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Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)

What are vital signs.

Vital signs are measurements of the body's most basic functions. The four main vital signs routinely monitored by medical professionals and health care providers include the following:

Body temperature

Respiration rate (rate of breathing)

Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.)

Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere.

What is body temperature?

The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature can range from 97.8 degrees F (or Fahrenheit, equivalent to 36.5 degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for a healthy adult. A person's body temperature can be taken in any of the following ways:

Orally. Temperature can be taken by mouth using either the classic glass thermometer, or the more modern digital thermometers that use an electronic probe to measure body temperature.

Rectally. Temperatures taken rectally (using a glass or digital thermometer) tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.

Axillary. Temperatures can be taken under the arm using a glass or digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth.

By ear. A special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature (the temperature of the internal organs).

By skin. A special thermometer can quickly measure the temperature of the skin on the forehead.

Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). A fever is indicated when body temperature rises about one degree or more over the normal temperature of 98.6 degrees Fahrenheit, according to the American Academy of Family Physicians. Hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.

About glass thermometers containing mercury

According to the Environmental Protection Agency, mercury is a toxic substance that poses a threat to the health of humans, as well as to the environment. Because of the risk of breaking, glass thermometers containing mercury should be removed from use and disposed of properly in accordance with local, state, and federal laws. Contact your local health department, waste disposal authority, or fire department for information on how to properly dispose of mercury thermometers.

What is the pulse rate?

The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can indicate the following:

Heart rhythm

Strength of the pulse

The normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Females ages 12 and older, in general, tend to have faster heart rates than do males. Athletes, such as runners, who do a lot of cardiovascular conditioning, may have heart rates near 40 beats per minute and experience no problems.

How to check your pulse

As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries, which are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the neck, on the inside of the elbow, or at the wrist. For most people, it is easiest to take the pulse at the wrist. If you use the lower neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. When taking your pulse:

Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.

Begin counting the pulse when the clock's second hand is on the 12.

Count your pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate beats per minute).

When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.

If unsure about your results, ask another person to count for you.

If your doctor has ordered you to check your own pulse and you are having difficulty finding it, consult your doctor or nurse for additional instruction.

What is the respiration rate?

The respiration rate is the number of breaths a person takes per minute. The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and other medical conditions. When checking respiration, it is important to also note whether a person has any difficulty breathing.

Normal respiration rates for an adult person at rest range from 12 to 16 breaths per minute.

What is blood pressure?

Blood pressure is the force of the blood pushing against the artery walls during contraction and relaxation of the heart. Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure as the heart contracts. When the heart relaxes, the blood pressure falls.

Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column in an old-fashioned manual blood pressure device (called a mercury manometer or sphygmomanometer) is raised by the pressure of the blood. Today, your doctor's office is more likely to use a simple dial for this measurement.

High blood pressure , or hypertension, directly increases the risk of heart attack, heart failure, and stroke. With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood.

Blood pressure is categorized as normal, elevated, or stage 1 or stage 2 high blood pressure:

Normal blood pressure is systolic of less than 120 and diastolic of less than 80 (120/80)

Elevated blood pressure is systolic of 120 to 129 and diastolic less than 80

Stage 1 high blood pressure is systolic is 130 to 139 or diastolic between 80 to 89

Stage 2 high blood pressure is when systolic is 140 or higher or the diastolic is 90 or higher

These numbers should be used as a guide only. A single blood pressure measurement that is higher than normal is not necessarily an indication of a problem. Your doctor will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of high blood pressure and starting treatment. Ask your provider when to contact him or her if your blood pressure readings are not within the normal range.

Why should I monitor my blood pressure at home?

For people with hypertension, home monitoring allows your doctor to monitor how much your blood pressure changes during the day, and from day to day. This may also help your doctor determine how effectively your blood pressure medication is working.

What special equipment is needed to measure blood pressure?

Either an aneroid monitor, which has a dial gauge and is read by looking at a pointer, or a digital monitor, in which the blood pressure reading flashes on a small screen, can be used to measure blood pressure.

About the aneroid monitor

The aneroid monitor is less expensive than the digital monitor. The cuff is inflated by hand by squeezing a rubber bulb. Some units even have a special feature to make it easier to put the cuff on with one hand. However, the unit can be easily damaged and become less accurate. Because the person using it must listen for heartbeats with the stethoscope, it may not be appropriate for the hearing-impaired.

About the digital monitor

The digital monitor is automatic, with the measurements appearing on a small screen. Because the recordings are easy to read, this is the most popular blood pressure measuring device. It is also easier to use than the aneroid unit, and since there is no need to listen to heartbeats through the stethoscope, this is a good device for hearing-impaired patients. One disadvantage is that body movement or an irregular heart rate can change the accuracy. These units are also more expensive than the aneroid monitors.

About finger and wrist blood pressure monitors

Tests have shown that finger and/or wrist blood pressure devices are not as accurate in measuring blood pressure as other types of monitors. In addition, they are more expensive than other monitors.

Before you measure your blood pressure:

The American Heart Association recommends the following guidelines for home blood pressure monitoring:

Don't smoke or drink coffee for 30 minutes before taking your blood pressure.

Go to the bathroom before the test.

Relax for 5 minutes before taking the measurement.

Sit with your back supported (don't sit on a couch or soft chair). Keep your feet on the floor uncrossed. Place your arm on a solid flat surface (like a table) with the upper part of the arm at heart level. Place the middle of the cuff directly above the bend of the elbow. Check the monitor's instruction manual for an illustration.

Take multiple readings. When you measure, take 2 to 3 readings one minute apart and record all the results.

Take your blood pressure at the same time every day, or as your healthcare provider recommends.

Record the date, time, and blood pressure reading.

Take the record with you to your next medical appointment. If your blood pressure monitor has a built-in memory, simply take the monitor with you to your next appointment.

Call your provider if you have several high readings. Don't be frightened by a single high blood pressure reading, but if you get several high readings, check in with your healthcare provider.

When blood pressure reaches a systolic (top number) of 180 or higher OR diastolic (bottom number) of 110 or higher, seek emergency medical treatment.

Ask your doctor or another healthcare professional to teach you how to use your blood pressure monitor correctly. Have the monitor routinely checked for accuracy by taking it with you to your doctor's office. It is also important to make sure the tubing is not twisted when you store it and keep it away from heat to prevent cracks and leaks.

Proper use of your blood pressure monitor will help you and your doctor in monitoring your blood pressure.

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Vital sign assessment.

Amit Sapra ; Ahmad Malik ; Priyanka Bhandari .

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Last Update: May 1, 2023 .

Definition/Introduction

Vital signs are an objective measurement of the essential physiological functions of a living organism. They have the name "vital" as their measurement and assessment is the critical first step for any clinical evaluation. The first set of clinical examinations is an evaluation of the vital signs of the patient. Triage of patients in an urgent/prompt care or an emergency department is based on their vital signs as it tells the physician the degree of derangement that is happening from the baseline. Healthcare providers must understand the various physiologic and pathologic processes affecting these sets of measurements and their proper interpretation. If we use a triage method where we select patients without determining their vital signs, it may not give us a reflection of the urgency of the patient's presentation. [1] The degree of vital sign abnormalities may also predict the long-term patient health outcomes, return emergency department visits, and frequency of readmission to hospitals, and utilization of healthcare resources.

Traditionally, the vital signs consist of temperature, pulse rate, blood pressure, and respiratory rate. Even though there are a variety of parameters that may be useful along with the traditional four vital sign parameters, studies have only found pulse oximetry and smoking status to have significance in patient outcomes. [2] Pulse oximetry sometimes helps to clarify the patient's physiological functions, which would sometimes be unclear by checking just the traditional vital signs. The inclusion of smoking status has the premise that the patient will be provided counseling by the provider on quitting smoking. In the past, some health care systems in the United States had used "pain as the fifth vital sign'. This approach is being abandoned due to the unintended opioid crisis that the country is currently facing. [3]

Issues of Concern

Patient safety is a fundamental concern in any health care organization, and early detection of any clinical deterioration is of paramount importance whether the patient is in the emergency department or on the hospital floor. The early detection of changes in vital signs typically correlates with faster detection of changes in the cardiopulmonary status of the patient as well as up-gradation of the level of service if needed. Vital signs assessment currently uses electronic equipment, but there is evidence that, outside of the intensive care units, respiratory rate assessment through observation, leading to insufficient, subjective, and unreliable results. [4]

In a case-control study conducted by Rothschild and colleagues, early warning criterion among patients on the medical floor, the presence of respiratory rate over 35/min (OR=31.1) was most strongly associated with a life-threatening adverse event. [5] Early warning score (EWS) tools, mostly using vital sign abnormalities, are critical in predicting cardiac arrest and death within 48 hours of measurement, even though the effect on in-hospital health outcomes and utilization of resources remains unknown. [5]

It seems intuitive that the higher the frequency of vital sign measurement, the faster the chances of clinical deterioration are detected. There is variability between institutes within and across nations depending on the acuity of clinical condition, any active intervention carried out, the amount of staff availability, cost issues, organizational practices, and leadership styles. The weighted average score deduced from the vital sign measurements (i.e., an early warning score) is used to determine the timing of the next observation sets. [4] [5]

Clinical Significance

Temperature

Body temperature is a variable, which is complex as well as nonlinear and is affected by many sources of internal and external variables. The normal body temperature for a healthy adult is approximately 98.6 degrees Fahrenheit/37.0 degrees centigrade. The human body temperature typically ranges from 36.5 to 37.5 degrees centigrade (97.7 to 99.5 degrees Fahrenheit. [6] Body temperature is regulated in the hypothalamus in a narrow thermodynamic range and maintained to optimize the synaptic transmission of biochemical reactions. [7]

Clinical decisions, especially in the pediatric population regarding the investigation and management, are based on the results of temperature measurement alone. Whereas at one end, missing that the patient's fever is severe or detecting a falsely positive fever reading can cause the patient to receive wrongful management. Galileo was the first scientist to uncover the concept of thermometers that began in the 16th century. In the year, 1709 Daniel Fahrenheit developed an alcohol-filled thermometer as well as a mercury-filled thermometer. [8]

