These numbers should be used as a guide only. A single blood pressure measurement that is higher than normal is not necessarily an indication of a problem. Your doctor will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of high blood pressure and starting treatment. Ask your provider when to contact him or her if your blood pressure readings are not within the normal range.
For people with hypertension, home monitoring allows your doctor to monitor how much your blood pressure changes during the day, and from day to day. This may also help your doctor determine how effectively your blood pressure medication is working. Either an aneroid monitor, which has a dial gauge and is read by looking at a pointer, or a digital monitor, in which the blood pressure reading flashes on a small screen, can be used to measure blood pressure. The aneroid monitor is less expensive than the digital monitor.
The cuff is inflated by hand by squeezing a rubber bulb. Some units even have a special feature to make it easier to put the cuff on with one hand. However, the unit can be easily damaged and become less accurate. Because the person using it must listen for heartbeats with the stethoscope, it may not be appropriate for the hearing-impaired.
The digital monitor is automatic, with the measurements appearing on a small screen. Because the recordings are easy to read, this is the most popular blood pressure measuring device.
It is also easier to use than the aneroid unit, and since there is no need to listen to heartbeats through the stethoscope, this is a good device for hearing-impaired patients. One disadvantage is that body movement or an irregular heart rate can change the accuracy.
These units are also more expensive than the aneroid monitors. In addition, they are more expensive than other monitors. The American Heart Association recommends the following guidelines for home blood pressure monitoring:. Sit with your back supported don't sit on a couch or soft chair. Keep your feet on the floor uncrossed. Place your arm on a solid flat surface like a table with the upper part of the arm at heart level. Place the middle of the cuff directly above the bend of the elbow.
Check the monitor's instruction manual for an illustration. Take multiple readings. When you measure, take 2 to 3 readings one minute apart and record all the results. Take the record with you to your next medical appointment. If your blood pressure monitor has a built-in memory, simply take the monitor with you to your next appointment. Call your provider if you have several high readings. Don't be frightened by a single high blood pressure reading, but if you get several high readings, check in with your healthcare provider.
When blood pressure reaches a systolic top number of or higher OR diastolic bottom number of or higher, seek emergency medical treatment. Ask your doctor or another healthcare professional to teach you how to use your blood pressure monitor correctly. Have the monitor routinely checked for accuracy by taking it with you to your doctor's office.
It is also important to make sure the tubing is not twisted when you store it and keep it away from heat to prevent cracks and leaks. Proper use of your blood pressure monitor will help you and your doctor in monitoring your blood pressure. Health Home Conditions and Diseases.
The four main vital signs routinely monitored by medical professionals and health care providers include the following: Body temperature Pulse rate Respiration rate rate of breathing Blood pressure Blood pressure is not considered a vital sign, but is often measured along with the vital signs. What is body temperature? A person's body temperature can be taken in any of the following ways: Orally. Guidelines and statements. Narrative reviews. Ethics and law. Medical education. For debate. Volume Issue Respiratory rate: the neglected vital sign.
Med J Aust ; 11 : Topics Health services administration. Anesthesia, analgesia and pain. Abstract The level of documentation of vital signs in many hospitals is extremely poor, and respiratory rate, in particular, is often not recorded.
What respiratory rate threshold value merits action? Why is respiratory rate so important? Respiratory rate and pulse oximetry While the introduction of pulse oximetry was a major advance in bedside monitoring, it still suffers from a number of practical drawbacks.
Education The lack of understanding of the purpose of pulse oximetry may be indicative of a broader lack of understanding of acute medicine by both nurses and junior medical staff. Solutions and recommendations It is possible for hospitals to systematically improve the frequency of recording of respiratory rates. Respiratory rate: summary of evidence and recommendations Respiratory rate is the vital sign least often recorded and most frequently completely omitted from hospital documentation.
Pulse oximetry measurement is not a replacement for respiratory rate measurement. View this article on Wiley Online Library. Correspondence: mcretikos optusnet. Competing interests:. Introduction of the medical emergency team MET system: a cluster randomised controlled trial.
Lancet ; An acute problem? The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation ; Long-term effect of introducing an early warning score on respiratory rate charting on general wards. Setting standards for assessment of ward patients at risk of deterioration. Br J Nurs ; Hogan J.
Respiratory rate predicts cardiopulmonary arrest for internal medicine patients. J Gen Intern Med ; 8: A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia ; Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions.
Clinical antecedents to in-hospital cardiopulmonary arrest. Reference lists of studies meeting the inclusion criteria were also reviewed for other relevant studies. To ensure rigour of the review, identified studies were appraised using the Critical Appraisal Skills Programme checklists [ 21 ]. After inclusion and exclusion criteria were applied, three studies were identified for review Table 1. Two of these studies were conducted in the United Kingdom, each in a single hospital.
The third study was conducted in three hospitals in New Zealand. Quantitative and qualitative research methods were used. Study participants were registered nurses, student nurses, doctors and health care assistants. These staff worked in a variety of acute clinical areas including general medical and surgical wards Table 1. Table 1: Reviewed studies. View Table 1.
The decision to assess respiratory rate was heavily based on nurses' perception of patient acuity. In , Hogan [ 24 ] used focus groups of qualified nurses, health care assistants and student nurses in one British hospital. If the patient was deemed to be in a stable condition, nurses were less likely to measure the respiratory rate [ 24 ]. Ansell et al. Half of the participants reported that respiratory rate assessment tends to be forgotten if the patient "looks comfortable" [ 22 ].
One nurse stated that if a patient was too agitated to have their respiratory rate accurately assessed, the respiratory rate would simply be estimated [ 22 ]. Participants in Ansell's study also reported that the skills of respiratory rate assessment were not clearly demonstrated during their undergraduate studies [ 22 ].
