Vital Signs That Are Not His Baseline
Mr. Chen, 82, has hypertension and a history of fainting. At 2:00 p.m. you take his vital signs: oral temperature 100.2°F, pulse 104 and irregular, respirations 24, blood pressure 148/86, oxygen saturation 94% on room air. His baseline for the last three days is 98.4°F, pulse 76 and regular, respirations 16, BP 128/74, SpO2 97%. He tells you he feels "a little dizzy" when he sits up and has not been drinking much today because his stomach is upset. He is due to be transferred to the dining room in 15 minutes for dinner.
1. Which findings are abnormal for him, and what do you do first?
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Everything except the blood pressure is a change from his baseline, and the combination matters more than any single number:
- Temperature 100.2°F vs. 98.4°F - a low-grade fever.
- Pulse 104 and irregular vs. 76 and regular - new tachycardia and a new irregular rhythm.
- Respirations 24 vs. 16 - tachypnea.
- SpO2 94% vs. 97% - a drop.
- Dizziness on sitting plus poor fluid intake raises concern for orthostatic drop and dehydration.
First actions: do not take him to the dining room. Keep him seated or lying safely, put the call light in his hand or stay with him, and notify the nurse immediately with all the numbers, his baseline for comparison, and his own words ("dizzy when I sit up," "stomach upset," "not drinking"). A CNA does not diagnose, but a change from baseline is always reported, not just written down. Document the values, the time, and to whom you reported.
2. The nurse asks you to recheck his blood pressure. How do you do it, and what would make you stop?
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Let him rest quietly at least 5 minutes: back supported, feet flat, arm supported at heart level, correct cuff size, cuff on bare skin. Deflate fully between readings and wait 1–2 minutes between measurements.
Because he is dizzy, measure lying, then sitting, and then standing only if the nurse orders it and only with someone there to steady him. A sustained drop on standing (about 20 mmHg systolic or 10 mmHg diastolic) is orthostatic and is reported as such.
Stop and get the nurse at once if he becomes pale, sweaty, faint, confused, short of breath, or reports chest pain - do not finish the series first.
Report each position's reading separately, not one number, and state which position it came from.
3. Mr. Chen insists, "I always go to dinner, I'm fine." What do you say and do?
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Acknowledge him and be honest without arguing or physically blocking him.
- "I hear you - you go to dinner every day. The nurse needs to look at you first because your pulse and temperature are up from your usual and you said you're dizzy. I don't want you to fall on the way."
- Offer the alternative: "I can bring your tray here, or we can go as soon as the nurse clears you."
- Stay with him. If he starts to stand, steady him with the gait belt and call for help rather than grabbing or pushing him back down.
- If he refuses to wait and tries to walk, do not physically restrain him - get the nurse, stay at his side, and document what he said and what you offered.
- An irregular pulse of 104 with new dizziness is not a "he's always like this" situation; it is a change that must reach the nurse before he walks down a hallway.