Health care providers use the axillary, rectal, oral, and tympanic membrane most commonly to record body temperature, and the devices most commonly used are the electronic and infrared thermometers. They can monitor temperature at different sites, and each site has its range as well as advantages and disadvantages. As clinicians, the understanding of these site-specific differences is crucial. For example, the oral temperature, which is the most commonly used method, is considered very convenient and reliable. Here we place the thermometer under the tongue and close the lips around it. The posterior sublingual pocket is the area that gives the highest reliability. The other commonly used methods are tympanic temperature, where the thermometer where we insert the thermometer into the ear canal, and the axillary temperature where we place the thermometer in the axilla while adducting the arm of the patient. Both these sites are convenient but generally considered less accurate and hence not recommended. [8]

For measuring the rectal temperature, the thermometer is inserted through the anus into the rectum after applying a lubricant. This method is very inconvenient, but since it measures the internal measurement, it is very reliable. It is usually considered the "gold standard" method of recording temperature. Gut temperature, measured with an ingested pill, also gives readings close to the rectal temperature. Besides the site, the time of day is an essential factor leading to variability in the temperature record, secondary to the circadian rhythm. The inability to consider this physiological diurnal variation of temperature can lead to the wrong conclusion that an individual's temperature suggests a disease state when it is a normal temperature at that time of day. There is also a variation of the body temperature in a regularly cycling female, referred to as the "circamensal" rhythm. Understanding of this rhythm is paramount in teaching patients, trying to conceive about the fertile period of the cycle. Besides the change with diurnal variation and menstrual variation, a person's relative physical fitness and age can affect the degree of temperature change during a day. Studies show that younger patients and fitter record larger temperature amplitudes, while older and less fit people record lesser amplitude changes. [9] Some studies have demonstrated a seasonal variation in body temperature; we need more research in this regard to reach a definitive conclusion. [9]

The most common sites of measuring the peripheral pulses are the radial pulse, ulnar pulse, brachial pulse in the upper extremity, and the posterior tibialis or the dorsalis pedis pulse as well as the femoral pulse in the lower extremity. Clinicians measure the carotid pulse in the neck. In day-to-day practice, the radial pulse is the most frequently used site for checking the peripheral pulse, where the pulse is palpated on the radial aspect of the forearm, just proximal to the wrist joint. Parameters for assessment of pulse include its rate, rhythm, volume, amplitude, and rate of increase, besides its symmetry The rate of the pulse is significant to measure for assessing the physiological and pathological processes affecting the body. The normal range used in an adult is between 60 to 100 beats/minute with rates above 100 beats/minute and rates below 60 beats per minute, referred to as tachycardia and bradycardia, respectively. The age-specific heart rate given for the pediatric age range appears in table -2.

Assessing whether the rhythm of the pulse is regular or irregular is essential. The pulse could be regular, irregular, or irregularly irregular. Changes in the rate of the pulse, along with changes in respiration are called sinus arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and slows down during expiration. Irregularly irregular pattern is more commonly indicative of processes like atrial flutter or atrial fibrillation. We should also be checking for the radial and the femoral pulse simultaneously. If there is any delay between the pulses, it could indicate conditions like the coarctation of the aorta. Assessing the volume of the pulse is equally essential. A low volume pulse could be indicative of inadequate tissue perfusion; this can be a crucial indicator of indirect prediction of the systolic blood pressure of the patient. If we can palpate the radial pulse, the systolic blood pressure is generally more than 80 mmHg. If we can palpate the femoral pulse, the systolic blood pressure is more than 70 mmHg, and if we can palpate the carotid pulse, the systolic blood pressure is more than 60 mmHg. [10] Checking for symmetry of the pulses is important as asymmetrical pulses could be seen in conditions like aortic dissection, aortic coarctation, Takayasu arteritis, and subclavian steal syndrome. Besides the above-stated parameters, amplitude and rate of increase is also an important consideration. Low amplitude and low rate of increase could be seen in conditions like aortic stenosis, besides weak perfusion states. High amplitude and rapid rise can be indicative of conditions like aortic regurgitation, mitral regurgitation, and hypertrophic cardiomyopathy.

Respiratory Rate

The respiratory rate is the number of breaths per minute. The normal breathing rate is about 12 to 20 breaths per minute in an average adult. In the pediatric age group, it is defined by the particular age group. Parameters important here again include rate, depth of breathing, and pattern of breathing. Rates higher or lower than expected are termed as tachypnea and bradypnea, respectively. Tachypnea is described as a respiratory rate of more than 20 breaths per minute that could occur in physiological conditions like exercise, emotional changes, or pregnancy. Pathological conditions like pain, pneumonia, pulmonary embolism, asthma, foreign body aspiration, anxiety conditions, sepsis, carbon monoxide poisoning, and diabetic ketoacidosis can also present with tachypnea. Bradypnea described as ventilation less than 12 breaths per minute can be seen due to worsening of any underlying respiratory condition leading to respiratory failure or due to usage of central nervous system depressants like alcohol, narcotics, benzodiazepines, or metabolic derangements. Apnea is the complete cessation of airflow to the lungs for a total of 15 seconds. It appears in cardiopulmonary arrests, airway obstructions, the overdose of narcotics, and benzodiazepines.

The depth of breathing is also a crucial parameter. Hyperpnea is described as an increased depth of breathing and is seen during exercise and in anxiety states, lung infections, and congestive heart failure. Hyperventilation, on the other hand, is described as both increased in the rate and depth of breathing and can again be seen in anxiety states like anxiety or due to exercise but is also seen in pathological conditions like diabetic ketoacidosis or lactic acidosis. The term hypoventilation describes the decreased rate and depth of ventilation. This condition results from excessive sedation, metabolic alkalosis, and in instances of obesity hypoventilation syndrome.

The pattern of breathing also gets affected in various conditions and indicates the underlying pathology. Biot respiration is a condition where there are periods of increased rate and depth of breathing, followed by periods of no breathing or apnea. These can vary in length of time. This pattern is suggestive of raised intracranial pressure as in space-occupying lesions of the skull or conditions like meningitis. Cheyne-Stokes respiration is a peculiar pattern of breathing where there is an increase in the depth of ventilation followed by periods of no breathing or apnea. This presentation occurs in conditions of raised intracranial pressure but is also seen with excessive usage of sedatives and worsening congestive heart failure. Kussmaul breathing refers to the increased depth of ventilation, although the rate remains regular. This presentation is in patients with renal failure and diabetic ketoacidosis. Orthopnea refers to difficulty in respiration occurring on lying horizontal but gets better when the patient sits up or stands It is seen characteristically in congestive heart failure. Paradoxical ventilation refers to the inward movement of the abdominal or chest wall during inspiration, and outward movement during expiration, which is seen in cases of diaphragmatic paralysis, muscle fatigue, and trauma to the chest wall.

Blood Pressure

Blood pressure is an essential vital sign to comprehend the hemodynamic condition of the patient. Unfortunately, though, there are a lot of inter-person variabilities when measuring it. Many times, the basic measurement techniques are not followed and lead to erroneous results.

All healthcare providers should be aware of making sure all the essential pre-requisites are met before checking the blood pressure of the patient. The patient should not have taken any caffeinated drink at least one hour before the testing and should not have smoked any nicotine products at least 15 minutes before checking the pressure. They should have emptied their bladder before checking the blood pressure. Full bladder adds 10 mmHg to the pressure readings. It is advisable to have the patient be seated for at least five minutes before checking their blood pressure. This step takes care of or at least minimizes the higher readings that could have occurred secondary to rushing in for the clinic appointment. The providers should not be having a conversation with the patient while checking his blood pressure. Talking or active listening adds 10 mmHg to the pressure readings. The patient’s back and feet should be supported, and their legs should be uncrossed. Unsupported back and feet add 6 mmHg to the pressure readings. Crossed legs add 2 to 4 mmHg to the pressure readings. The arm should be supported at the heart level. Unsupported arm leads to 10 mmHg to the pressure readings. The patient’s blood pressure should get checked in each arm, and in younger patients, it should be tested in an upper and lower extremity to rule out the coarctation of the aorta. Using the correct cuff size is very important. Smaller cuff sizes give falsely high, and larger cuff sizes give a falsely lower blood pressure reading. [11]

Nursing, Allied Health, and Interprofessional Team Interventions

Variability of Vital Signs in the Geriatric Age Group

Since vital signs are an indication of the changes in physiological processes, they tend to change with age. With age, core body temperature tends to be lower, and the ability of the body to change with different kinds of stressors becomes minimized. Even subtle variation from the core body temperature can be a significant finding as fever in an older patient often indicates a more severe infection and is associated with increased rates of life-threatening consequences. [12]

There can be a decrease in response to changes in the oxygen and carbon dioxide at the molecular level along with anatomical changes resulting due to stiffness of muscles and compliance of the chest wall. Respiratory rate sometimes might be the most neglected of the vital signs reported in hospitalized patients but is more sensitive than other vital signs in picking up a critically ill patient. [13]

The aging blood vessels also lead to higher arterial stiffness, leading to higher systolic blood pressure and increased pulse pressure. There is also the issue of orthostatic hypotension due to decreased autonomic responsiveness. This response becomes exaggerated with the use of polypharmacy and reduced fluid intake. Thus, it is imperative to check orthostatic vitals in this population. Resting heart rate, in contrast, is often observed to increase with age due to deconditioning and autonomic dysregulation. [14]

Limitations of Vital Signs

Accurately measuring vital signs is a clinical skill that needs time and practice to refine. A review of literature is abundant about the inter-observer variability observed and reported secondary to lack of this skill. Clinicians should be wary of this and always re-check the vital signs themselves if there is a profound or unexpected change. Clinics and organizations should continuously strive to check and educate their nursing and ancillary staff to sharpen these skills.

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VItal Sign Tables Table 1: Types of Digital Thermometers for Use by Age 6 Table 2: Normal Heart Rate (beats/minute) as per the Pediatric Advanced Life Support (PALS) Guidelines. Table 3: Normal Respiratory Rate (Beats/Minute) as per the Pediatric Advanced (more...)

