Vital Signs for Nurses

An Introduction to Clinical

Observations

Vital Signs for Nurses

An Introduction to Clinical

Observations

Joyce SmithLecturer in Adult Nursing

School of Nursing and MidwiferyUniversity of Salford, UK

Rachel RobertsMatron

Calderdale and Huddersfield NHS Foundation Trust, UK

A John Wiley & Sons, Ltd., Publication

This edition first published 2011 by Blackwell Publishing Ltd 2011 by Joyce Smith and Rachel Roberts

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Library of Congress Cataloging-in-Publication Data

Vital signs for nurses : an introduction to clinical observations / Joyce Smith, Lecturerin Adult Nursing, School of Nursing and Midwifery, University of Salford, UK,Rachel Roberts, Matron, Calderdale and Huddersfield NHS Trust, UK.

p. ; cm.Includes bibliographical references and index.ISBN 978-1-4051-9038-1 (paperback : alk. paper)

1. Vital signs – Measurement. 2. Physical diagnosis. 3. Nursing. I. Roberts, Rachel,1970- author, II. Title.

[DNLM: 1. Physical Examination – nursing. 2. Vital Signs. WY 100.4]RT48.S 636 2011616.07′54 – dc22

2010049555

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF [9781444341867],ePub [9781444341874], MobiPocket [9781444341881]

Set in 9/11 Palatino by Laserwords Private Limited, Chennai, India.

1 2011

Contents

Preface viiAcknowledgements ixIntroduction xi

1 Legal and Ethical Principles 1Joyce Smith

2 Infection Prevention 20Rachel Roberts

3 The Respiratory System 49Joyce Smith and Rachel Roberts

4 The Cardiovascular System 61Joyce Smith and Rachel Roberts

5 Temperature 82Rachel Roberts and Joyce Smith

6 Urine Output 96Rachel Roberts

7 Pain: The Fifth Vital Sign 115Rachel Roberts and Joyce Smith

8 Early Warning Scoring Tools 138Joyce Smith

9 Communication 156Rachel Roberts

10 Nutrition 167Rachel Roberts

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0 Contents

11 Blood Glucose Monitoring 187Joyce Smith

12 Record Keeping 205Joyce Smith and Rachel Roberts

13 Continuing Professional Development 214Joyce Smith

14 Reflective Practice 222Rachel Roberts

15 Conclusion and Multiple Choice Questions 231Joyce Smith

Glossary of Terms 237Answers to Practice Points and Multiple Choice Questions 245Index 263

vi

Preface

This book will provide a comprehensive resource for a cadet,student nurse or a registered nurse working within any adulthealthcare environment. It is a valuable resource for registerednurses, allied health professionals or healthcare students undertak-ing or working towards a BTEC qualification, foundation degreeor relevant in-house courses linked to vital signs monitoring.

Vital signs monitoring and the reporting of any clinical changesare fundamental in the delivery of quality patient care. Chapter 1relates to legal and ethical principles and Chapter 2 reiterates theimportance of infection prevention. Both chapters are integral toevery aspect of healthcare delivery including vital signs monitoring.The remaining chapters focus on different aspects of physiologicalmonitoring and a brief overview of the related anatomy and phys-iology. The concluding chapters discuss record keeping, reflectivepractice and continuing professional development. We hope thisbook will help healthcare professionals involved in monitoringa patient’s vital signs link theory to practice, promote reflectionupon their own practice and assist in their continuing professionaldevelopment.

The aim of the book is to develop the underpinning knowledgeand skills in both theory and practice for the adult patient found inhospital, private sector or community settings. This will enable staffto demonstrate their knowledge and skills when performing vitalsigns monitoring. In a changing National Health Service (NHS)climate, performing and monitoring vital signs, including goodstandards of record keeping, has never been more important.

vii

Acknowledgements

We would like to acknowledge the Pennine Acute NHS Trustfor allowing us to reproduce several charts and clinical proce-dures. Special thanks to the following people who kindly agreed toproofread chapters within the book:

Sylvia Maxfield, Infection Control Nurse, Pennine Acute TrustDr Tracy Birdsey, Lecturer in Diabetes and Physiology Open

UniversityLis Bourne, Lecturer in Health Care Ethics and Law, University of

Salford

We would like to dedicate this book to our families for theirsupport and patience as well as for accepting limited time togetherwhen the book took priority over many evenings and weekends.Special thanks therefore to Patrick, Eleanor, Irene, Marion, Robert,Emma, Helen, Ian, Matthew, Abbi and Eleanor.

ix

Introduction

The focus on performing, recording and documenting vital signshas never been more important. For over a decade it has beenrecognised as problematic within clinical practice (McQuillan et al.,1998; Kenward et al., 2001; Goldhill et al., 1999; Goldhill, 2005).Research has highlighted that a patient’s physiological deteriora-tion has not been acted upon in a timely manner despite vital signsmonitoring being an essential part of nursing care. In responseto the concerns highlighted within publications by the NationalConfidential Enquiry into Patient Outcome and Death (NCEPOD)(NCEPOD, 2005) and the National Patient Safety Agency (NPSA)(NPSA, 2007a, 2007b), the National Institute for Health and ClinicalExcellence (NICE) (NICE, 2007) has developed clinical guideline 50Acutely Ill Patients in Hospital and Response to Acute Illness in Adultsin Hospital.

