Virginia Mason Medical Center

VIRGINIA MASON MEDICAL CENTER PCT-101 COURSE FOCUS NOTES FOR MID-TERM

The mid-term will include questions from the first part of the course regarding workplace safety, infection control, standard precautions, positioning & lifting, the integumentary system, and body mechanics.

Height and weight are not technically vital signs but are an important part of planning care for the patient.  The weight scale is always calibrated first before weighing the patient.  Newly admitted patients are always weighed for baseline measurement.  The PCT is responsible to obtain the patient’s height & weight for admission data, along with vital signs.

Vital signs (VS) are taken at least every shift. It is the PCT’s responsibility to know how often VS are to be taken: every shift, every 4 hours, every hour, every 15 minutes, etc.

When reporting VS to the nurse or practitioner, always write it down. Do not mention VS only in passing. Chart VS asap.

VS are reported as TPR & BP & O2 Sat. That is to report in this order: temperature, pulse, respiration & blood pressure & oxygen saturation. It is important that when you check VS that you obtain all of these measurements, chart them, and notify the nurse of any abnormalities.

The PCT is responsible to know normal value ranges for VS; however, it is not the PCT’s responsibility to interpret the VS for the practitioner by saying that “everything’s normal.” Always give values by their number.

Normal temp range: Fahrenheit: 98.6° Centigrade: 37° (Carter & Lewsen, pg. 293)  A difference of 0.5° to 1° Fahrenheit is considered to be within normal limits  Temperature can be measured as oral, rectal, axillary, or tympanic. When recording temp always specify if rectal, axillary or tympanic. Otherwise it is assumed to be an oral temperature.  The signs of an elevated temperature are easy to recognize: flushed face, hot skin, unusually bright eyes, restlessness, and thirst.  A lifeless manner and pale, cool, clammy skin are often signs of a sub- normal temperature.

Normal pulse range: 60 to 100 beats per minute (BPM) (Carter & Lewsen, pg. 296)  Do not use your thumb to palpate the artery because the thumb has its own pulse!  Pulses are usually taken as radial pulse.  An apical pulse is taken by using your stethoscope and reported as an apical pulse; it is the most accurate pulse. While taking an apical pulse with a stethoscope, the first sound (“lubb”) is the sound of the tricuspid and mitral valves closing during ventricular diastole.  Pulses can be felt and counted at the carotid artery or femoral artery.  There are other pulse “checks” that are usually not counted. Some examples include the brachial pulse or the pedal pulse.

Normal respiration range: 12 to 20 (Carter & Lewsen, pg. 297)  It is important to note the rate (breaths per minute), rhythm or regularity of breathing, the amount of effort the patient requires, and the quality or depth of respirations.  If the patient complains of difficulty breathing, raise the head of the bed and stay with the patient. It is important that the patient with respiratory distress is not left alone. Call for the nurse to help.  Be aware that respiratory failure leads to cardiac arrest.

Normal oxygen saturation range: 92% to 100%

When caring for a person who is receiving oxygen therapy, the PCT is responsible for  knowing what flow rate was ordered and  checking the flow meter frequently to make sure that the flow rate is set properly.  The PCT also checks the water level in the humidity bottle frequently, and checks to make sure that there are bubbles.  The PCT is responsible for checking the pulse oximeter to make sure that the reading is within the normal range along with  monitoring the patient’s respiration rate, rhythm, and quality.

Normal blood pressure (BP) range: 100/60 to 140/90 (Carter & Lewsen, pg. 302)  When checking the BP, do not go by the movement of the dial or mercury only. You must listen for Korotkoff sounds.  When reading about blood pressures, you will often see mmHg. This means millimeters mercury.  Orthostatic hypotension, or low blood pressure on changing positions, affects many people and is the reason patients are encouraged to sit or “dangle” before standing up from a lying position.  The PCT will be responsible to check postural blood pressures and must be aware of which patients require this and when. The postural BP is recorded as lying, sitting, standing. A difference of 25 mmHg systolic or 10 mmHg diastolic is significant and must be reported.  When reporting a blood pressure, it is essential that the PCT also report the pulse rate at the same time. BP and pulse readings always accompany each other and are meaningful to the healthcare provider.  When checking BP the PCT must know any restrictions on either arm, such as the presence of an IV, history of mastectomy, dialysis graft, cellulitis, or other vascular abnormalities.

If you are unsure of your readings, double check again. If you are still uncertain, let the nurse know and he/she will check to confirm.

If you are not able to get any VS and the patient is unresponsive, of course always call out for help and initiate an emergency code immediately.

Vagus Nerve: Although all of the cranial nerves are important, one nerve deserves special attention. The vagus nerve (cranial nerve X) serves a much larger portion of the body than the others. It affects many body functions that are beyond conscious control. Branches of the vagus innervate muscles of the pharynx, larynx, respiratory tract, heart, esophagus, and parts of the abdominal viscera. Therefore, the vagus nerve has reflex control of heart rate, sneezing, hunger, secretions from glands in the stomach, and constrictions within the respiratory tract. It is also involved in sympathetic and parasympathetic responses. For this reason, it is called “the wanderer.”

Resources: Rosdahl, C.B. & Kowalski, M.T. (2003). Textbook of Basic Nursing, 8th Ed. Lippincott, Williams & Wilkins; Philadelphia, PA. p. 223; pp. 562-581. Carter, P.J. & Lewsen, S. (2005). Textbook for Nursing Assistants: A Humanistic Approach to Caregiving. Lippincott, Williams & Wilkins; Philadelphia, PA.