Vital Signs Table 5: Acceptable Blood Pressure Dimensions for Various arm sizes. Contributed by Amit Sapra, MD

Vital Signs Table 6: BP targets by different organizations Contributed by Amit Sapra, MD

Vital Signs Table 7: Normal Blood Pressure as per the Pediatric Advanced Life Support (PALS) Guidelines. Contributed by Amit Sapra, MD

Disclosure: Amit Sapra declares no relevant financial relationships with ineligible companies.

Disclosure: Ahmad Malik declares no relevant financial relationships with ineligible companies.

Disclosure: Priyanka Bhandari declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Sapra A, Malik A, Bhandari P. Vital Sign Assessment. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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What are Vital Signs?

Vital signs are measurements of the body to check your body’s basic functions. You might be thinking, why do we call them “vital signs,” right? This is because accessing vital signs is the first critical step used to assess patients.

If you’ve been to an emergency department, you have definitely seen a triage counter where nurses check their patient’s vital signs on their first encounter. This tells the physician how unstable the patient’s values are from the normal value.

As health care providers, it’s essential to know the conditions in which the measurements of vital signs change.

There are six main vital signs that healthcare professionals routinely monitor. These include;

Temperature

Respirations

Blood pressure

Oxygen saturation

Mnemonic to remember it is TPRBP-Ox

Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere.

Why do we check vital signs?

In a case-control study conducted by Rothschild and colleagues, early warning criterion among patients on the medical floor, the presence of respiratory rate over 35/min was most strongly associated with a life-threatening adverse event. Thus, early warning score (EWS) tools, mostly using vital sign abnormalities, are critical in predicting cardiac arrest and death within 48 hours of measurement, even though the effect on in-hospital health outcomes and utilization of resources remains unknown.

It is advised that the earlier you detect the abnormalities, the earlier you can provide the correct treatment. This way, you can prevent diseases, complications, and even death.

Vital signs assessment helps in disease prevention and early intervention.

For example, I saw a patient with a 200/180 mm Hg blood pressure and mild headache during a routine examination. I immediately informed the doctor and administered an antihypertensive. In this scenario, if I had not checked the blood pressure, the patient would have ended up with severe complications like a stroke, angina, among other issues. This is why vital signs play an important role in providing timely interventions.

Now let’s discuss each vital sign one by one.

The human body temperature ranges from 6.5 to 37.5 degrees centigrade (97.7 to 99.5 degrees Fahrenheit). The hypothalamus of the brain regulates body temperature. Therefore, having an optimum temperature is necessary for optimum body and organ functioning. For example, our enzymes will not properly function at high temperatures.

The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle.

A person’s body temperature can be taken in different ways that include:

You can measure temperature by mouth using an oral thermometer such as the digital thermometers that use an electronic probe to measure body temperature.

You can check the body temperature through the rectum by using a rectal thermometer. Rectal body temperature is considered one of the most accurate measures of core body temperature. It tends to be 0.5 to 0.7 degrees Fahrenheit higher than when taken by mouth.

Temperatures can be taken under the arm using the same type of thermometer used in oral measurements. Temperatures taken by this route tend to be 0.3 to 0.4 degrees Fahrenheit lower than those temperatures taken by mouth.

A tympanic thermometer can quickly measure the temperature of the eardrum, which reflects the body’s core temperature (the temperature of the internal organs).

A temporal thermometer can quickly measure the skin’s temperature on the forehead, such as thermal guns.

In certain conditions, your body temperature gets abnormally high (hyperthermia) or low (hypothermia). While a traditional normal temperature reading is 98.6 degrees Fahrenheit, a fever is indicated when body temperature rises to 100.4 Fahrenheit. Conversely, hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.

Did you know that in newborn babies, hypothermia is more serious than hyperthermia? Hypothermia is one of the leading causes of death in neonates; therefore, it is necessary to take proper measures to keep babies warm at normal temperatures.

Pulse is also referred to as the heart rate. It is the measurement of heartbeats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the blood flow. By measuring the heart rate, you can assess the following things;

Heart rhythm
Strength of the pulse

The normal heart rate is 60 to 100 beats/minute. However, you should know about the conditions in which heart rate increases or decreases. The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Females ages 12 and older, in general, tend to have faster heart rates than males. Athletes, such as runners, who do a lot of cardiovascular conditioning, may have heart rates near 40 beats per minute and experience no problems.

How to check the pulse

As the blood passes through the arteries, you feel the pulse or beats by firmly pressing the arteries, which are located close to the surface of the skin at certain points of the body using your fingers.

You can assess the pulse on the sides of the neck (carotid pulse), inside the elbow (brachial pulse), or at the wrist (radial pulse).

For most people, it is easiest to check the pulse at the wrist. However, if you use the lower neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. When checking the pulse:

Press firmly but gently on the arteries using your first or second finger until you feel the beat.
Begin counting the pulse by keeping an eye on the clock.
Count the pulse for 60 seconds (or for 15 seconds, and then multiply by four to calculate beats per minute).
Focus on counting the beats.
If unsure about the results, ask another person to count for you.

Have the patient calm and in a relaxed position before measuring the pulse.

Respiratory rate or respirations

The respiratory rate is the number of breaths the person takes in a minute. The rate is usually measured when a person is at rest and involves counting the number of breaths for one minute by counting how many times the chest rises.

Respiration rates may increase with fever, illness, and other medical conditions. Therefore, it is important to note whether a person has any difficulty breathing when checking respiration.

Normal respiration rates for an adult at rest range from 12 to 20 breaths per minute.

Blood pressure is the pressure or force exerted against the walls of the arteries during contraction (systole) or relaxation (diastole) of the heart.

Each time the heartbeats, it pumps blood into the arteries resulting in the highest blood pressure as the heart contracts. When the heart relaxes, the blood pressure falls.

You might have noticed that blood pressure is recorded in a two-number form. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and fills with blood. Both the systolic and diastolic pressures are recorded as “mm Hg” (millimeters of mercury).

Normal blood pressure is 120/80 mm Hg, but it depends on age, gender, and underlying co-morbidities. Always check for the person’s baseline before marking them as normotensive, hypotensive, or hypertensive.

Hypertension

Hypertension means high blood pressure. It directly increases the risk of heart attack, heart failure, and stroke. With high blood pressure, the arteries may have an increased resistance against blood flow, causing the heart to pump harder to circulate the blood.

Categories of blood pressure

Normal blood pressure is systolic of less than 120 and diastolic of less than 80 (120/80)
Elevated blood pressure is systolic of 120 to 129 and diastolic less than 80.
Stage 1 high blood pressure is systolic is 130 to 139 or diastolic is between 80 to 89.
Stage 2 high blood pressure is when systolic is 140 or higher or the diastolic is 90 or higher.

Remember, a single reading of blood pressure is insufficient to assess someone for high and low blood pressure. In fact, we want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of high blood pressure and starting treatment. In addition, always encourage your patients to record their readings to see the trends to prescribe accurate treatment.

However, in an acute setting, it is important to alert the physician or provider when you notice that the blood pressure has fallen outside of the normal range.

How to check blood pressure

You can check blood pressure digitally using a digital meter or manually using an aneroid monitor or sphygmomanometer.

Manual blood pressure measurement (palpatory method)

To check blood pressure without the aid of an automated machine, You will need several medical items. Which Include:

a stethoscope
A blood pressure cuff with a squeezable balloon and an aneroid monitor that has a numbered dial to read measurements.

Make your patient sit comfortably on a chair with the arm at rest on a table. Secure the cuff on the bicep and squeeze the balloon to increase the pressure.

Watch the aneroid monitor, increase the pressure to about 30 mm Hg over normal blood pressure or 180 mm Hg if this is unknown. When the cuff is inflated, place the stethoscope just inside the elbow crease under the cuff.

Slowly deflate the balloon and listen through the stethoscope. When the first beats hit, note the number on the aneroid monitor. This is systolic pressure.

Continue listening until the steady heartbeat sound stops and record the number from the aneroid monitor again. This is the diastolic pressure. These two numbers are the blood pressure reading.

Nursing pearls for blood pressure measurement

When checking the blood pressure, it is important to remember:

Manual cuffs come in different sizes, depending on the size of the arm. Using the right size ensures the most accurate reading.
The cuff should always sit directly on the bare skin.
Ask the patient to take a few deep breaths and relax for up to 5 minutes before measuring blood pressure.
Avoid talking during the test.
Place the client’s feet flat on the floor and sit up straight while measuring the blood pressure.
Avoid checking blood pressure in a cold room.
Support the arm of the patient as close to heart level as possible.
Measure the blood pressure at a few different times during the day.
Encourage the patient to avoid smoking, drinking, and exercise for 30 minutes before taking blood pressure.
Ask the patient to empty the bladder before taking a blood pressure test. A full bladder may give an incorrect blood pressure reading.

Digital blood pressure measurement

Taking a digital blood pressure is easy and quick. You can simply secure the cuff on the client’s arm and press the “start” button. It will automatically take the blood pressure and give a reading on the screen.

However, sometimes the readings are not quite accurate; therefore, you may need to confirm it with manual BP apparatus.

Pain is also a vital sign. Often, nurses and health professionals ignore this due to time pressure, but it is crucial as an early warning sign for detecting disease. Since pain is subjective, self-report is considered the Gold Standard and most accurate measure of pain.

Pain occurs due to many physiological changes in the body, such as inflammation, internal organ damage/injury, bleeding, etc.

How to assess pain?

The PQRST method of assessing pain is a valuable tool to accurately describe, assess, and document a patient’s pain. The method also aids in the selection of appropriate pain medication and evaluating the response to treatment.

Nurses can help patients report their pain more accurately by using these concrete PQRST assessment questions:

P=Provocative

What were you doing when the pain started? What caused it? What makes it better or worse? What seems to trigger it? Stress? Position? Certain activities?

What relieves it? Medications, massage, heat/cold, changing position, being active, resting?

What aggravates it? Movement, bending, lying down, walking, standing?

Q = Quality/Quantity

What does it feel like? Use words to describe the pain, such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting, or stretching.

R = Region/Radiation

Where is the pain located? Does the pain radiate? Where? Does it feel like it travels/moves around? Did it start elsewhere and is now localized to one spot?

S = Severity Scale

How severe is the pain on a scale of 0 to 10, with zero being no pain and 10 being the worst pain ever? Does it interfere with activities? How bad is it at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?

