Vital Signs in Children Health Article

Definition

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).