Monitoring a patient vital signs

Sometimes, the health of a patient in hospital may get worse suddenly (this is called becoming
acutely ill). There are certain times when this is more likely, for example following an
emergency admission to hospital, after surgery and after leaving critical care. However, it can
happen at any stage of an illness. It increases the patient's risk of needing to stay longer in
hospital, not recovering fully or dying.

Monitoring patients (checking them and their health) regularly while they are in hospital and
taking action if they show signs of becoming worse can help avoid serious problems.

Monitoring vital signs - for example, a patient’s blood pressure, pulse rate, respiration rate - is a
crucial aspect of patient care in hospital. Vital signs indicate a patient’s clinical condition, are
necessary to calculate early warning scores and used to determine the monitoring, escalation
and interventions that are required subsequently. There is evidence that nurses’ compliance
with vital sign monitoring protocols and guidelines may be poor, especially at night.

Nurses see patients more often than other specialists and are in the best position to monitor
them. They look out for any problems and assess the patient’s progress and response to
treatment. Basically, by careful monitoring and recording, a nurse answers the question: what
is happening to this patient? Monitoring body functions by checking vital signs helps to answer
this question. Changes or abnormalities in vital signs indicate changes in the patient’s condition.
However, they are not 100% reliable and stable vital signs do not always mean that everything
is OK. Bodily fluids, including blood and urine, can be analysed, usually in a laboratory. And it is
now possible to get images of what is going on inside the body using technological aids like X-
rays and ultrasound scans. For more detailed information, there are endoscopes, which are
used to look inside the body, and biopsies where tissue is removed for examination. Some
patients with chronic illnesses like heart disease, diabetes and asthma can self-monitor. They
communicate with doctors and nurses by phone and online. Patients can also be monitored
from a distance using satellite technology and the internet. This has major advantages; the
patient doesn’t have to keep visiting a hospital and it saves a lot of money.

1. Text Comprehension. Use the information in the text to complete the sentences with
the correct answer, a, b or c.
1. Nurses are in a good position to …
a) monitor patients.
b) specialize.
c) get to know their patients.
2. ‘What is happening to this patient?’ is a
question which ….
a) only nurses can answer.
b) monitoring helps to answer.
c) nurses must ask.
3. Stable vital signs mean ….
a) everything is probably OK.
b) a change in a patient’s condition.
c) something’s definitely wrong.
4. Technological aids give information
about….
a) internal organs.
b) bodily fluids.
c) vital signs.
5. An endoscopy gives...
a) less information than an X-ray.
b) more detail than a scan.
c) less information than a biopsy.
6. Self-monitoring is….
a) done by doctors and nurses.
b) done at a hospital.
c) cheap and convenient.
2. Vocabulary. Label these signs and symptoms according to their type. Write ‘C’ for
cognitive, ‘M’ for motor, ‘I’ for internal and ‘E’ for external.
 The ultrasound is showing no abnormalities. _____I___
 The ECG readout shows stable bpm. _____I___
 Sometimes she is unable to walk and falls over. ___M_____
 The EEG shows that the patient is waking up. ____C____
 He is irrational and seems confused. ___c_____
 She is very pale. ____E____
 .Her arm is paralyzed. _____M___

3. Complete sentences 1–7 using the words or phrases in the box.

a) The patient is having a hypoglycaemic episode and his blood

Paralysis
glucose level is abnormally low . Lack co-ordination
b) You may observe that the patient is nervous and anxious Pale skin
Irrational
which makes her shake and shiver.
Abnormally low
c) Sometimes he may lack co-ordination so he seems to be Shake and shiver
drunk. Slurred
d) You may observe some paralysis with the patient unable to move his limbs.
e) They will have pale skin which is cold to the touch.
f) It is difficult to understand her because her speech is very slurred .
g) There may be personality changes, they may exhibit strange and
_______________ behavior.
a) Work with a partner. Match each reading with a vital sign .
b) 120 bpm  temperature
c) 38.5  blood pressure
d) 150/90  heart rate
e) 18 bpm  respiration
4. Taking a blood sample. Vocabulary Match the illustrations to words