When/at what time did the pain start? How long did it last? How often does it occur: hourly? Daily? Weekly? Monthly? Is it sudden or gradual? What were you doing when you first experienced it? When do you usually experience it: daytime? Night? Early morning? Are you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs and symptoms? Does it ever occur before, during, or after meals? Does it occur seasonally?

Nursing pearls for Pain documentation

In addition to facilitating accurate pain assessment, careful and complete documentation demonstrates that you are taking all the necessary steps to ensure your patients receive the highest quality pain management. It is important to document the following:

Patient’s perception of the pain scale. Describe the patient’s ability to assess pain level using the 0-10 pain scale.
Patient satisfaction with pain level with current treatment modality. Ask the patient what their pain level was before taking pain medication and after taking pain medication. If the patient’s pain level is not acceptable, what interventions were taken?
Timely re-assessment following an intervention and response to treatment. Quote the patient’s response. Communication with the physician. Always report any change in condition.
Patient education provided and the patient’s response to learning. Don’t write “patient understands” without a supportive evaluation such as the patient can verbalize, demonstrate, describe, etc.

Oxygen Saturation

Oxygen saturation or O2 Sats is our sixth vital sign which indicates the amount of oxygen traveling through the body with the red blood cells. Normal oxygen saturation is usually between 95% and 100% for most healthy adults.

How to measure O2 Sat?

As part of vital signs, we measure it non-invasively with the help of a pulse oximeter. However, in critically ill clients, a more invasive and continuous monitoring system is used to measure arterial blood gases through an arterial line.

Because the device primarily measures light absorption of pulsatile flow (the ‘p’ in Sp02 refers to pulse or pulsatile flow), pulse oximeter readings represent arterial oxygen saturation levels rather than venous oxygen saturation levels. An oxygen saturation level will not be correct if the pulsatile flow is restricted or impeded. Blood pressure and pulse oximetry should not be taken on the same limb because the compression of a blood pressure cuff will obliterate the pulsatile flow.

A clip is applied at the finger of the client which consists of the sensor to measure oxygen saturation, and you can see the reading on the monitor. Always keep in mind that when the patient is moving, a lot of vibrations take place, so the reading appears on the screen is incorrect; therefore, keep the patient calm and relaxed, then apply the saturation probe (clip) and watch for a regular graph in order to get the most accurate reading.

Nursing Pearls

Hypoxemia is a condition in which the client’s oxygen saturation is below the normal range, thus as a nurse, you should ask him or her to perform deep breathing exercises.
Assess the client for airway patency and air entry.
In case of severe shortness of breath and persistent hypoxemia, you need to administer supplemental oxygen to prevent cellular death.
To improve gaseous exchange, keep the patient in semi-fowlers or fowler’s position because it promotes lung expansion.
Keep in mind that whenever supplemental oxygen is being administered, consider using humidified oxygen (through humidifier) to avoid mucosal dryness and irritation.
The patients with COPD should not be hyper oxygenated, rather, their appropriate oxygen saturation should be kept between 88-92%.

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Chapter 3: Measuring and Recording the Vital Signs

Introduction.

The measurement and recording of the vital signs is the first step in the process of physically examining a patient - that is, in collecting objective data about a patient's signs (i.e. what the nurse can observe, feel, hear or measure). This is a fundamental skill for nurses working in all clinical areas, but one which only develops with practice. This chapter introduces the knowledge and skills required by nurses to accurately measure and record a patient's vital signs - that is, their blood pressure (BP), pulse or heart rate (HR), temperature (T°), respiratory rate (RR) and blood oxygen saturation (SpO 2 ).

This chapter begins with an introduction to the importance of measuring the vital signs in nursing practice. It goes on to describe the measurement of each of the vital signs and the collection of other supporting data (e.g. height, weight, pain score), discussing key strategies and considerations. The chapter then reviews the processes involved in recording the data collected about the vital signs. Finally, the chapter discusses how a nurse should go about interpreting the data they have obtained, to build a clinical picture of the patient and plan for their care.

Learning objectives for this chapter

By the end of this chapter, we would like you:

To describe the place of measuring and recording the vital signs in the health observation and assessment process.
To state the normal parameters of each vital sign for a healthy adult.
To understand how to accurately measure each vital sign.
To understand how to collect other key health data (e.g. height, weight, pain score).
To describe how to correctly record this data.
To explain how this data should be interpreted and used in nursing practice.

Important note

This section of the chapter assumes a basic knowledge of human anatomy and physiology. If you feel you need to revise these concepts, you are encouraged to consult a quality nursing textbook.

If you need assistance with writing your essay, our professional nursing essay writing service is here to help!

Measurement and recording of the vital signs

As described in the introduction of this chapter, the measurement and recording of the vital signs is a fundamental skill for nurses working in all clinical areas. The vital signs - blood pressure (BP), pulse or heart rate (HR), temperature (T°), respiratory rate (RR) and blood oxygen saturation (SpO 2 ) - provide baseline indicators of a patient's current health status. It is important to note that some nurses measure and record the vital signs at the commencement of the physical examination, while others integrate the collection of vital signs data into the physical examination; either approach is fine, provided the nurse is systematic in the way in which they approach their assessment, and so collects accurate and complete health data.

As you saw in the previous chapter of this module, health observation and assessment involves three concurrent steps:

The measurement and recording of the vital signs is the first step in the process of physically examining a patient. This step involves collecting objective data - that is, data about a patient's signs (i.e. what the nurse can observe, feel, hear or measure). Data collected during the physical examination, including measurements of the vital signs, is combined with that collected during the health history (as described in the previous chapter of this module), to build a complete picture of the clients' health status.

The normal parameters for each of the vital signs of healthy adults are listed following:


Blood pressure (BP)	120/80 mmHg
Pulse or heart rate (HR)	60-100 beats per minute
Temperature (T°)	36.5°C to 37.5° Celsius
Respiratory rate (RR)	10 to 16 breaths per minute
Blood oxygen saturation (SpO )	98%-100%

Nurses should become thoroughly familiar with the parameters for each of the vital signs. However, it is important for nurses to remember that these are average values for healthy adults. Some adults may have values which fall outside of these ranges. For example, very fit adults may have a pulse or heart rate which normally sits at or below 60 beats per minute; similarly, adults with respiratory conditions often have an oxygen saturation which normally sits well below 98%. Children and neonates have differing normal parameters for each of the vital signs; nurses who work with these patient groups must become familiar with these. When interpreting vital signs, it is important that nurses use critical thinking to interpret the entire clinical picture of the individual patient with whom they are working.

Measurement of blood pressure

Blood pressure is often abbreviated to 'BP'. Blood pressure uses two measurements, each recorded in millimetres of mercury (mmHg) - for example, 120mmHg / 80mmHg, often abbreviated to 120/80. Blood pressure is defined as the pressure of the blood against the arterial walls:

When the heart contracts (systolic BP - the first measurement), and
When the heart rests (diastolic BP - the second measurement).

Essentially, blood pressure is a measurement of the relationship between: (1) cardiac output (the volume of blood ejected from the heart each minute), and (2) peripheral resistance (the force that opposes the flow of blood through the vessels). Blood pressure also depends on factors such as the velocity of the blood, the intravascular blood volume and the elasticity of the vessel walls, etc.

The difference between the systolic and diastolic blood pressures is referred to as the pulse pressure . This normally ranges between 30mmHg and 40mmHg.

Blood pressure can be measured in a number of different ways. It is measured directly by inserting a small catheter into an artery - however, as a very invasive procedure, this strategy is typically only used for patients who are critically ill and for whom blood pressure is very difficult to measure accurately. In all other settings, blood pressure is measured indirectly using: (1) a sphygmomanometer and a stethoscope (a 'manual' measurement), or (2) a non-invasive blood pressure monitor (an 'automatic' measurement). This section of the chapter will teach both methods.

It is important that nurses familiarise themselves with the equipment used to measure the vital signs.

Review the image of a sphygmomanometer to the left, which is labelled with the device's key features:

Measuring blood pressure using a sphygmomanometer and a stethoscope (a 'manual' measurement): The client should be sitting or lying down. The arm used to take the blood pressure should be at the client's side, slightly flexed and with the palm turned upwards. The nurse should palpate the brachial pulse, in the antecubital space (i.e. the groove between the biceps and triceps muscles, in the bend of the elbow). A blood pressure cuff should be placed 2.5 centimetres above the site of the brachial pulse, with the bladder of the cuff (usually marked with a white stripe) centred over the artery. The cuff should be secured so it fits evenly and snugly around the arm.

The manometer - the device used to read the blood pressure measurement - should be positioned at the nurse's eye level. The valve on the pressure bulb should be closed by turning it clockwise. Avoid closing the valve too tightly, or it may be too difficult to release when the time comes to do so.

Place the stethoscope over the patient's brachial pulse, and hold it with your non-dominant hand. Place the binaurals (earpieces) of the stethoscope in your ears. Using your dominant hand, inflate the cuff to around 180mmhg (note that you may need to go higher if the patient's systolic blood pressure is >180mmHg, however this is rare). Then, release the valve to deflate the cuff, slowly and steadily (around 2 to 3mmHg per second to reduce measurement errors). You are listening for two things:

The first Korotkoff sound. This is a sharp thump or tap of the brachial pulse, which indicates the systolic blood pressure. Read the pressure (in mmHg) on the manometer at the point this occurs.
The disappearance of all Korotkoff sounds (i.e. all the noises related to the brachial pulse). This indicates the diastolic blood pressure. Read the pressure (in mmHg) on the manometer at the point this occurs.

Once these two measurements have been made, the cuff should be completely deflated and removed from the client's arm. The two blood pressure readings should be promptly recorded.

Measuring blood pressure using a non-invasive blood pressure monitor (an 'automatic' measurement): This is achieved using the same principles as with the manual measurement, described above. However, it involves using an electronic monitoring device; this measures the circulating blood flow using an electronic sensor and, therefore, does not require the nurse to listen for Korotkoff sounds. The cuff of an automatic blood pressure monitor is applied in the same way as described above. The nurse then presses a 'start' button to instruct the machine to inflate the cuff, take a measurement and provide a reading.

