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

Brigham and Women's Hospital

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)

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Vital Signs

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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

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Vital Signs

• Temperature (T)
• Pulse (P)
• Respiration (R)
• Oxygen Saturation (SaO2)
• Blood Pressure (B/P)

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Sphygmomanometer

• Blood pressure cuff

attached to a gauge

• Bulb to inflate cuff
• Use with a stethoscope

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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

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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

• f the arm)
• Review chart for previous BP

readings and go 20 points higher

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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)

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Blood Pressure via Sphygmomanometer

• When no more sound is

heard, open the screw to completely deflate the cuff

• Record the systolic and

diastolic pressures

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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)

Oxygen Saturation

• Pulse oximetry measures peripheral arterial
• xygen 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

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Conclusion

• Taking and recording Vital signs in a

careful and accurate manner provides important information about the patient’s

• verall condition
• Questions?