Baseline Observations

Question 1

Define respiration?

Answer 1

According to the skills for midwifery practice respiration is defined by which the body gains oxygen (inspiration) and excretes carbon dioxide (expiration)

Question 2

What is the normal respiratory rate in an adult?

Answer 2

12-20bpm

Question 3

What is the normal respiratory rate in a newborn?

Answer 3

30-60bpm

Question 4

What is the procedure for measuring respiratory rate?

Answer 4

1) Count breaths by observing the chest movement for 60 seconds
2) Record findings. As part of the NMC Code all procedures must be clearly documented, it enables consistency and for us to be able to see any deviations from the norm.

Question 5

Why might you NOT obtain informed consent for measuring respiratory rate?

Answer 5

It makes people aware of their breathing and therefore may affect findings

Question 6

What is the technical term to describe a rapid respiratory rate?

Answer 6

Tachypnoea

(Often is rapid,shallow breathing and can occur in response to metabolic acidosis,exercise, fear and fever

Question 7

What is the technical term used to describe a low respiratory rate?

Answer 7

Bradypnoea

Respiratory rate of below 8, or more commonly 10 breaths per minute

Question 8

What factors influences normal respiratory rates?

Answer 8

• Exercise
• Pain (hyperventilating)
• Infection (when infection impairs lung function the lungs work harder to oxygenate the body)
• Fever also increases the body’s oxygen demands
• High altitude

Question 9

Why do we carry out a maternal assessment for respiration?

Answer 9

• It is part of the baseline observations
• Whenever other vital signs are recorded, particularly when completing MEOWS chart
• Admission to hospital
• After recovery from pain relief
• Any signs of altered breathing pattern

Question 10

When would a respiration assessment be carried out on a baby?

Answer 10

• At birth as part of the APGAR score
• Whenever vital signs are being recorded e.g meconium-stained amniotic fluid
• Maternal prolonged rupture of membranes
• Known maternal group B strep, hypothermia
• During resuscitation

Question 11

What is the definition of body temperature?

Answer 11

According to the skills for midwifery practice body temperature is defined as the balance between heat gain and heat loss. Humans are homeothermic and therefore their temperature is maintained at 37 degrees Celsius.

Question 12

What is the normal range for temperature?

Answer 12

36.0-37.5 degrees Celsius.

Question 13

What are the five temperature recording sites?

Answer 13

1) Skin
2) Mouth (under the tongue)
3) Rectal
4) Axillary (armpit)
5) Ear (tympanic membrane)

Question 14

A temperature of 38 degrees and above can indicate what?

Answer 14

Low grade pyrexia (mild infection), an allergy, labour

Question 15

How does the body adapt to heat loss?

Answer 15

• Shivering
• Goose bumps
• Behavioural changes

Question 16

How does the body adapt to heat production?

Answer 16

• Sweating
• Flushed skin
• Behavioural changes

Question 17

When should a temperature assessment be carried out?

Answer 17

According to Nice guidelines temperature assessment is part of the MEOWS assessment, it provides a baseline and should be carried out as part of the assessment or whenever any deviations of the norm are recognised. Nice guidelines state that temperature should be measured at the onset of labour, (4 hourly when in labour) (hourly if in a birthing pool), pre-labour rupture of membranes, before and during transfusion of blood/blood products.

Question 18

What equipment is used to gain a temperature reading?

Answer 18

Choosing the equipment for temperature measurement may depend upon the site chosen and the availability of chosen apparatus. However, as we are practicing in an infectious environment of the COVID pandemic it is safer to use disposable (chemical dot) thermometers which as inserted under the tongue for 1 minute with the temper dots facing downwards in the sublingual pocket.

Question 19

What is the procedure to measure temperature?

Answer 19

As part of the NMC Code it is important that informed consent is given prior to any procedure being carried out.

1) Obtain informed consent
2) Wash hands and don PPE
3) Place the thermometer under the tongue , so the temper dots face downwards in the sublingual pocket
4) Keep the thermometer here for 60 seconds
5) Remove after the 60 seconds
6) Record findings
7) Doff PPE, clean equipment and wash hands

As part of the NMC Code documentation is important, it provides consistency and allows us to detect any deviations from the norm.

Question 20

What is a pulse?

Answer 20

According to the skills for midwifery practice a pulse if defined as a pressure wave which is transmitted through the arterial tree and the rhythmic expansion and recoil of the elastic arteries as the left ventricle ejects blood into the circulation.

Question 21

What are the indications to measure pulse?

Answer 21

• On admission (baseline)
• To monitor well-being
• To monitor deviations
• During labour
• During auscultation
• PN assessment
• Spontaneous rupture of membranes (SROM)

Question 22

What are we measuring when it comes to pulse?

Answer 22

• Rate
• Rhythm
• Volume

Question 23

What does pulse volume mean?

Answer 23

The force in which the heart beats, indicating the amount of blood being pumped through he heart. Can be;

• Strong
• Full/bounding
• Weak

Question 24

What does pulse rhythm mean?

Answer 24

The spacing of heartbeats (regular/normal or irregular/ intermittent)

Question 25

Where are the three main places to take pulse?

Answer 25

• Neck
• Brachial
• Radial

Question 26

How long should you measure a pulse for?

Answer 26

60 seconds

However, according to NICE guidelines you can also measure pulse for 30 seconds and double it, although this can provide inaccurate results such as if a woman has an irregular pulse.

Question 27

What is tachycardia?

Answer 27

Heart rate over 100bpm

Question 28

What is bradycardia?

Answer 28

Heart rate below 60bpm

Question 29

What is a normal pulse rate?

Answer 29

Between 60-100bpm

Question 30

How does maternal BPM change during pregnancy?

Answer 30

According to the skills for midwifery practice it increases 10-20bpm from 7-32 weeks gestation. Lowers slightly during the third trimester but increases during labour.

Question 31

What is the procedure for taking a pulse reading?

Answer 31

As part of the NMC Code informed consent must always be obtained.

1) Obtain informed consent
2) Don PPE and wash hands
3) Ensure the woman is comfortable
4) Locate the radial artery (in the wrist along the thumb line)
5) Place the first and second finger over the artery and press firmly put gently
6) Do this for 60 seconds
7) As part of the NMC Code always document findings
8) Doff PPE and wash hands
9) Discuss findings with the woman

It is a good idea to use the same practitioner as these reduces any mistakes and provides continuity.

Question 32

What would happen if temperature begins to accelerate and rise over 40 degrees?

Answer 32

Humans cannot tolerate extreme body temp changes, should a temp rise to 40 and above cellular damage begins to occur and if it continues to rise this can cause brain damage and even be fatal.

Question 33

What does the ‘core temperature, refer to?

Answer 33

Refers to the temperature within the brain,abdominal and thoracic organs, reflecting the warmest parts of the body.

Question 34

What part of the body acts as the body’s thermostat?

Answer 34

It is the hypothalamus that acts as the body’s thermostat.