It is important to highlight that although automatic blood pressure measurements are quick and convenient, they are not as accurate as manual blood pressure measurements. If a non-invasive blood pressure monitor returns a reading which is outside the expected parameters, it should always be checked with a manual measurement. Furthermore, it is worth noting that a cuff must fit correctly on a patient's arm, and be placed correctly so the bladder of the cuff is above the brachial artery, if a non-invasive blood pressure monitor is to return an accurate reading.

As described in the above section, the upper arm is the most common site to measure blood pressure; however, if this is not possible, blood pressure may also be measured from the thigh. Research suggests that the systolic blood pressure is slightly higher in the leg than in the arm, but the diastolic blood pressures are roughly similar. Blood pressure is taken on the thigh using the same technique described above.

In some cases, a patient may have their blood pressure taken a number of times in a number of positions (e.g. lying, sitting, standing). This is done to assess the client for orthostatic hypotension . This occurs when there is a 20 to 30mmHg drop in blood pressure when the client changes positions, and it may indicate health problems.

It is important for nurses to note that there are a number of common errors associated with blood pressure measurement. Errors may result if:

The client's arm is positioned above or below the level of their heart.
The cuff used is too large or too narrow for the client's arm.
The cuff is wrapped too loosely or unevenly around the client's arm.
The cuff is not deflated to a pressure higher than the patient's systolic blood pressure.
The cuff is deflated at a rate slower or faster than 2 to 3mmHg per second.
The cuff is reinflated (e.g. to check readings) before it is completely deflated.
The stethoscope is pressed too firmly against the brachial artery.
The nurse fails to wait 2 minutes before repeating the blood pressure measurement.

As described above, the majority of the common errors associated with blood pressure measurement are related to the size and position of the cuff. Blood pressure cuffs come in a variety of sizes, and it is essential that nurses select the correct size for the individual patient with whom they are working - if the cuff is too large, blood pressure will be underestimated, and if it is too small, blood pressure will be overestimated. Ideally, the width of the cuff should be 40% of the circumference of the limb from which the blood pressure is being measured, and the bladder within must encircle at least 80% of the limb.

As you saw in an earlier section of this chapter, the average blood pressure of a healthy adult is 120mmHg/80mmHg, typically written as 120/80. When measuring a client's blood pressure, a nurse may identify that it is high - a condition referred to as hypertension , or low - a condition referred to as hypotension . There may be a number of pathophysiological causes of hypertension (e.g. brain injury, systemic vasoconstriction, fluid retention, etc.) and hypotension (e.g. fluid / blood loss, dehydration, etc.). It is important for nurses to recognise that there are also a number of physiological factors which affect blood pressure measurement; for example, recent exercise, feeling anxious or angry, experiencing pain, ingesting caffeine or tobacco, and obesity can all result in a patient recording higher than normal blood pressure. Remember: when interpreting vital signs, it is important that nurses use critical thinking to interpret the entire clinical picture of the individual patient with whom they are working.

Measurement of pulse or heart rate

Pulse or heart rate is often abbreviated to 'HR'. It is defined as the number of times a person's heart beats in a one-minute period. It is recorded at a rate of 'beats per minute'. Each contraction of the heart results in the ejection of blood into the vascular system, and this is felt in key locations of the body as a 'pulse'. In addition to assessing the rate at which a person's heart is beating, when measuring a person's HR, a nurse should also assess for the rhythm and quality of the pulse.

A patient's pulse may be measured using the same types of non-invasive, automatic monitors used to measure blood pressure, as described in the previous section of this chapter. However, it is generally preferred that heart rate is assessed by palpating a pulse, and it is this technique which will be taught in this chapter.

To measure a pulse, a nurse should place their fingers over an artery and feel for the pulse. Generally, pulses are palpated with the pads of the index and middle fingers. Firm pressure is applied to the pulse, but not so much pressure that the artery is occluded. There are a number of locations on the body in which a nurse may palpate an artery to feel for a pulse; the most common are:

The radial artery, located on the outer edge of each wrist.
The brachial artery, located in the antecubital space on each arm.
The carotid artery, located on the inner sides of the sternocleidomastoid muscle in the neck.

It is important for nurses to note that a patient's heart rate can also be assessed by auscultating the heart. This is referred to as measuring the apical pulse .

When measuring the HR, a nurse may:

Count the number of pulses for 60 seconds.
Count the number of pulses for 30 seconds, and multiply by 2 - if the HR is regular.
Count the number of pulses for 15 seconds, and multiply by 4 - if the HR is regular.

As described, it is important that a nurse assesses the pulse for regularity. If the pulse is irregular (i.e. the time between each beat varies, or beats are skipped, etc.), the pulse must be counted for one full minute (60 seconds). Additionally, an irregular pulse must be documented when recording the vital signs.

It is also important that the nurse assess the quality of the pulse - that is, its key characteristics. A patient's pulse may be described using terms such as thready (meaning the pulse is 'weak') or bounding (meaning the pulse is 'full' and 'strong'). This is important information that is used, along with HR and regularity of the pulse, to assess the health of the cardiovascular and other body systems.

The average pulse or heart rate for a healthy adult is 60 to 100 beats per minute. If a patient's pulse is >100 beats per minute, this is referred to as tachycardia ; pain, infection, dehydration, stress, anxiety, thyroid disorder, shock, anaemia, certain heart conditions, etc. can all result in tachycardia. If a patient's pulse is <60 beats per minute, this is referred to as bradycardia ; cardiac conduction defects, overdose (e.g. central nervous system depressants), head injury, severe hypoxia (with impending respiratory / cardiac arrest), shock, etc. can all result in bradycardia.

Measurement of temperature

Temperature is often abbreviated to 'T°'. This is defined as the temperature, in degrees Celsius (°C), of a person's body. Temperature is typically measured using a thermometer, which may be either automatic or manual. Temperature may be measured by one of several different routes:

Orally, with the thermometer placed under the tongue (i.e. in the right or left sublingual pockets). This is the safest way of recording a patient's temperature, and also one of the most accurate. When taking an oral temperature measurement, nurses should take care to ensure the patient has not recently (within the last 10 minutes) ingested hot or cold foods or liquids, that the thermometer is covered by an appropriate shield (for hygiene purposes), and that the patient closes their mouth completely while the thermometer reads their temperature. Automatic thermometers can take up to 30 seconds to record a temperature reading.
Via the tympanic membrane, with the thermometer placed onto the tympanic membrane within the ear. When taking a tympanic temperature measurement, nurses should take care to ensure that the thermometer is covered by an appropriate shield (for hygiene purposes), and that the sensor comes into contact with all sides of the ear canal.
Via the axilla, with the thermometer placed under the arm. Although the axilla is a convenient location from which to record a temperature measurement, the accuracy of temperature measurements recorded here are uncertain (i.e. the axilla probably poorly reflects core body temperature).
Rectally, with the thermometer inserted into the patient's rectum. This is both a safe and accurate way of recording a patient's body temperature, but it is both uncomfortable and invasive; therefore, it is not often used in most clinical settings.

When using an automatic or electronic thermometer to record a patient's temperature, the nurse should place the thermometer in the location on the patient's body at which the temperature is to be recorded, press 'start', and wait for an audible signal and the measurement to register on a display screen. If using a manual thermometer, the thermometer must be located on the patient's body as described, and the nurse must wait at least one full minute before reading the measurement on the gauge of the thermometer. It is worth noting that manual thermometers are rarely used in most clinical settings in the United Kingdom.

The average temperature for a healthy adult is 36.5°C to 37.5°C. If a patient's temperature is >37.5°C, they are said to have hyperthermia or a fever. If a patient's temperature is <36.5°C, they are said to have hypothermia . Causes of variations from normal temperature include infection, stress, dehydration, recent exercise, being in a hot or cold environment, drinking a hot or cold beverage, and thyroid disorders.

Measurement of respiratory rate

Respiratory rate is often abbreviated to 'RR'. This is defined as the number of times a person inhales and exhales in a 1 minute period. It is recorded at a rate of 'breaths per minute'.

Respiratory rate is typically measured by counting the number of times a patient completes a full ventilatory cycle (inhalation plus exhalation) in a 1 minute period. This can be measured by watching the rise and fall of the patient's chest and / or abdomen, or (though less commonly) the breath sounds may also be auscultated. It is best that nurses measure a patient's respiratory rate when the patient is unaware that they are doing so, as this will prevent the patient unconsciously (or even consciously!) changing the way they breathe.

When measuring the RR, a nurse may:

Count the number of pulses for 30 seconds, and multiply by 2 - if the RR is regular.
Count the number of pulses for 15 seconds, and multiply by 4 - if the RR is regular.

In addition to assessing a patient's heart rate, the nurse should assess:

The rhythm, or pattern / regularity, of the patient's breathing.
The depth of the patient's breathing, or level of lung expansion (normal, shallow, or deep).
The effort associated with the patient's breathing, often evaluated by observing for accessory muscle use and tissue retractions, etc.

The average respiratory rate for a healthy adult is 10 to 16 breaths per minute. If a patient's RR is >16 breaths per minute, this is referred to as tachpynoea ; this may result from cellular hypoxia, acidosis, conditions that interfere with gas exchange / ventilation / perfusion (e.g. pulmonary oedema, pneumonia, pulmonary embolism), shock, pain, anxiety, asthma, respiratory disease, cardiac disease, etc. If a patient's RR is <10 breaths per minute, this is referred to as bradypnoea ; this may result from head injury, stroke, overdose (particularly of central nervous system depressants), respiratory failure, etc.

Measurement of blood oxygen saturation

Blood oxygen saturation is often abbreviated to 'SpO 2 '. This is defined as the amount of oxygen present in a person's blood - specifically, bound to their haemoglobin - at a given time. It is measured as a percentage, using a non-invasive automatic measuring device called a pulse oximeter. The probe of a pulse oximeter is usually placed on the end of a patient's finger or toe or, less commonly, on their earlobe or their nose. A reading is given on the machine's screen after a period of approximately 15 seconds.

The blood oxygen saturation of a healthy adult is typically 98%-100%. A variety of problems, particularly those related to the respiratory and cardiovascular systems (refer to the information on HR and RR, above), can result in a patient's blood oxygen saturation reducing below this normal range.

