Question

1. Identify the location of radial, brachial, and apical pulse.

2. What are the normal ranges of Vital signs?

3. Identify errors in vital sign reading for (Temperature, respiration, Blood    

     Pressure)

Answer 1

1.

Radial pulse:

The pulse site found on the inside of the wrist. Along thumb side.

Measuring a Radial Pulse.

• Wash your hands to prevent the spread of infection.
• Supporting the patient's arm and hand with the palm down, press the first, second, and third finger of your dominant hand gently against the radius bone until you feel the contraction and expansion of the artery with each heartbeat. Do not use your thumb; it has a strong pulse of its own and you may be counting your pulse.
• Count the pulsations for 30 seconds using a watch with a second hand or digital display to time yourself. Multiply the count by 2 to determine the rate for 1 minute. If the pulse is abnormal in any way, count for a full minute to get a more accurate reading.

Apical Pulse:

Pulse taken with a stethoscope and near the apex of the heart.

Measuring an Apical Pulse:

• Warm the stethoscope in your hands. A cold stethoscope may surprise the patient and alter the pulse rate.
• Place the stethoscope at the apex (pointed end) of the heart, in the left center of the chest, just below the nipple. The pulse can usually be heard best at the apex.
• Count the pulse for one full minute.

Brachial Pulse :

Pulse felt in bend of either arm.

Measuring the Brachial Pulse:

• With the right palm of the client turned up, and the arm straightened (slightly bent at the elbow), place the first two fingers of your hand on the inner third (side toward the body) of the crease of the elbow.
• Press firmly and hold for five seconds. If the brachial pulse is still not felt, begin again from the center of the arm and work your way toward the innermost (toward the body) part of the elbow fold crease.
• You should be able to feel the brachial pulse by using this method.
• Both pulse and blood pressure will be measured in the same arm. The right arm will always be used unless specific conditions prohibit its use.

2.

Normal vital sign ranges for the average healthy adult while resting are:

• Blood pressure: 90/60 mm Hg to 120/80 mm Hg
• Breathing: 12 to 18 breaths per minute
• Pulse: 60 to 100 beats per minute
• Temperature: 97.8°F to 99.1°F (36.5°C to 37.3°C)/average 98.6°F (37°C)

3. Errors in Vital signs reading :

• Incorrect Cuff Size and Location

Blood pressure is a key vital sign to obtain, and it seems everyone is worried about their blood pressure. This is because high and low blood pressure are indications of underlying diseases. A very high blood pressure could indicate uncontrolled hypertension, a stroke, a medication reaction, etc. Low blood pressure could indicate internal bleeding, systemic infection (sepsis), an adrenal crisis, etc.
Blood pressure cuffs should be sized appropriately to fit the patient’s arm.The bladder (the part that inflates with air) should encompass 80% of the person’s arm circumference. That means it should just about fall short of wrapping around their entire arm.
Most adults with regular-sized arms will fit the regular adult size, and larger individuals or gym-rats will benefit from the larger size. It should fit nice and snug, but not too-snug.
Incorrect cuff sizes will lead to incorrect blood pressure measurements. If you place a cuff too small on an individual, the blood pressure will likely be falsely elevated. If you place a cuff to big on an individual the reading could be falsely decreased.

• Incorrect Positioning

It is important to maintain proper positioning While taking vital signs.
The MOST IMPORTANT thing to remember while taking blood pressure is that the blood pressure cuff is at the level of the heart.The arm above their heart will read falsely lowered readings, and the arm below may render falsely elevated readings.

• Incorrect Temperature Method

It is important to use the correct temperature method for the correct situation, as using the wrong method can lead you to not picking up on a fever.

Oral Method:

If the patient recently drank something, this can lead to a falsely lower reading. The colder and more recently they drank it, the more likely it is to interfere with the reading. Cold beverages can decrease the temperature for up to 30 minutes, and hot beverages can falsely elevate the temperature for up to 5 minutes or so. Additionally, if the patient has a high respiration rate (greater than 20 breaths per minute), this can lead to falsely low readings.

Rectal Method:

The rectal thermometer is the “gold standard” because it is the closest to the core-body temperature, but it is not always practical. Rectal temperatures are also frequently obtained in children under a certain age. It depends on facility protocol, but obtaining rectal temperatures in infants and young children (often under 2 years) is common, especially if they present with complaints of fever.

Rectal temperatures tend to be 0.5-1.0°F HIGHER than the “normal” oral temperatures – 98.6°F.

Pulse:

Measure the rate of the pulse (recorded in beats per minute). Count for 30 seconds and multiply by 2 (or 15 seconds x 4). If the rate is particularly slow or fast, it is probably best to measure for a full 60 seconds in order to minimize the impact of any error in recording over shorter periods of time.

While takiong radial pulse do not use your thumb; it has a strong pulse of its own and you may be counting your pulse which leads to an measurement error.

Respiration:

Respirations are recorded as breaths per minute. They should be counted for at least 30 seconds as the total number of breaths in a 15 second period is rather small and any miscounting can result in rather large errors when multiplied by 4.