One nurse stated "I can't remember being taught the rationale, you just did it as part of your observations" [ 22 ]. Some participants in Hogan's study stated that respiratory rate assessment and oxygen therapy were taught at the same time during their studies [ 24 ]. This resulted in the conclusion that only patients receiving oxygen therapy needed to have their respiratory rate assessed [ 24 ]. A study by Philip et al. An anonymous, self-reported questionnaire was used for data collection.
A lack of training or knowledge was one of the key reasons respiratory rate assessment is neglected. Five respondents reported that staff do not think that respiratory rate is important. Some nurses had the perception that respiratory rate measurement was only important in certain patients [ 23 ]. A lack of time due to heavy workloads and concerns about completing important tasks resulted in some nurses neglecting respiratory rate assessment.
Participants in Philip's study [ 23 ] reported they were unable to assess respiratory rates for 30 seconds or more due to time constraints or perceived lack of time. Others similarly reported that as measuring the respiratory rate takes more time than measuring other vital signs, priority is often given to other tasks considered more important [ 22 ].
This was particularly an issue as there is no automated machine for respiratory rate assessment [ 22 ]. Other factors contributing to the neglect of respiratory rate assessment were also reported. These however were not dominant themes across the reviewed studies and were only reported in single studies.
These other factors were: laziness and not carrying a watch with a second hand [ 23 ], and interruptions during respiratory rate assessments [ 22 ]. The recognition of nurses' failure to consistently assess and record respiratory rate is not a new issue.
Research spanning more than two decades has highlighted the extent of this clinical problem. The dearth of studies examining the reasons for this is therefore quite surprising, particularly given the importance of respiratory rate assessment to patient outcomes.
This review provides insight into why respiratory rate is often neglected in clinical practice and also questions the validity of respiratory rate recordings in observation charts. The neglect of respiratory rate measurement is a concern given that vital signs assessment is a critical part of patient care. Respiratory rate assessment has many uses such as: to monitor fluctuations in a patient's condition or recognize acute changes, to indicate signs of deterioration and to recognize the need for treatment escalation [ 8 ].
Respiratory rate increases in hypovolemia and an increased respiratory rate can be an early marker of acidosis [ 25 ]. During clinical deterioration, compensatory mechanisms normally increase heart and respiratory rates first without significant changes in the blood pressure [ 26 ]. An abnormal respiratory rate is also common prior to cardiac arrest [ 27 , 28 ]. It is a key nursing responsibility to recognize and interpret physiological abnormalities [ 29 , 30 ]. However the ritualization of vital signs assessments within nursing cultures might contribute to their ad hoc measurement [ 31 ].
If nurses view a task as nothing more than part of their daily role, the "vital" component of vital signs might be forgotten. Senior nurses in one of the reviewed studies [ 23 ] reported the need for a culture shift towards nurses understanding the importance of accurate assessment including the knowledge base that supports it. Some of this review's findings may reflect the delegation of certain nursing tasks such as vital signs assessment, to less qualified nursing staff or even non-nursing staff.
Some participants in the reviewed studies for instance were health care assistants. This cultural shift suggests that vital signs are no longer perceived as being vital but are seen as 'just another task' that needs to be completed during a shift. Whilst this may be a pragmatic change in long term residential facilities, it creates a significant risk for patients in the acute setting.
It has therefore been argued that vital signs 'get no respect' and should be renamed cardinal signs [ 32 ]. Nurses' perception of patient acuity is a key factor in compliance with vital sign assessment. A systematic review similarly found that staff were more likely to be alerted to patient deterioration through intuitive judgement and used vital signs assessment to confirm this rather than vice versa [ 33 ].
In a study of vital signs assessment in a British emergency department, there was a significant relationship between the failure to record vital signs and lower triage categories [ 1 ]. This supports the finding of this review that nurses' perceptions of illness acuity influences their decision making about respiratory rate assessment.
If the nurse deems the patient not to be acutely ill, it is likely the respiratory rate will not be assessed. Research has explored why some key nursing care is missed or delayed [ 34 ].
The main reasons identified included: too few staff, poor use of existing staff resources, time required for the intervention, poor teamwork, ineffective delegation, habit and ritual [ 34 ]. Some of these factors, such as the time it takes to manually assess the respiratory rate, were found in this review.
It has been suggested that staff may lack the knowledge and skills to safely care for deteriorating patients [ 36 ]. Research also suggests that nurses may lack the knowledge and skills for performing a comprehensive respiratory assessment [ 40 , 41 ]. The failure of participants in the reviewed studies to value respiratory rate as a critical vital sign is consistent with these research findings.
Nurses' failure to accurately measure, record and report vital signs therefore has a link to adverse clinical outcomes. It is unclear why some clinicians perceive RR to be a less important vital sign. One possible explanation is that RR is not measured by a machine, unlike other vital signs. In a survey of ward nurses, most reported relying on oxygen saturation to evaluate respiratory dysfunction [ 42 ] despite research showing that clinicians' knowledge of pulse oximetry is often poor [ 43 ].
A heavy reliance on technical equipment also suggests heavy workloads and challenges with time management. This implies that other nursing tasks were given greater priority and may reflect a lack of understanding of the importance of respiratory rate as a vital sign. In a qualitative study of ward nurses' experiences of caring for critically ill patients, being 'equipment focused' was a key finding [ 44 ]. The reliance upon equipment was often to the detriment of a holistic approach to patient assessment [ 44 ].
The majority of nurses in one of the reviewed studies believed that respiratory rate recordings are unreliable as it is not measured accurately due to a perceived lack of time [ 23 ].
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