Measurement of height, weight and body mass index (BMI)

Although not strictly vital signs, a patient's height, weight and - subsequently - their body mass index (BMI) can provide a nurse with important information about their overall health and physical condition. A patient's weight is measured using a scale, whilst their height is measured using a platform ruler or tape measure. Body mass index can then be calculated, using the following formula: BMI = Weight (kg) / Height (m) 2 It is worth noting that most clinical areas have charts which assist nurses to calculate BMI.

BMI is a useful, objective measurement of a person's body condition, based on their unique height and weight. A patient's BMI is interpreted as follows:


<18.5	Underweight
18.6 to 24.9	Normal weight
25 to 29.9	Overweight
>30	Obese

It is worth noting that the accuracy of the BMI measurement - and, therefore, its utility in the clinical context - is subject to much conjecture. As always, it is important that nurses use critical thinking to interpret the entire clinical picture of the individual patient with whom they are working.

Measurement of pain

In many clinical areas, pain is considered the sixth 'vital sign'. Pain is generally assessed using a strategy which can be remembered using the 'OPQRST' mnemonic

O	Onset: "When did the pain begin?"
P	Provocation and palliation: "What makes the pain worse? What helps the pain?"
Q	Quality: "Describe the pain." (E.g. sharp, dull, stabbing, etc.).
R	Region and radiation: "Where do you feel the pain? Does the pain spread to other areas of your body?"
S	Severity: "On a scale of 1 to 10, where 1 is no pain and 10 is the most severe pain you have experienced, how would you rate the pain?" (Note that there are a range of other pain scales - including visual scales for paediatric and non-verbal patients - which may be used in health care settings).
T	Time: "How long has the pain been present?"

It is also important to highlight that there are a number of visual scales which can be used to assess pain in patients who are non-verbal. In patients who cannot describe their pain or communicate that they are experiencing pain, nurses should look for other signs of pain - such as restlessness, agitation, tachycardia, diaphoresis, pallor, etc.

Recording the vital signs

So far, this chapter has described in detail the processes involved in measuring a patient's vital signs. Once these have been measured, the information must be documented so that it can be used to: (1) assess the patient's condition, and (2) inform the care which is appropriate for that patient. As you saw in a previous chapter of this module, there are a variety of different ways that data can be recorded, and this generally differs between clinical settings and organisations; nurses are encouraged to familiarise themselves with the documentation strategies used in the organisation where they work. Regardless of how data is recorded, however, documentation must be complete, accurate, concise, legible and free from bias. You should revise the principles of documenting health observation and assessment data from the earlier chapter of this module, if required.

Often in the United Kingdom, a patient's vital signs are recorded using early warning score tools. These pieces of documentation allow a nurse to graphically represent a patient's vital sign measurements to identify changes over time, and to calculate simple scores which describe a patient's risk of deterioration into serious illness. Early warning score tools may also provide a nurse with information about how they should respond if they identify that a patient's vital signs are outside the expected ranges - for example, by increasing the frequency of monitoring, by requesting a medical review or by initiating an emergency call.

Interpreting the vital signs

Once you have measured and recorded a patient's vital signs, it is important that you are able to analyse and interpret the data you have collected. Essentially, this means attempting to understand and make sense of this data, based on the patient's physiological condition. Remember: it is important that nurses use critical thinking to interpret the entire clinical picture of the individual patient with whom they are working. Let's consider a case study example:

Elizabeth is a graduate nurse working in the Accident and Emergency Department (A&E) of a large tertiary hospital in London. She is caring for a young man, Luke, who has been transported by road ambulance following a high-speed motor vehicle accident. Luke has an open, mid-shaft femoral fracture which is bleeding heavily.

Whilst receiving handover from the paramedics who attended the scene, Elizabeth measures Luke's vital signs, finding:

A HR of 101 beats per minute (high).
A RR of 18 breaths per minute (high).
A BP of 60/110 (low).

The paramedics estimate that Luke has lost 1000mL of blood.

Elizabeth analyses and interprets this assessment data. She knows Luke has lost a significant amount of blood, which is likely to result directly in his low BP. Luke's high HR and RR are probably to compensate for his low blood pressure (i.e. his heart beats faster, and he breathes more rapidly, in an attempt to increase perfusion to his organs). Luke's high HR and RR may also be a response to the significant pain he is likely to be experiencing, and also shock at the situation in which he finds himself.

In analysing and interpreting her measurements of Luke's vital signs in this way, Elizabeth can plan effective care for Luke. She also has a baseline which she can use to evaluate the effectiveness of the care provided.

It is important to remember that learning to measure and record a patient's vital signs accurately, and to analyse and interpret the data collected, are skills which comes with practice. As a student and new graduate nurse, it is essential that you take every possible opportunity to practice collecting, recording and interpreting the vital signs of a variety of different patients, in a range of different clinical settings.

As you have seen in this chapter, the measurement and recording of the vital signs is the first step in the process of physically examining a patient - that is, in collecting objective data about a patient's signs (i.e. what the nurse can observe, feel, hear or measure). This chapter began with an introduction to the importance of measuring the vital signs in nursing practice. It went on to describe the measurement of each of the vital signs and the collection of other supporting data (e.g. height, weight, pain score), discussing key strategies and considerations. The chapter then reviewed the processes involved in recording data collected about the vital signs. Finally, the chapter discussed how a nurse should go about interpreting the data they have obtained, to build a clinical picture of the patient and plan for their care. In completing this chapter, you have become equipped with the knowledge and skills you require to accurately measure and record a patient's vital signs.

Now we have reached the end of this chapter, you should be able:

Reference list

Cox, C. (2009). Physical Assessment for Nurses (2nd edn.). West Sussex, UK: Blackwell Publishing, Ltd.

Jensen, S. (2014). Nursing Health Assessment: A Best Practice Approach . London, UK: Wolters Kluwer Publishing.

Wilson, S.F. & Giddens, J.F. (2005). Health Assessment for Nursing Practice (4th edn.). St Louis, MI: Mosby Elsevier.

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Practical Guide to History Taking, Physical Exam, and Functioning in the Hospital and Clinic

Chapter 3: Vital Signs

Charlie Goldberg, MD

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Introduction, temperature, respiratory rate.

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Vital signs (aka “vitals”) include the measurement of temperature, respiratory rate, pulse, blood pressure, and oxygen saturation. These numbers provide critical information (hence the name “vitals”) about a patient’s state of health. In particular, vital signs:

Can point to the existence of an acute medical problem.

Are a means of rapidly quantifying the magnitude of an illness and how well the body is coping with the resultant physiologic stress. Often, the more deranged the vitals, the sicker is the patient.

Are a marker of chronic disease states. For example, hypertension is defined as chronically elevated blood pressure.

Most patients will have had their vital signs measured by a nurse or healthcare assistant before you see them. However, these values are of such great importance that you should get in the habit of repeating them yourself if they are very abnormal. As noted later in this chapter, there is significant potential for measurement error, so repeat determinations can provide critical information.

In the outpatient/elective visit setting, the patient should have had the opportunity to rest for approximately 5 minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated (or lying in bed if hospitalized or presenting with acute symptoms).

Observation

Start by looking at the patient in their entirety, if possible, from an out-of-the-way perch. Do they seem anxious, in pain, or upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient.

This can be done via oral, ear, rectal, or nontouch sensors.

Temperature is measured in either Celsius or Fahrenheit, with a fever defined as greater than 38 to 38.5°C or 101 to 101.5°F.

Temperature measurement is of greatest importance when there is concern about infection or other acute inflammatory states.

Respirations are recorded as breaths per minute.

They should be counted for at least 30 seconds because the total number of breaths in a 15-second period is small and any miscounting can result in relatively large errors when multiplied by 4.

Try to measure the respiratory rate as surreptitiously as possible so that the patient does not consciously alter their rate of breathing, which can happen if they feel they are being watched. This can be done by observing the rise and fall of the patient’s chest area while you appear to be taking their pulse.

Normal respiratory rate (RR) is between 12 and 20 breaths per minute.

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1.3 Vital Signs

Vital signs are typically obtained prior to performing a physical assessment. Vital signs include temperature recorded in Celsius or Fahrenheit, pulse, respiratory rate, blood pressure, and oxygen saturation using a pulse oximeter. See Figure 1.8 [1] for an image of a nurse obtaining vital signs. Obtaining vital signs may be delegated to unlicensed assistive personnel (UAP) for stable patients, depending on the state’s Nurse Practice Act, agency policy, and appropriate training. However, the nurse is always accountable for analyzing the vital signs and instituting appropriate follow-up for out-of-range findings. See Appendix A to review a checklist for obtaining vital signs.

The order of obtaining vital signs is based on the patient and their situation. Health care professionals often place the pulse oximeter probe on the patient while proceeding to obtain their pulse, respirations, blood pressure, and temperature. However, in some situations this order is modified based on the urgency of their condition. For example, if a person loses consciousness, the assessment begins with checking their carotid pulse to determine if cardiopulmonary resuscitation (CPR) is required. [2]

Temperature

Accurate temperature measurements provide information about a patient’s health status and guide clinical decisions. Methods of measuring body temperature vary based on the patient’s developmental age, cognitive functioning, level of consciousness, and health status, as well as agency policy. Common methods of temperature measurement include oral, tympanic, axillary, temporal, no touch, and rectal routes. It is important to document the route used to obtain a patient’s temperature because of normal variations in temperature in different locations of the body. Body temperature is typically measured and documented in health care agencies in degrees Celsius (ºC). [3]

Oral Temperature

Normal oral temperature is 35.8 – 37.3ºC (96.4 – 99.1ºF). An oral thermometer is shown in Figure 1.9. [4] The device has blue coloring, indicating it is an oral or axillary thermometer, as opposed to a rectal thermometer that has red coloring. Oral temperature is reliable when it is obtained close to the sublingual artery. [5]

Image showing an electronic oral thermometer

Remove the probe from the device and slide a probe cover (from the attached box) onto the oral thermometer without touching the probe cover with your hands. Place the thermometer in the posterior sublingual pocket under the tongue, slightly off-center. Instruct the patient to keep their mouth closed but not bite on the thermometer. Leave the thermometer in place for as long as is indicated by the device manufacturer. The thermometer typically beeps within a few seconds when the temperature has been taken. Read the digital display of the results. Discard the probe cover in the garbage (without touching the cover) and place the probe back into the device. [6] See Figure 1.10 [7] of an oral temperature being taken.

