in similar positions each time, as a change in either can affect the results. The equipment required is a watch with a second hand, an electronic thermometer, an electronic or manual sphygmomanometer, and a stethoscope.
Follow the manufacturer's guidelines for taking a temperature with an electronic thermometer. Read the result displayed on the LCD screen and then record it in the patient's chart.
KEY TERMS
Blood pressure—The tension of the blood in the arteries measured in millimeters of mercury by a sphygmomanometer or by an electronic device.
Occlusion—Closed, or blocked.
p.r.n.—pro re nata, when required.
Respiration—The gaseous exchange between the tissue cells and the atmosphere.
The pulse can be recorded in many areas where a surface artery runs over a bone, but the radial artery in the wrist is the more common option. To take the pulse, place the index, middle, and ring fingers over the radial artery that is located above the wrist on the anterior surface of the thumb side of the arm. Apply gentle pressure to avoid obstructing the patient's blood flow. The rate, rhythm, strength and tension of the pulse should be noted. If there are no abnormalities detected, the pulsations can be counted for half a minute, and the result doubled. If, however, any irregularities are present, the pulse should be recorded for one full minute to avoid any discrepancies.
Keeping the fingers on the wrist, the frequency of respirations in one minute should be noted. The patient should not be made aware that breathing is being monitored; he or she may consciously modify his or her breathing, thereby affecting the respiratory rate. The pulse and respiration results are noted in the patient's chart.
If the child is old enough, the blood pressure is taken using a cuff that is the correct size. This will provide a more accurate reading.
With an electronic unit, the cuff is placed level with the heart and wrapped around the upper arm. Following the manufacturer's guidelines, the cuff is inflated and then deflated automatically; the nurse records the reading.
If blood pressure is monitored manually, a cuff is placed level with the heart and wrapped around the upper arm. Placing a stethoscope over the brachial artery in front of the elbow with one hand and listening through the earpiece, the cuff is inflated until the artery is occluded and no sound is heard. The cuff is then inflated a further 10 mmHg above the last audible sound. The valve in the pump is slowly opened no faster than 5 mm Hg per second to deflate the pressure in the cuff until a sound is heard over the brachial artery. This point is noted as the systolic pressure. The pressure is further deflated until a soft, muffled sound is heard. That point is noted as the diastolic pressure.
The results are charted: first, the systolic is noted, then the diastolic pressure. It is done in the following manner: xxx/xx (e.g., 120/70).
Aftercare
The child should be made comfortable and give assurance that recording vital signs is part of normal health checks, and that it is necessary to ensure that health is being correctly checked. Electronic temperature monitors have disposable protective guards for hygiene to prevent the spread of infections. Any abnormalities in the vital signs must be reported to the medical staff.
Complications
There is a nationwide initiative to ban the sale of mercury thermometers and mercury devices for monitoring blood pressure. There are concerns among health activists regarding mercury contaminating the environment after its disposal. In fact, several states have banned the use of products containing mercury. Mercury thermometers are not longer sold by many large, commercial retailers. The Environmental Protection Agency recommendation is to use alternatives to mercury products, to avoid the need for increased regulations in the future and to protect human health and wildlife.
Results
The vital signs are recorded and compared with normal ranges for the patient's age and medical condition. With the interpretation of the results, a decision is made regarding the need for any further action.
Health care team roles
The nurse can provide counseling on the normal development of children and the prevention of illness and injuries. Alternatively, the nurse can guide the child's caregiver to the patient's doctor.
PERIODICALS
Board, Michele. "Comparison of disposable and glass mercury thermometers." Nursing Times Vol. 91, no. 33, pp 36-37.
ORGANIZATIONS
American Association of Critical Care Nurses, 101 Columbia, Aliso Viejo, CA, 92656.
American Nurses Association, 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024. (202) 651-7000.
National Association of Neonatal Nurses, 4700 W Lake Avenue, Glenview, IL 60025. (847) 375-3660 or (800) 451-3795.
National Association of Pediatric Nurse Associates and Practitioners, NAPNAP, 1101 Kings Highway, N, Suite 206, Cherry Hill, NJ 08034. (856) 667-1773.