a) antiseptic wipe

b) cotton ball

c) needle

d) plaster

e) specimen tube

f) syringe

g) tourniquet

5. Complete these instructions for taking a blood sample with the words.
a) Put a (n) plaster over the cotton ball and check the patient feels OK.
b) Pull out the needle and put a (n) coton ball onto the wound. Press hard.
c) Ask the patient to roll up their sleeve and use a (n) antiseptiv wipe to clean the
patient's arm.
d) Write the patient's full name and on the specimen tube.
e) Tie the tourniquet tightly around the patient's upper arm and insert the needle
into the vein.
f) Use the syringe to fill the tube with blood.
6. Complete the description of Complete Blood Count.
Infection clot
platelets red blood cells
haemoglobin white blood cells
oxygen
A CBC measures the number of different cells that make up the blood. It looks at: red
blood cells these take oxygen from the lungs to the body's tissues, and take carbon
dioxide away at the same time. The CBC also measures the amount of haemoglobin
(a protein in the cells that carries the oxygen), and looks at the size and shape of the
cells.
White blood cells -these protect the body against infection .
platelets-these make the blood_clot.
 7. A biochemistry or Hematology lab report. Terms used to describe lab results:

Elevated Down
Raised Reduced
+ Up
- Low
High

Potassium : within normal limits

normal
unremarkable

Complete the sentences describing the results of the report above.

a) Hemoglobin is _______________________, one hundred and forty-three grams per
litre.
b) Creatinine is slightly _________________.
c) Alkaline Phosphatase is_______________, one hundred and thirty-
one________________________.
d) ALT is slightly____________, nine __________________________________.
e) Bilirubin is _____________, seven___________________________.
f) WBC is __________________________.
8. Pair Work. The pictures below show the implementation of checking vital signs.

Choose one picture then, make a conversation exchange and give appropriate
instructions when you want to check patient’s vital signs by using helpful phrases.
9. Escorting a patient to tests. Use the words to complete: MRI_ECG _CT_X
When are these used ?

Complete the dialogue :

appointment help warm
blanket Radiology wheelchair (2x)
Care walk X-ray(2x)
cold walking stick

[K = Kelly nurse; J = Jake; C = Claire nurse )

K: Can you walk…..to the…Care Department, do you think?
J: Is there a … walking stick …or a… wheelchair, maybe? I'm a bit weak this
morning.
K: There's a … wheelchair ……...
J: I prefer that, thanks.
K: Of course. Let me……help…. you. There you are. Are you…warm.. enough?
J: I'm a bit …cold.., actually.
K: Let me give you …blancket….a. Is that better?
J: Thanks.
K: Here we are at…Radiology.. Morning, Claire.
C: Kelly, hi.
K: Claire, this is Jake Peterson. He has an…appointment …for an …X ray… at 10.30.
C: Good morning, Jake. I'm Claire. I'm taking…X-ray..of you today and ...

Blanket- trolley- walking stick- wheelchair

 10. Extra speaking activity. Asking Questions and Giving Answers
“At the ultrasound scan”

Nurse Mrs. Murphy

1. Ok , Mrs Murphy, just lie back on this examination 6..I don’t know. But I guess I
table. Are you comfortable?
2. Have you had plenty of water to drink? do.
3. Good, we need your bladder full. I'm putting some gel
 It’s not very clear. How can
onto your abdomen That helps the I ultrasound work
well. you understand anything of
4. Your notes say the baby has stopped moving. Is that
right? that?
5. And you are in the twenty- second week of your
pregnancy? 5. No. it’s actually twenty –
6. Right. Well the ultrasound scan is very simple. When I
three already.
pass the transducer over your abdomen, it bounces
sound waves off the baby's body and it makes a picture  Oh, my God!
here on the monitor. Then we can see if there is
anything wrong, it shows up any abnormalities. A scan 3.OK. It’s a little cold and
can usually show if the baby is a boy or a girl. Do you
want to know the baby's sex? unpleasant…
7. OK. I’m passing the transducer over you abdomen
9.Really? I wanted a girl.
now. Ah, here we are. There’s the baby. Can you see
it? 2.Yes - three glasses.
8. Well, here’s the head Can you see that? And there's the
hand and five lingers. And there's a foot -can you see? 1.Yes, thank you
9. Can you see the heart beating? The baby's alive and
looks good. Yes. Everything is normal And look -it's a
boy!!!
10. You did. Just a moment, Well you're not going to be  Yes. I’m a bit worried. I
disappointed - you're going to have twins –a boy and a
girl needed to be sure that it is

ok.

 Yes. It’s so tiny!!!