presentation title sub title here pediatric considerations: kids & vital signs vital signs in...
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Pediatric Considerations:
Kids & Vital Signs
Vital Signs in the Ambulatory Setting:An Evidence-Based Approach
Cecelia L. CrawfordRN, MSN
Children in the Clinic• Children are NOT small adults• Anxiety & fear can affect vital signs
Allow parents & family members to stay with child
Allow child to stay in parent’s arm or lap
• May need special equipment & techniques to take vital signs Temperature Pulse Respirations Blood Pressure
VS – It’s All About The Numbers!
Terminal Digit PreferenceHCW may show a preference for certain numbers in
Pulse, Respirations, & auscultated BP readings* Zeros, even numbers, odd numbers Research study on BP revealed 99% of auscultated
SBP/DBP readings ended in zero, demonstrating lack of adherence to AHA recommendations*
HCW should be aware of this possible tendency
(*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)
Ear (Tympanic) TemperatureCan be affected by heat & cold:
Heating & cooling measuresHeat & ice packs, heating blanketsChild wrapped in blanket for a long time
Extreme outside and inside temperaturesVery hot or very cold roomsVery hot or very cold days
Bathing or swimming May need to wait 20 minutes for accurate temp
Ear (Tympanic) Temperature
•Can also be affected by: Impacted ear wax & ear
infections Whether an ear tug is used
•Should NOT be used if child had ear surgery
Ear (Tympanic) Temperature Insert covered thermometer probe into ear canal & use ear tug
to position properly: Children 1 year & older: Gently pull top of ear back, up, & out Children less than 1 year: Gently pull top of ear straight back Point tip towards nose
• Less than 2 yrs: point tip between eyebrows & sideburns
http://www.lane.k12.or.us/CSD/CAM/level1/ASSESS
Ear (Tympanic) Temperature•What Patients Think About Ear Temperatures
Parents like them! Fast, easy, clean, and safe
Children react better! Faster measurement Stay in parent’s lap or arms
No holding or restraining No positioning
Pulse - Brachial• Used for infants and small
children• Place fingertips of first 2
or middle 3 fingers over the brachial pulse area Inside of the elbow
• Lightly press your fingertips on the pulse area
Normal Pulse Rates
Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)
Babies to age 1: 100–160
Children ages 1 to 10: 60–140
Children age 10 & older: 60–100
Respiratory Rate
• Count for 60 sec• If panting, use stethoscope to count• Agitation can result in inaccurate RR
Normal Respiratory Rates
Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)
AGE BREATHS/MIN
Newborn to 6 weeks 30 - 60
Infant (6 weeks to 6 months) 25 - 40
Toddler ( 1 to 3 years) 20 - 30
Young Children ( 3 to 6 years) 20 - 25
Older Children (10 to 14 years) 15 - 20
Blood Pressure•Automated BP machines cannot be used in children with:
Seizures, shaking, or shivers Weak pulses Agitation Any situation where the arm cannot be kept still
Blood Pressure• Allow child to remain in
parent’s arm or lap• Use the right-sized cuff• Switch automated BP
machine to the pediatric setting Adult setting is too high for
children!
Normal BP Measurements
Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)
AGE Normal BP
Newborn to 6 weeks * Systolic 50 - 70
Infant (6 weeks to 6 months) * Systolic 70 - 95
Toddler ( 1 to 3 years) * Systolic 80 - 100
Young Children ( 3 to 6 years) Systolic 80 - 110
Older Children (10 to 14 years) Systolic 90 - 120
(* BP is often not taken on children less than 3 years of age)
Children in the Clinic• YOU can make the difference:
Welcoming presence Decrease the child’s anxiety & fears Reassure the parents & family Accurate vital signs