Question

Vital Signs Case Study

Mr. Charles Lamont is a 64-year-old patient who is visiting his primary care physician with complaints of vomiting x 3 days and inability to keep anything down. His wife is waiting for him in the lobby. She is hoping that Mr. Lamont will tell the physician about his recent bout of coughing and shortness of breath. He smokes 1½ packs of cigarettes per day. His wife has been encouraging him to stop, but he has not shown any interest in quitting. Laura, the registered nurse, takes Mr. Lamont into an examination room. Laura asks him about his overall health and he tells her about a nagging cough and feeling of dizziness when he tries to get up. Laura examined Mr. Lamont and observed dry, scaly skin, an inflamed hemorrhoid, and tremors to his fingers and toes. The patient also vomits after drinking a cup of apple juice. He also reports pain in his feet. Laura instructed the UAP to takes Mr. Lamont’s vital signs with the following results: blood pressure, 156/94 mm Hg sitting; temperature, 98.8° F orally; radial pulse, 52 beats/min and irregular; respirations, 25 breaths/min and regular; and pulse oximetry 87%. Laura retakes the pulse prior to documenting and reporting the findings to the physician. She also documents the vital signs in the computerized medical record.

The primary care physician examines Mr. Lamont and tells him that he should quit smoking. He gives him an antihypertensive medication to help lower his blood pressure. Mr. Lamont asks Laura if she can teach his wife how to take his blood pressure. Laura agrees and brings Mrs. Lamont in to explain the process. Laura decides that she will use demonstration to teach Mrs. Lamont the procedure, but she also wants to explain some important concepts such as:

a. Choose a cuff that is the right size

b. Ensure that the patient is sitting or lying.

c. Support the extremity.

d. Ensure proper cuff application.

Answer 1

Ans) a.Choose a cuff that is the right size

- If a cuff that is not right size is used, the reading will be false.

Example: If the cuff is too wide, the reading will be false or low, if the cuff is too narrow or short, the reading will be false and high.

b. Ensure that the patient is sitting or lying.

- The arm needs to be at heart level to ensure accurate reading if the arm is below heart level the reading will be false and high.

- If the arm is above heart level the reading will be false and low.

- The preferred position is sitting unless orthostatic hypotension is indicated.

c. Support the extremity.

- If the arm is supported, the reading will be false and high.

d. Ensure proper cuff application.

- If the cuff is wrapped too loose or evenly the reading will be false and high.