Pediatric Considerations: Kids & Vital Signs

1. Pediatric Considerations: Kids & Vital Signs Vital Signs in the Ambulatory Setting:An Evidence-Based Approach Cecelia L. Crawford RN, MSN

2. 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

3. VS – It’s All About The Numbers! Terminal Digit Preference HCW 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)

4. Ear (Tympanic) Temperature Can be affected by heat & cold: • Heating & cooling measures • Heat & ice packs, heating blankets • Child wrapped in blanket for a long time • Extreme outside and inside temperatures • Very hot or very cold rooms • Very hot or very cold days • Bathing or swimming • May need to wait 20 minutes for accurate temp

5. 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

6. 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

7. 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

8. 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

9. Normal Pulse Rates Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

10. Respiratory Rate • Count for 60 sec • If panting, use stethoscope to count • Agitation can result in inaccurate RR

11. Normal Respiratory Rates Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006)

12. 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

13. 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!

14. Normal BP Measurements Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter (2006) (* BP is often not taken on children less than 3 years of age)

15. Children in the Clinic • YOU can make the difference: • Welcoming presence • Decrease the child’s anxiety & fears • Reassure the parents & family • Accurate vital signs