Basic Nursing Skills
What you must understand
You must be able to obtain and record vital signs accurately and know when a value is abnormal. Typical adult ranges: oral temperature 97.6–99.6 °F (36.5–37.5 °C); pulse 60–100 beats per minute and regular; respirations 12–20 per minute; blood pressure under about 120/80 mmHg; oxygen saturation 95–100%. Count respirations for a full minute when irregular, and count without telling the resident (they will change their breathing if they know). For blood pressure, use the correct cuff size (too small a cuff reads falsely high), support the arm at heart level, and avoid an arm with an IV, dialysis fistula, or on the side of a mastectomy. Report a sudden drop in pressure on standing - orthostatic hypotension - and dizziness.
Also know intake and output measurement (record everything taken in and out, in milliliters), daily weights (same time, same scale, same clothing), specimen collection (clean-catch midstream urine, 24-hour urine kept cold, stool specimens), enemas, warm and cold applications, pulse oximetry, and admission, transfer, and discharge procedures. Range of motion, positioning, and skin inspection are basic skills too: check skin at every turn, especially over bony prominences.
Traps the exam sets
- Counting an irregular pulse for 15 seconds and multiplying.
- Taking a blood pressure on the arm with the fistula or IV.
- Letting a resident know you are counting respirations.
- Charting a value you did not actually measure, or guessing a fraction.
Rule of thumb
Measure, then compare with what is normal for this resident, and report changes rather than just numbers. Worked example: Mr. T's usual pulse is 72. Today it is 118 and irregular. You recount for a full minute, note it, and report the change to the nurse.