Taking the CNA exam can feel overwhelming, but you'll be ready to succeed with a positive attitude and thorough preparation. This guide will walk you through the essential steps for measuring and recording vital signs - manual blood pressure, radial pulse, and respirations.
Key tips on Measuring and Recording Vital Signs
🔑 Stay Organized: Keep your supplies organized and within reach to avoid interruptions during the procedure.
🔑 Hand Hygiene: Always wash your hands before and after each procedure to maintain hygiene and prevent infection.
🔑 Documentation: Ensure all readings are accurately documented. Double-check your entries for any errors.
Part 1: Measuring and Recording Manual Blood Pressure 🩺
Supplies Needed:
⚕️ A blood pressure cuff
⚕️ A stethoscope
⚕️ Alcohol wipes
⚕️ A piece of paper
⚕️ A pen or pencil
Steps:
Explain the Procedure:
🩺 Speak clearly, slowly, and directly.
Sanitize Equipment:
🩺 Wipe the bell/diaphragm and earpieces of the stethoscope with alcohol wipes.
Position the Patient's Arm:
🩺 Place the patient's arm with the palm up and the upper arm exposed.
Locate the Brachial Artery:
🩺 Feel for the brachial artery on the inner aspect of the arm, at the bend of the elbow.
Place the Blood Pressure Cuff:
🩺 Wrap the cuff around the upper arm, ensuring the sensor/arrow is over the brachial artery site.
Prepare the Stethoscope:
🩺 Insert the earpieces into your ears and place the bell/diaphragm over the brachial artery site.
Inflate the Cuff:
🩺 Inflate the cuff to 160mm Hg to 180mm Hg. If a beat is heard immediately upon deflation, completely deflate the cuff and reinflate to no more than 200mm Hg.
Deflate the Cuff Slowly:
🩺 Note the first sound (systolic reading) and the last sound (diastolic reading). If rounding is necessary, round up to the nearest 2 mm of mercury.
Remove the Cuff:
🩺 Carefully remove the cuff from the patient's arm.
Ensure Patient Comfort:
🩺 Make sure the signaling device is within the patient's reach.
Wash Your Hands:
🩺 Clean your hands thoroughly before recording any readings.
Record the Readings:
🩺 Accurately document both systolic and diastolic pressures, ensuring they are within plus or minus 8 mm of the evaluator's reading.
🥼 Tips for Measuring Manual Blood Pressure:
Correct Cuff Size: Ensure the blood pressure cuff is the correct size for the patient's arm. An incorrect size can lead to inaccurate readings.
Positioning: The patient's arm should be at heart level, supported, and relaxed. Improper positioning can affect the accuracy of the reading.
Ear Placement: Ensure the earpieces of the stethoscope are pointed slightly forward. This positioning improves sound clarity.
Inflation Technique: Inflate the cuff smoothly and steadily. Avoid over-inflating, as this can cause discomfort to the patient.
Deflation Rate: Deflate the cuff slowly, about 2-3 mm Hg per second. A slower deflation rate ensures accurate readings.
Double-Check: If you are unsure of the reading, it is okay to repeat the process. However, wait a minute before re-inflating the cuff to allow the blood flow to normalize.
Part 2: Measuring Radial Pulse 🩺
Supplies Needed:
⚕️ Analog watch
⚕️ Notepad
⚕️ Pen
Steps:
Introduce Yourself:
🩺 Explain to the patient what you will be doing.
Wash Your Hands:
🩺 Clean your hands thoroughly before starting the procedure.
Locate the Radial Pulse:
🩺 Place two fingers on the patient's wrist, on the side of their thumb.
🩺 You should feel a "bump-bump" indicating the radial pulse.
🩺 If you cannot feel anything, try pressing harder and moving your fingers around the thumb side of the wrist near the visible veins until you find the pulse.
Count the Pulse:
🩺 Count the patient's pulse for precisely 60 seconds.
Document the Pulse:
🩺 Record the value in the patient's charting system, noting the number and method (radial).
🥼 Tips for Measuring Radial Pulse:
Finger Placement: Use the index and middle fingers to feel the pulse. Avoid using your thumb as it has its own pulse and can cause confusion.
Consistency: For the most accurate measurement, count the pulse for a full 60 seconds. Do not estimate or extrapolate from a shorter count.
Relax the Patient: Ensure the patient is relaxed, seated, or lying down. An anxious or active patient might have an elevated pulse rate.
Part 3: Measuring and Recording Respirations
Respiration Rate Overview:
🩺 A healthy adult's respiration rate is 12 to 20 breaths per minute.
🩺 Count respirations immediately after taking the pulse while the patient is resting and unaware.
Prepare the Patient:
🩺 Tell the patient you are taking their pulse again, but actually record their respiration count to ensure natural breathing.
Count Respirations:
🩺 While holding their wrist, observe the chest rise and fall, counting the first chest fall as breath one.
🩺 Count respirations for one full minute.
Record Respirations:
🩺 Document the respiration rate in the patient's chart.
🥼 Tips for Measuring and Recording Respirations:
Discretion: Count respirations without making the patient aware. Inform them you are taking their pulse to ensure they breathe naturally.
Observation: Focus on the rise and fall of the chest or abdomen. Each rise and fall counts as one breath.
Consistency: Count for a full minute to ensure accuracy. This is particularly important if the patient has irregular breathing patterns.
Documentation: Record the respiration rate immediately after counting. This ensures you don't forget the value.