Image showing nurse taking oral temperature of simulated patient

Some factors can cause an inaccurate measurement using the oral route. For example, if the patient recently consumed a hot or cold food or beverage, chewed gum, or smoked prior to measurement, a falsely elevated or decreased reading may be obtained. Oral temperature should be taken 15 to 25 minutes following consumption of a hot or cold beverage or food or 5 minutes after chewing gum or smoking. [8]

Tympanic Temperature

The tympanic temperature is typically 0.3 – 0.6°C or 0.5 – 1°F higher than an oral temperature. It is an accurate measurement because the tympanic membrane shares the same vascular artery that perfuses the hypothalamus (the part of the brain that regulates the body’s temperature). See Figure 1.11 [9] of a tympanic thermometer. The tympanic method should not be used if the patient has a suspected ear infection. [10] Accumulation of cerumen, earwax, may also reduce the accuracy of tympanic readings.

Remove the tympanic thermometer from its holder and place a probe cover on the thermometer tip without touching the probe cover with your hands. Turn the device on. Ask the patient to keep their head still. For an adult or older child, gently pull the helix (outer ear) up and back to visualize the ear canal. For an infant or child under age 3, gently pull the helix down. Insert the probe just inside the ear canal but never force the thermometer into the ear. The device will beep within a few seconds after the temperature is measured. Read the results displayed, discard the probe cover in the garbage (without touching the cover), and then place the device back into the holder. [11] See Figure 1.12 [12] for an image of a tympanic temperature being taken.

Image showing use of tympanic thermometer being inserted in simulated patient's ear canal

Axillary Temperature

The axillary method is a minimally invasive way to measure temperature and is commonly used in children. It uses the same electronic device as an oral thermometer (with blue coloring). However, the axillary temperature can be as much as 1ºC lower than the oral temperature. [13] An armpit (axillary) temperature is usually 0.3⁰ C (0.5⁰ F) to 0.6⁰ C (1⁰ F) lower than an oral temperature.

Remove the probe from the device and place a probe cover (from the attached box) on the thermometer without touching the cover with your hands. Ask the patient to raise their arm and place the thermometer probe in their armpit on bare skin as high up into the axilla as possible. The probe should be facing behind the patient. Ask the patient to lower their arm and leave the device in place until it beeps, usually about 10–20 seconds. Read the displayed results, discard the probe cover in the garbage (without touching the cover), and then place the probe back into the device. See Figure 1.13 [14] for an image of an axillary temperature. [15]

Image showing a nurse taking axillary temperature, via armpit of simulated patient

Rectal Temperature

Measuring rectal temperature is an invasive method. Some sources suggest its use only when other methods are not appropriate. However, when measuring infant temperature, it is considered a gold standard because of its accuracy. A rectal temperature is 0.5°F (0.3°C) to 1°F (0.6°C) higher than an oral temperature. [16] See Figure 1.14 [17] for an image of a rectal thermometer.

Photo showing a digital rectal thermometer

Before taking a rectal temperature, ensure the patient’s privacy. Wash your hands and put on gloves. For infants, place them in a supine position and raise their legs upwards toward their chest. Parents may be encouraged to hold the infant to decrease movement and provide a sense of safety. When taking a rectal temperature in older children and adults, assist them into a side lying position and explain the procedure. Remove the probe from the device and place a probe cover (from the attached box) on the thermometer. Lubricate the cover with a water-based lubricant, and then gently insert the probe 2–3 cm (approximately 0.5 in for babies less than 6 months old to 1 inch) into the anus or less, depending on the patient’s size. [18] Remove the probe when the device beeps. Read the result and then discard the probe cover in the trash can without touching it. Cleanse the device as indicated by agency policy. Remove gloves and perform hand hygiene.

Temporal Temperature

Temporal temperature is taken by using a device placed on the forehead. Temporal thermometers contain an infrared scanner that measures the heat on the surface of the skin resulting from blood moving through the temporal artery in the forehead. Temporal temperature is typically 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature. It is a quick, noninvasive method, but accurate measurement is dependent on good contact with the skin and good placement on the forehead.

See Table 1.3a for normal temperature ranges for various routes.

Table 1.3 Normal Temperature Ranges [19]


Oral	35.8 – 37.3ºC (96.4 -99.1ºF)
Axillary	34.8 – 36.3ºC (96.4 -97.3ºF)
Tympanic	36.1 – 37.9ºC (97.0 -100.2ºF)
Rectal	36.8 – 38.2ºC (98.2 -100.8ºF)
Temporal	35.2 – 37.0ºC (95.4 – 98.6ºF)

Pulse refers to the pressure wave that expands and recoils arteries when the left ventricle of the heart contracts. It is palpated at many points throughout the body. The most common locations to palpate pulses as part of vital sign measurement include radial, brachial, carotid, and apical areas as indicated in Figure 1.15. [20]

Image showing common pulse assessment locations on a human skeletal form, with labels

Pulse is measured in beats per minute wherever a pulse can be palpated. The normal adult pulse rate (heart rate) at rest is 60–100 beats per minute with different ranges according to age. The pulse rate is a measurement of the number of times the heart beats per minute. The pulse rate may differ from the heart rate if the force of the heart contraction is not strong enough to generate a pulse because the pulse is palpated whereas the heart rate is typically auscultated. See Table 1.3b for normal heart rate ranges by age. It is important to consider each patient situation when analyzing if their heart rate is within normal range. Begin by reviewing their documented baseline heart rate. Consider other factors if the pulse is elevated, such as the presence of pain or crying in an infant. It is best to complete the assessment when a patient is resting and comfortable, but if this is not feasible, document the circumstances surrounding the assessment and reassess as needed. [21] For example, pulse rate may be artificially elevated when individuals experience physical or mental stress. Therefore, it is best to collect a pulse rate assessment when the patient is resting.

Table 1.3b Normal Heart Rate by Age


Preterm	120 – 180
Newborn (0 to 1 month)	100 – 160
Infant (1 to 12 months)	80 – 140
Toddler (1 to 3 years)	80 – 130
Preschool (3 to 5 years)	80 – 110
School Age (6 to 12 years)	70 – 100
Adolescents (13 to 18 years) and Adults	60 – 100

Pulse Characteristics

When assessing pulses, the characteristics of rhythm, rate, force, and equality are included in the documentation.

Pulse Rhythm

A normal pulse has a regular rhythm, meaning the frequency of the pulsation felt by your fingers is an even tempo with equal intervals between pulsations. For example, if you compare the palpation of pulses to listening to music, it follows a constant beat at the same tempo that does not speed up or slow down. Some cardiovascular conditions, such as atrial fibrillation, cause an irregular heart rhythm. If a pulse has an irregular rhythm, document if it is “regularly irregular” (e.g., three regular beats are followed by one missed and this pattern is repeated) or if it is “irregularly irregular” (e.g., there is no rhythm to the irregularity). [22]

The pulse rate is counted with the first beat felt by your fingers as “One.” It is considered best practice to assess a patient’s pulse for a full 60 seconds, especially if there is an irregularity to the rhythm. [23]

Pulse Force

The pulse force is the strength of the pulsation felt on palpation. Pulse force can range from absent to bounding. The volume of blood, the heart’s functioning, and the arteries’ elastic properties affect a person’s pulse force. [24] Pulse force is documented using a four-point scale:

3+: Full, bounding
2+: Normal/strong
1+: Weak, diminished, thready
0: Absent/nonpalpable

If a pulse is absent, a Doppler ultrasound device is typically used to verify perfusion of the limbs. The Doppler is a handheld device that allows the examiner to hear the whooshing sound of the pulse. This device is also commonly used when assessing peripheral pulses in the lower extremities, such as the dorsalis pedis pulse or the posterior tibial pulse. See the following video demonstrating the use of a Doppler device.

View a YouTube Video of Using a Doppler Ultrasound Device to Assess a Pulse [25]

Pulse Equality

Pulse equality refers to a comparison of the pulse forces on both sides of the body. For example, a nurse often palpates the radial pulse on a patient’s right and left wrists at the same time and compares if the pulse forces are equal. However, the carotid pulses should never be palpated at the same time because this can decrease blood flow to the brain. Pulse equality provides data about medical conditions such as peripheral vascular disease and arterial obstruction. [26]

Radial Pulse

Use the pads of your first three fingers to gently palpate the radial pulse. The pads of the fingers are placed along the radius bone on the lateral side of the wrist (i.e., the thumb side). Fingertips are placed close to the flexor aspect of the wrist (i.e., where the wrist meets the hand and bends). See Figure 1.16 [27] for correct placement of fingers in obtaining a radial pulse. Press down with your fingers until you can feel the pulsation, but not so forcefully that you are obliterating the wave of the force passing through the artery. Note that radial pulses are difficult to palpate on newborns and children under the age of five, so the brachial or apical pulses are typically obtained in these populations. [28]

Carotid Pulse

The carotid pulse is typically palpated during medical emergencies because it is the last pulse to disappear when the heart is not pumping an adequate amount of blood. [29]

Locate the carotid artery medial to the sternomastoid muscle, between the muscle and the trachea, in the middle third of the neck. In order to palpate the carotid, place the index and middle fingers on the patient’s neck to the side of individual’s trachea. With the pads of your three fingers, gently palpate one carotid artery at a time so as not to compromise blood flow to the brain. See Figure 1.17 [30] for correct placement of fingers in a seated patient. [31]

Image showing hand placed on simulated patients neck to check carotid pulse

Brachial Pulse

A brachial pulse is typically assessed in infants and children because it can be difficult to feel the radial pulse in these populations. If needed, a Doppler ultrasound device can be used to obtain the pulse.

The brachial pulse is located by feeling the bicep tendon in the area of the antecubital fossa. Move the pads of your three fingers medially from the tendon about 1 inch (2 cm) just above the antecubital fossa. It can be helpful to hyperextend the patient’s arm to accentuate the brachial pulse so that you can better feel it. You may need to move your fingers around slightly to locate the best place to accurately feel the pulse. You typically need to press fairly firmly to palpate the brachial pulse. [32] See Figure 1.18 [33] for correct placement of fingers along the brachial artery.

