Part 2 Rectal precautions, pulse, breathing, and blood pressure

Should the patient talk during a blood pressure measurement?

No. Avoid talking during the measurement.

What should you do with a concerning blood pressure reading?

Assess the patient and report the reading promptly.

What does SpO₂ stand for?

Peripheral oxygen saturation.

What does SpO₂ estimate?

The percentage of hemoglobin carrying oxygen.

What can interfere with a pulse oximeter reading?

Movement, cold fingers, poor circulation, nail products, and device limitations.

How can cold fingers or poor circulation affect a pulse oximeter?

They can make the reading less reliable.

Can nail products affect a pulse oximeter reading?

Yes.

Does every patient have the same oxygen saturation target?

No. Some patients have individualized targets.

What should you assess along with the oxygen saturation reading?

The patient's breathing, appearance, responsiveness, and overall condition.

What three findings require immediate assessment and appropriate emergency assistance?

New respiratory distress, blue or gray discoloration, or decreased responsiveness.

Should you delay emergency help while troubleshooting a pulse oximeter?

No. Get help while assessing the patient.

What sequence does the guide give for handling abnormal vital signs?

Assess → Verify → Compare → Report → Document.

What does “Assess” mean when a vital sign is abnormal?

Check the patient's condition and symptoms.

What does “Verify” mean when a vital sign is abnormal?

Check measurement technique and confirm the reading when appropriate.

What does “Compare” mean when reviewing vital signs?

Compare the reading with the patient's usual values and previous readings.

What does “Report” mean when a vital sign is concerning?

Promptly notify the appropriate clinician or activate emergency assistance as needed.

What does “Document” mean after checking vital signs?

Record measured values, relevant observations, notifications, and actions taken.

What breathing symptom should be reported promptly?

Difficulty breathing.

What chest symptom should be reported promptly?

Chest pain.

What changes in thinking or consciousness should be reported promptly?

New confusion or fainting.

What change in oxygen saturation should be reported promptly?

A significant drop.

When is an abnormal pulse or blood pressure especially concerning?

When it is markedly abnormal and the patient has symptoms.

Why is a sudden change from the patient's usual vital signs important?

It may signal a change in the patient's condition.

What should you do if a patient has respiratory distress even when the monitor reading looks normal?

Assess immediately and obtain appropriate help.

What takes priority when a patient looks seriously unwell: troubleshooting equipment or getting help?

Assessing the patient and getting appropriate emergency help.