Vital signs

Vital signs typically measured in clinical trials are blood pressure (both systolic or SBP and diastolic or DBP) and heart rate, often measured as pulse rate, in beats per minute. Weight might also be of interest. In our ongoing scenario of 

Chapter 9 Confirmatory clinical trials Safety data 

The clinicians on the study team might also be interested in sustained changes in vital signs. Hypothetical examples of definitions of sustained changes might be  

Appropriate categorical analyses could then be used with these data. 

In addition to focusing on one time point at a time when looking for changes of predefined magnirndes, it may also be of interest to the study team to investigate the possible occurrence of sustained changes across time. Hypothetical examples might be  

In these carefuhy constructed hypothetical examples, the magnitudes of change from baseline that are of interest when looking at three consecutive time points are smaher than those when looking at the changes one time point at a time. These 

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The nurse should take and record vital signs. When appropriate, it is important to obtain a description of the signs and symptoms of the infection from the patient or family. The nurse assesses the infected area (when possible) and records finding on the patient s chart. It is important to describe accurately any signs and symptoms related to the patient s infection, such as color and lype of drainage from a wound, pain, redness and inflammation, color of sputum, or presence of an odor. In addition, the nurse should note the patient s general appearance. A culture and sensitivity test is almost always ordered, and the nurse must obtain the results before giving the first dose of penicillin. 

FEVER The nurse takes vital signs every 4 hours or as ordered by the primary health care provider. It is important to report any increase in temperature to the primary health care provider because additional treatment measures, such as administration of an antipyretic drug or change in the drug or dosage, may be necessary. 

It also is important to take and record vital signs before the first dose of die antibiotic is given. The primary health care provider may order culture and sensitivity tests, and tiiese should also be performed before die first dose of die drug is given. Odier laboratory tests such as renal and hepatic function tests, complete blood count, and urinalysis may also be ordered by the primary health care provider. 

An ongoing assessment is important during therapy widi die tetracyclines, macrolides, and lincosamides. The nurse should take vital signs every 4 hours or as ordered by die primary health care provider. The nurse must notify the primary health care provider if tiiere are changes in the vital signs, such as a significant drop in blood pressure, an increase in die pulse or respiratory rate, or a sudden increase in temperature. 

A. monitoring vital signs every 4 hours B comparing initial and current signs and symptoms... 

Before administering these drug, the nurse takes and records the patient s vital signs and identifies and records... 

When performing the ongoing assessment, the nurse observes the patient daily for the appearance of adverse reactions. These observations are especially important when a drug is known to be nephrotoxic or ototoxic. It is important to report any adverse reactions to the primary health care provider. In addition, the nurse carefully monitors vital signs daily or as frequently as every 4 hours when the patient is hospitalized. 

AMPHOTERICIN B. Fever (sometimes with shaking chills) may occur within 15 to 20 minutes of initiation of the treatment regimen. It is important to monitor the patient s temperature, pulse, respirations, and blood pressure carefully during the first 30 minutes to 1 hour of treatment. The nurse should monitor vital signs every 2 to 4 hours during therapy, depending on the patient s condition. 

Unless ordered otherwise, the nurse should save all stools that are passed after the drug is given. It is important to visually inspect each stool for passage of the helminth. If stool specimens are to be saved for laboratory examination, the nurse follows hospital procedure for saving the stool and transporting it to the laboratory. If the patient is acutely ill or has a massive infection, it is important to monitor vital signs every 4 hours and measure and record fluid intake and output. The nurse observes the patient for adverse drug reactions, as well as severe episodes of diarrhea. It is important to notify the primary health care provider if these occur. 

When an antimalarial drug is given to a hospitalized patient for treatment of malaria, the preadministration assessment includes vital signs and a summary of the nature and duration of the symptoms. Laboratory tests may be ordered for the diagnosis of malaria Additional laboratory tests, such as a complete blood count, may be ordered to determine the patient s general health status. 

If the patient is hospitalized with malaria, the nurse takes the vital signs every 4 hours or as ordered by the... 

Before the first dose of an amebicide is given, the nurse records the patient s vital signs and weight. The nurse evaluates the general physical status of the patient and looks for evidence of dehydration, especially if severe vomiting and diarrhea have occurred. 

