Clinical Research Coordinator Skills Program Brigham and Women's - PowerPoint PPT Presentation

Clinical Research Coordinator Skills Program Brigham and Women's Hospital

Agenda • Vital Signs • Lecture (~45 min) • Demonstration (~20 min) • Hands-On Practice (~45 min) 10-Minute Break • EKG • Lecture (~45 min) • Demonstration (~20 min) • Hands-On Practice (~45 min) Brigham and Women's Hospital

Vital Signs Brigham and Women's Hospital

This Skill Requires • Provider direction • Standard Precautions • Using Purell before and after contact with the patient or the patient’s environment • Two patient identifiers • An explanation of procedure to the patient • Patient Privacy Brigham and Women's Hospital

Vital Signs • Temperature (T) • Pulse (P) • Respiration (R) • Oxygen Saturation (SaO2) • Blood Pressure (B/P) Brigham and Women's Hospital

Temperature • Measurement of body heat • Normal range: 96 ° F to 100 ° F • Varies in different parts of the body • Inform provider using predetermined parameters • Thermometer is the instrument used to measure temperature – Oral/axillary thermometer Brigham and Women's Hospital

Oral or Axillary Temperature • Placement/route • Oral (po): under the tongue, on the side of the mouth • Axillary (ax): in the center of the armpit against the skin • Hold thermometer in place until it sounds “beep” • Remove and read display • Document on appropriate form Brigham and Women's Hospital

Helpful Hints • Do not take an oral temperature if patient: – has just had a hot or cold drink (wait 10 minutes) – has an injured mouth or nose – has a mask over his/her face – is confused or uncooperative Brigham and Women's Hospital

Pulse • Measurement of heart rate • Normal adult range: 60 to 100 beats per minute (higher in infant or child) • Note the rhythm • Regular: beats follow one after another in the same pattern • Irregular: extra time or less time between beats Brigham and Women's Hospital

Counting the Pulse: Radial Artery • Locate the radial artery (most common) in the inner aspect of the wrist on the thumb side • Feel for the pulse by placing the second and third fingers on the radial artery • Count the number of beats for one full minute, or count for 30 seconds and multiply by two (if pulse is irregular, count for a full minute) • Record Brigham and Women's Hospital

Respiration • Measurement of the rise and fall of the chest/abdomen • Normal adult range: 12 to 24 breaths per minute (higher in infant or child) • Note the pattern • Regular: even amount of time between breaths • Irregular: slow or fast Brigham and Women's Hospital

Respiration • Methods • Observe or place your hand on patient’s chest to see or feel the patient’s chest rise and fall • One rise (inspiration) and one fall (expiration) is counted as one respiration • Count for a full minute • Record Brigham and Women's Hospital

Respiration • Patient with dyspnea (difficulty breathing) • Signs and symptoms • May state that he/she is having trouble breathing • Breathing is irregular, fast, or slow • May have cyanosis (blue color) around the mouth, lips, skin or fingernails • May be restless, disoriented, or confused • Can be life-threatening • Always notify the provider Brigham and Women's Hospital

Blood Pressure (BP) • Measurement of blood pressing or pushing against the walls of the artery • Measures two different values • Systolic number (upper number): pressure in the heart and blood vessels as the heart contracts and blood is pumped into the aorta • Diastolic number (lower number): pressure as the heart relaxes and fills with blood Brigham and Women's Hospital

Blood Pressure (BP) • Normal adult BP according to AHA: < 120 mmHg systolic < 80 mmHg diastolic • Two methods to measure blood pressure non-invasively – Sphygmomanometer – Automated monitor Brigham and Women's Hospital

Sphygmomanometer • Blood pressure cuff attached to a gauge • Bulb to inflate cuff • Use with a stethoscope Brigham and Women's Hospital

Blood Pressure Cuffs • Cuffs come in different sizes • Accurate blood pressure measurement requires correct cuff size to fit the patient’s arm • Do not use B/P cuff on an arm with any injury, surgery, weakness, swelling or intravenous (IV) line Brigham and Women's Hospital

Blood Pressure via Sphygmomanometer • Wrap the cuff around the patient’s arm above the elbow with the arrow over the brachial pulse • Feel for the brachial pulse with your fingers (antecubital space located at the bend in the elbow on the small finger side of the arm) • Review chart for previous BP readings and go 20 points higher Brigham and Women's Hospital

Blood Pressure via Sphygmomanometer • Once inflated, control the screw with your thumb and index fingers • Open the screw SLOWLY to deflate the cuff with your thumb and index fingers • Listen and note the number on the dial or column of the first strong beat (systolic) • Then listen and note the last strong beat (diastolic) Brigham and Women's Hospital

Blood Pressure via Sphygmomanometer • When no more sound is heard, open the screw to completely deflate the cuff • Record the systolic and diastolic pressures Brigham and Women's Hospital

Blood Pressure via Sphygmomanometer: Helpful Hints • Wipe the earpieces of the stethoscope with an alcohol wipe before putting them in your ears (less often if it’s a personal stethoscope) • Turn the tips of the earpieces so that they point toward the tip of your nose (hear the sounds more clearly) • Always read the gauge at eye level • Never leave an inflated cuff on a patient more than a few minutes (prevents blood from circulating to the lower arm) • Always deflate the cuff completely after taking the blood pressure • Do not try to get a measurement more than 2 times on the same arm (try the other arm) Brigham and Women's Hospital

Oxygen Saturation • Pulse oximetry measures peripheral arterial oxygen saturation (SaO2) • Probe consists of two light emitting diodes and photodetector • Movement, nail polish, poor perfusion and disease processes can infer with SaO2 readings. Uptodate.com Brigham and Women's Hospital

Conclusion • Taking and recording Vital signs in a careful and accurate manner provides important information about the patient’s overall condition • Questions? Brigham and Women's Hospital