Vital Signs RTEC 93 Venipuncture for Radiographers

When do you wash your hands? When hands are visibly soiled Before and after patient contact After removal of gloves After using the toilet After blowing or wiping the nose Upon leaving an isolation area How long do you wash?

Equipment Needed A Stethoscope A Blood Pressure Cuff (Sphygmomanometer) A Watch Displaying Seconds

Vital Signs Indication of Homeostasis Primary Mechanisms Heart beat Blood pressure Body temperature Respiratory rate Electrolyte balance Physical assessment include measurement of vital signs Body Temperature Pulse Respiration Blood Pressure Mental Status

General Considerations for taking vital signs Ideally the patient should be sitting with feet on the floor and their back supported. The examination room should be quiet and the patient comfortable. History of hypertension, slow or rapid pulse, and current medications should always be obtained.

Body Temperature CAUTION: Do not mix oral and rectal thermometers. Normal average body temperature: 98.6 F Humans can survive between 106 F and 93.2 F. Hypothermia Hyperthermia Measuring Body Temperature Oral Rectal Axillary Tympanic Temporal Artery (TA) Thermometers

Pulse Pulse rate: Adult = 60 to 100 beats per minute Children under 10 = 70 to 120 beats per minute Tachycardia Bradycardia

Common Sites Used for Taking a Patient's Pulse 1. Radial artery--inside the wrist near the base of the thumb 2. Brachial artery--located in the depression proximately ½ inch from the crease on the inside of the elbow 3. Carotid artery--located in the groove on either side of the windpipe 4. Apical--at the apex of the heart (stethoscope needed)

Pulse Wash Hands Identify your patient Introduce your self and explain the procedure Position the patient lying down or seated, with palm up, arm comfortable and supported Sit or stand facing your patient.

Pulse Grasp the patient's wrist with your free (non- watch bearing) hand (patient's right with your right or patient's left with your left). There is no reason for the patient's arm to be in an awkward position, just imagine you're shaking hands. Compress the radial artery with your index and middle fingers. Is using your thumb a good idea?

Radial, Brachial or Carotid Artery

Pulse Note whether the pulse is regular or irregular: Regular - evenly spaced beats, may vary slightly with respiration Regularly Irregular - regular pattern overall with "skipped" beats Irregularly Irregular - chaotic, no real pattern, very difficult to measure rate accurately

Pulse Count the pulse for 15 seconds and multiply by 4. Count for a full minute if the pulse is irregular. Record the rate and rhythm.

Respiratory Rate Breaths per minute: Adult = 12 to 20 Children under 10 = 20 to 30 per min Tachypnea Bradypena Dyspnea Apnea

Respiratory Rate Best done immediately after taking the patient's pulse. Do not announce that you are measuring respirations. Have patient remove bulky clothing (if possible) that might interfere with observation of chest movement. Position patient sitting or supine.

Respiratory Rate Place your fingers on patient's wrist as if you are taking his pulse. Also, if there is difficulty in seeing chest movement, you may fold the patient's arm diagonally across their chest, allowing you to feel the movement instead. Without letting go of the patients wrist begin to observe the patient's breathing. Is it normal or labored?

Respiratory Rate Inspiration + Expiration = 1 Count breaths for 15 seconds and multiply this number by 4 or 30 seconds and multiply by 2 or for 1 minute to yield the breaths per minute.

Pulse Oximeter Normal Pulse Oximeter = 95% to 100%

Oxygen Oxygen constitutes 21% of atmospheric gases If O2 levels in the body drop below 21% homeostasis is altered. Hypoxia: Inadequate amount of oxygen at the cellular level.

Blood Pressure Systolic pressure = mmHg Diastolic pressure = mmHg Hypertension Hypotension

Blood Pressure Wash Hands Identify your patient Introduce your self and explain the procedure Position the patient lying down or seated, comfortable Position the patient's arm so the anticubital fold is level with the heart. Support the patient's arm with your arm or a bedside table. Position the patient's arm so it is slightly flexed at the elbow.

Blood Pressure Locate brachial pulse by palpation Place cuff 1 to 2 inches above elbow or anticubital fold. Proper cuff size is essential to obtain an accurate reading. Position arrow on the cuff over brachial artery CAUTION: The inflated cuff is not to stay in place any longer than 2 minutes

Blood Pressure Position gauge where you will have full view to observe the column or dial Place ear piece of stethoscope facing forward in ears. This is the only correct placement any time a stethoscope is used Do not use thumb to stabilize diaphragm on arm, as your pulse may be heard instead of the patient's blood pressure

Blood Pressure Palpate the radial pulse and inflate the cuff until the pulse disappears. This is a rough estimate of the systolic pressure Place the stethoscope over the brachial artery. Inflate the cuff to 30 mmHg above the estimated systolic pressure. Release the pressure slowly, no greater than 5 mmHg per second.

Blood Pressure The level at which you consistently hear beats is the systolic pressure Continue to lower the pressure until the sounds muffle and disappear. This is the diastolic pressure Release remaining air Record the blood pressure as systolic over diastolic ("120/70" for example).

Central Line Injections by RT Does California Law address arterial injection by RT’s ? What are the important parts of the law to know?

Central Line Injections by RT The California Law does not address arterial injection by RT Employers policies Saline flush

Review Vital Signs Homeostasis Body Temperature Pulse Respiration Blood Pressure Mental Status Pulse Oximeter

Questions? Vital Signs Demo and practice in lab