Discussion: N789 The Pediatric Nurse

Discussion: N789 The Pediatric Nurse

The pediatric nurse from the local tertiary center has called the health department to report a child in hospitalized with a diagnosis of plumbism. The public health nurse is familiar with this family as she is providing case management for this woman during her pregnancy. There are two other children under the age of 5 in the home. This mother lives in a neighborhood where all the houses were built before in 1940’s and at one time were considered upscale and fashionable. In the last 20 years, many have been abandoned, others have been divided into apartments and most tenants could be described as living in poverty with limited education and underemployed. This neighborhood is located in an older section of a moderately large city.

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A literature review identified a few key themes. It was noted that collection of vital signs generally included a pattern of hourly vitals for the first 4 hours, then a reduction to every 4 hours. Despite some variance in both the literature and in the external site review, overall the most common pattern identified was that post-operative vital signs were assessed every 4 hours (Zeitz & McCutheon, 2002). However, another theme identified was the paucity of research outlining a clear standard for the frequency of taking vital signs. This theme reinforces the importance of applying the nursing process and critical thinking to facilitate early identification of concerns regarding a patient’s status. Embedding the nursing process in care supports a comprehensive approach and strategy, and can mitigate delayed interventions, failure to treat, and the related negative sequelae. Nurses have an important role in the development of policies and procedures; their input supports the policy and aligns with the systematic and comprehensive approach recognized in the nursing process (Zeitz & McCutheon, 2002).

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A review of the literature, as well as nursing associations and governing bodies, does not outline a specific directive on best practice in the frequency of obtaining vital signs. The Academy of Medical-Surgical Nurses recognizes this variance in vital signs routines, from every 15 minutes for the first hour, to every 4 hours once the patient is stable (AMSN, 2019). As in the cyclical nature of the nursing process, one must circle back to the patient and apply the nursing process to identify the patient’s current needs. Obtaining vital signs is a basic and quick assessment that nurses complete as part of a comprehensive assessment. A proactive approach to care and use of the nursing process can ensure early identification of complications and avoid failure to rescue and the resulting negative sequelae (Watkins, Whisman, & Booker, 2015).

While the organization’s policy directs the frequency of vital sign assessments, nurses may also be required to take additional vital signs, such as before providing additional analgesic or cardiac medications. Routine assessment of vital signs is a key step in the nursing process to help identify trends and patterns. This can be helpful in the early identification of complications such as hypotensive shock or infection, or a cardiac event such as atrial fibrillation or pulmonary embolism.