In support of NICE clinical guideline 50, the Department ofHealth (DH) has reinforced the principles and standards set withinthe guidelines that NHS trusts must implement. One of the keyrecommendations states that anyone performing and monitoringthe patients’ vital signs be trained and assessed as competent (DH,2007, 2009) as part of maintaining patient safety (NPSA, 2007a,2007b).

This book is designed to be read as a whole or allow the readerto dip in and out of relevant areas of interest. The importance ofeach element of the patients’ vital signs will be explored in moredetail within each dedicated chapter. Within each chapter, learningobjectives will be outlined to assist the readers in achieving theirlearning outcomes. The chapters will incorporate written and visualinformation for the readers to enhance their reflection during theirlearning experience. Case studies, activities or points for reflectionhave been included to relate the theory within each chapter to the

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0 Introduction

reader’s area of practice. Optional case studies and activity boxesare highlighted throughout the book as ‘Practice points’. Takingthe time to complete the practice point will encourage you to reflecton your practice as well as to evaluate your current knowledge.

It is hoped that this book will empower the readers to gainmore confidence in their knowledge and skills in recognising andresponding to the patient’s vital signs. References and websiteaddresses will be incorporated at the end of each chapter. Atthe back of the book is a glossary of terms that may be usefulto the reader in explaining the bold and italic terminology usedwithin the text. Answers to the practice points can be found at theconclusion of the book.

REFERENCESDepartment of Health (2007). Acutely Ill Patients in Hospital: Recognition

of and Response to Acute Illness in Adults in Hospital. NICE clinicalguideline 50. London, NICE.

Department of Health (2009). Competencies for Recognising and Respond-ing to Acutely Ill Patients in Hospital. http://www.dh.gov.uk/publications.

Goldhill DR, White SA, and Sumner A (1999). Physiological valuesand procedures in the 24 h before ICU admission from the ward.Anaesthesia 54, 529–534.

Goldhill DR (2005). Preventing surgical deaths: critical care and inten-sive care outreach services in the postoperative period. British Journalof Anaesthesia 95(1), 88–94.

Kenward G, Castle N, and Hodgetts T (2001). Time to put the R backin TPR. Nursing Times 97(40), 32–33.

McQuillan P, Pilkington A, Allan A, et al. (1998). Confidential inquiryinto quality of care before admission to intensive care. British MedicalJournal 316, 1853–1858.

National Confidential Enquiry into Patient Outcome and Death(NCEPOD) (2005). An Acute Problem? www.ncepod.org.uk

National Institute for Health and Clinical Excellence (NICE) (2007).Acutely Ill Patients in Hospital: Recognition of and Response to AcuteIllness in Adults in Hospital. London, NICE.

National Patient Safety Agency (2007a). Recognising and RespondingAppropriately to Early Signs of Deterioration in Hospitalised Patients.London, NPSA, Available at: http//tinyurl.com/yk8qbx5 [Accessed26th March 2010].

National Patient Safety Agency (2007b). Safer Care for the AcutelyIll Patient: Learning from Serious Incidents. London, NPSA, Avail-able at: http://www.nrls.npsa.nhs.uk/resources/?entryid45=59828[Accessed 26th March 2010].

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1Legal and Ethical Principles

INTRODUCTIONLegal and ethical issues/dilemmas are abundant in healthcarepractice and it is therefore important that nurses understand thelaw, ethical theory and professional guidance in order to be able toaccount for their practice. The law and ethical principles underpinall aspects of health care; therefore, as a member of the healthcareteam, one needs to have an awareness of the legal and ethicalissues that impact on healthcare professionals when undertakingand recording patients’ vital signs. The legal, professional andethical principles discussed throughout this chapter relate to adultpatients only. All healthcare professionals taking responsibilityfor treating a patient thereby owe that patient a duty of care(Fullbrook, 2007a; NMC, 2008). The concept of ‘duty of care’ wasintroduced in Donoghue v Stevenson (1932) AC562 and Lord Atkinintroduced the ‘neighbour principle’.

You must take reasonable care to avoid acts or omissions that you canreasonably foresee would be likely to injure your neighbour. Who thenin law is my neighbour? The answer seems to be persons who are soclosely and directly affected by my act that I ought reasonably to havethem in contemplation as being so affected when I am directing my mindto the acts or omissions which are called in question

(Dimond, 2008, p. 40).

LEARNING OUTCOMESBy the end of this chapter, you will be able to discuss the following:

❑ The legal system in England and Wales❑ Ethical principles

Vital Signs for Nurses: An Introduction to Clinical Observations, First Edition.Joyce Smith and Rachel Roberts. 2011 Joyce Smith and Rachel Roberts. Published 2011 by Blackwell Publishing Ltd.

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