Pain can be defined as an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage. Pain is subjective, and the patient s report of pain should always be taken seriously. Pain management in acute and chronic illness is an important responsibility of the nurse Many nurses consider pain as the fifth vital sign and assessment of pain just as important as the assessment of temperature, pulse, respirations, and blood pressure Accurate assessment of pain is necessary if pain management is to be effective Fhtients with pain are often undertreated. 

During the ongoing assessment, the nurse monitors the patient for relief of pain. If pain recurs it is important to assess its severity, location, and intensity. The nurse monitors the vital signs every 4 hours or more frequently if necessary. Hot, dry, flushed skin and a decrease in urinary output may develop if temperature elevation is prolonged and dehydration occurs. The nurse assesses the joints for decrease in inflammation and greater mobility. 

Nursing care includes close monitoring of the patient immediately after insertion of the epidural catheter and throughout therapy for respiratory depression. Vital signs are taken every 30 minutes, apnea monitors are used, and a narcotic antagonist, such as naloxone, is readily available... 

The nurse immediately reports to the primary health care provider any significant change in the patient s vital signs. Narcotic analgesics can cause hypotension. Particularly vulnerable are postoperative patients and individuals whose ability to maintain blood pressure has been compromised. 

Ms. Taylor is receiving meperidine for postoperative pain management. In assessing Ms. Taylor approximately 20 minutes after receiving an injection of meperidine, the nurse discovers Ms. Taylor s vital signs are blood pressure 100150 mm Hg, pulse rate 100 bpm, and respiratory rate 10 /min. Determine what action, if any, the nurse should take. 

As part of the ongoing assessment during the administration of naloxone, the nurse monitors the blood pressure, pulse, and respiratory rate at frequent intervals, usually every 5 minutes, until the patient responds. After the patient has shown response to the drug, the nurse monitors vital signs every 5 to 15 minutes. The nurse should notify tlie primary healdi care provider if any adverse drug reactions occur because additional medical treatment may be needed. The nurse monitors die respiratory rate, rhydun, and depdi pulse blood pressure and level of consciousness until the effects of die narcotics wear off. 

For the physical assessment, the nurse generally appraises the patient s physical condition and limitations. If the patient has arthritis (any type), the nurse examines the affected joints in the extremities for appearance of the skin over the joint, evidence of joint deformity, and mobility of the affected joint. Fhtients with osteoporosis are assessed for pain particularly in the upper and lower back or hip. Vital signs and weight are taken to provide a baseline for comparison during therapy. If the patient has gout, the nurse examines the affected joints and notes the appearance of the skin over the joints and any joint enlargement. 

When administering a cholinergic blocking drug, the daily ongoing assessment requires that the nurse closely observes the patient. The nurse checks vital signs,... 

Before administering a barbiturate or miscellaneous sedative and hypnotic, the nurse takes and records the patient s blood pressure, pulse, and respiratory rate In addition to the vital signs, the nurse assesses the following patient needs. 

The nurse withholdsthe drug and notifiesthe primary health care provider if any one or more vital signs significantly varies from the database, if the respiratory rate is 10/min or below, or if the patient appearslethargic. In addition, it is important to determine if there are any factors (eg, noise, lights pain, discomfort) that would interfere with steep and whether these maybe controlled or eliminated. 

Treatment of barbiturate toxicity is mainly supportive (ie, maintaining a patent airway, oxygen administration, monitoring vital signs and fluid balance). The patient may require treatment for shock, respiratory assistance, administration of activated charcoal, and in severe cases of toxicity, hemodialysis. 

W EIGHT LOSS. When an amphetamine or anorexiant is prescribed for obesity, the nurse obtains the patient s weight and vital signs at the time of each outpatient visit. 

When use of the CNS stimulants causes insomnia, the nurse administers the drug early in the day (when possible) to diminish sleep disturbances. The patient is encouraged not to nap during the day. Other stimulants, such as coffee, tea, or cola drinks, are avoided. In some patients, nervousness, restlessness, and palpitations may occur. The vital signs are checked every 6 to 8 hours or more often if tachycardia, hypertension, or palpitations occur. Many times these adverse reactions will diminish with continued use as tolerance develops. If tolerance develops, the dosage is not increased. 

The nurse obtains the vital signs at die time of the initial assessment to provide baseline data. The primary healtii care provider may order many laboratory and diagnostic tests, such as an electroencephalogram, computed tomographic scan, complete blood count, and hepatic and renal function tests to confirm the diagnosis and identify a possible cause of the seizure disorder, as well as to provide a baseline during therapy with anticonvulsants. 

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