Image showing hand checking brachial pulse on simulated patient's inner elbow

Apical Pulse

The apical pulse rate is considered the most accurate pulse and is indicated when obtaining assessments prior to administering cardiac medications. It is obtained by listening with a stethoscope over a specific position on the patient’s chest wall. Read more about listening to the apical pulse and other heart sounds in the “ Cardiovascular Assessment ” section.

Respiratory Rate

Respiration refers to a person’s breathing and the movement of air into and out of the lungs. Inspiration refers to the process causing air to enter the lungs, and expiration refers to the process causing air to leave the lungs. A respiratory cycle (i.e., one breath while measuring respiratory rate) is one sequence of inspiration and expiration. [34]

When obtaining a respiratory rate, the respirations are also assessed for quality, rhythm, and rate. The quality of a person’s breathing is normally relaxed and silent. However, loud breathing, nasal flaring, or the use of accessory muscles in the neck, chest, or intercostal spaces indicate respiratory distress. People experiencing respiratory distress also often move into a tripod position, meaning they are leaning forward and placing their arms or elbows on their knees or on a bedside table. If a patient is demonstrating new signs of respiratory distress as you are obtaining their vital signs, it is vital to immediately notify the health care provider or follow agency protocol.

Respirations normally have a regular rhythm in children and adults who are awake. A regular rhythm means that the frequency of the respiration follows an even tempo with equal intervals between each respiration. However, newborns and infants commonly exhibit an irregular respiratory rhythm.

Normal respiratory rates vary based on age. The normal resting respiratory rate for adults is 10–20 breaths per minute, whereas infants younger than one year old normally have a respiratory rate of 30–60 breaths per minute. See Table 1.3c for ranges of normal respiratory rates by age. It is also important to consider factors such as sleep cycle, presence of pain, and crying when assessing a patient’s respiratory rate. [35]

Read more about assessing a patient’s respiratory status in the “ Respiratory Assessment ” section.

Table 1.3c Normal Respiratory Rate by Age [36]


Newborn to one month	30 – 60
One month to one year	26 – 60
1-10 years of age	14 – 50
11-18 years of age	12 – 22
Adult (ages 18 and older)	10 – 20

Oxygen Saturation

A patient’s oxygenation status is routinely assessed using pulse oximetry, referred to as SpO2. SpO2 is an estimated oxygenation level based on the saturation of hemoglobin measured by a pulse oximeter. Because the majority of oxygen carried in the blood is attached to hemoglobin within the red blood cells, SpO2 estimates how much hemoglobin is “saturated” with oxygen. The target range of SpO2 for an adult is 94-100%. For patients with chronic respiratory conditions, such as chronic obstructive pulmonary disease (COPD), the target range for SpO2 is often lower at 88% to 92%. Although SpO2 is an efficient, noninvasive method to assess a patient’s oxygenation status, it is an estimate and not always accurate. For example, if a patient is severely anemic and has a decreased level of hemoglobin in the blood, the SpO2 reading is affected. Decreased peripheral circulation can also cause a misleading low SpO2 level.

A pulse oximeter includes a sensor that measures light absorption of hemoglobin. See Figure 1.19 [37] for an image of a pulse oximeter. The sensor can be attached to the patient using a variety of devices. For intermittent measurement of oxygen saturation, a spring-loaded clip is attached to a patient’s finger or toe. However, this clip is too large for use on newborns and young children; therefore, for this population, the sensor is typically taped to a finger or toe. An earlobe clip is another alternative for patients who cannot tolerate the finger or toe clip or have a condition, such as vasoconstriction or poor peripheral perfusion, that could affect the results.

Image showing pulse oximeter in use on simulated patient's index finger

Read more about pulse oximetry in the “ Oxygen Therapy ” chapter.

Nail polish or artificial nails can affect the absorption of light waves from the pulse oximeter and decrease the accuracy of the SpO2 measurement when using a probe clipped on the finger. An alternative sensor that does not use the finger should be used for these patients or the nail polish should be removed. If a patient’s hands or feet are cold, it is helpful to clip the sensor to the earlobe or tape it to the forehead.

Blood Pressure

Read information about how to accurately obtain blood pressure measurement in the “ Blood Pressure ” chapter.

Interpreting Results

After obtaining a patient’s vital signs, it is important to immediately analyze the results, recognize deviations from expected normal ranges, and report deviations appropriately. As a nursing student, it is vital to immediately notify your instructor and/or collaborating nurse caring for the patient of any vital sign measurement out of normal range.

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15.3 Vital Signs

Learning objectives.

By the end of this section, you will be able to:

Describe the steps involved for preparing to obtain vital signs
Understand how and when to monitor vital signs
Discuss the importance of using critical judgment when validating data
Explain proper techniques for documenting data

A vital sign is a marker of physiological homeostasis and are essential in the analysis of monitoring patient progress. Vital signs include the body temperature, pulse, respiratory rate, and blood pressure. Vital signs are gathered during the initial encounter with the patient to establish a baseline and routinely thereafter, according to condition, to assess disease progression or resolution. When vital signs are abnormal, a patient’s plan of care is typically altered. When vital signs are taken routinely, the healthcare team can analyze them to observe the response to treatments or disease progression. The combination of multiple vital sign measurements over a period of time also provides the typical and normal ranges for an individual patient. These individualized ranges are the vital sign trends. The vital signs provide a snapshot of the circulatory, respiratory, and neurological status of the patient.

Preparing to Obtain Vital Signs

Prior to obtaining vital signs, the nurse should gather the necessary equipment, check the patient’s vital sign trends and pertinent history, and verify the healthcare provider’s orders regarding frequency and parameters. To complete the vital signs, the nurse must obtain a thermometer, stopwatch, stethoscope, pulse oximeter, and blood pressure cuff. Many of these items may be present on the facility’s vital sign machine. Some facilities keep designated vital sign equipment at the patient’s bedside. At times, vital signs are obtained via an electronic monitoring device either continually (such as in critical care units) or scheduled ( Figure 15.14 ). When these devices are used, it is the nurse’s responsibility to manually collect the data received.

Reviewing the patient’s vital sign trends could provide valuable information for the nurse. For example, if the patient’s health record indicates that their heart rate is typically around 65 beats per minute, then the nurse checks it and finds it to be 96 beats per minute, further investigation may be warranted. Although this value is normal for the population in general, it is not normal for that patient.

Health history may influence obtaining vital signs. For example, a mastectomy would prevent the nurse from obtaining blood pressure on that arm due to the risk of lymphedema , and a wound might prevent placement of blood pressure cuff. Oral trauma would change the route of obtaining the temperature, and a wound over the wrist may interfere with the palpation of a pulse . Being prepared prior to entering the room will prevent errors.

Life-Stage Context

Older adults and normal temperature ranges.

The normal temperature range in older adults tends to be on the lower end of the normal adult temperature ranges. As we age, our metabolic rate gradually decreases which, in turn, causes a gradual decline in our temperature. When caring for an older adult, a temperature on the high end of normal could indicate a fever, and even a serious infection, since their trends are lower (Hernandes Júnior & Sardeli, 2021).

Monitoring Vital Signs

The frequency at which a nurse should obtain vital signs is determined by the stability of the patient, facility protocols, and healthcare provider orders. Heart rate, respiratory rate, blood pressure, and oxygen saturation may be monitored continuously in critical settings or with patients who are unable to manage their airways or sufficiently perfuse their body. It is important to note that the nurse can use nursing judgment to recheck vital signs at any time despite the frequency noted in the orders. The orders indicate the minimum frequency by which the nurse should take the patient’s vital signs. Any change in the patient’s status such as a new complaint or new assessment finding would prompt the nurse to obtain a set of vital signs. Whenever a nurse feels that the practitioner needs to be updated on the patient’s status, the nurse should obtain a complete set of vital signs to communicate a thorough picture of the patient to the practitioner.

Clinical Judgment Measurement Model

Take action: change in patient status.

A nurse is caring for a gentleman recovering from a total knee replacement, postoperative day 2. The healthcare provider has ordered vital signs every four hours, physical therapy, pain medications, and a resumption of home medications. Since surgery, he has been doing well in physical therapy, and his pain has been controlled with IV ketorolac (Toradol) and oral acetaminophen (Tylenol). He last received ketorolac at 0430. His last set of vital signs were obtained two hours ago at 0400:

Temperature 98.1°F (36.7°C)
Pulse 68 beats per minute
Respiratory rate 16 breaths per minute
Blood pressure 119/58 mm Hg

This morning, he stated that his pain has been getting worse, not better, since his last dose of pain medicine. He also asked for Tylenol for a headache.

After noting the change in the patient’s condition, the nurse needs to take action. Even though it is not time to obtain the ordered vital signs, nursing judgment dictates the need to get another set of them. The vital signs are as follows:

Temperature 99.8°F (37.7°C)
Pulse 84 beats per minute
Respiratory rate 22 breaths per minute
Blood pressure 132/64 mm Hg

After administering the dose of acetaminophen, the nurse contacts the healthcare provider to report the change in the patient’s condition and the updated vital signs.

Postoperatively, vital signs are monitored according to a facility’s protocol, with more frequent vital signs obtained initially after the procedure, which then is progressively spaced out to the unit protocol frequency ( Table 15.4 ). This postoperative protocol is used because of the anesthesia and medication’s effects and the nature of the procedure. Anesthesia and medication may cause respiratory depression and other reactions, among other complications. The procedure itself could have caused bleeding or damage to a body area. More frequently measured vital sign s may show subtle changes, which can then be used to determine the healthcare team’s course of action.

Protocol	Time	Data
Immediately	1015
Every fifteen minutes for the first hour	1030 1045 1100 1115
Every thirty minutes for two hours	1145 1215 1245 1315
Every hour for four hours	1415 1515 1615 1715
Revert to unit protocol’s or healthcare practitioner’s orders

Consider this scenario: A patient has arrived from the operating room after an emergency appendectomy. The unit postoperative vital sign protocol is as follows: Obtain vital signs on arrival to the unit, then every fifteen minutes × one hour, every thirty minutes × two hours, every hour × four hours, every four hours throughout admission. Following is an example of why vital sign monitoring is so important in discovering subtle changes and performing interventions to prevent complications.

Time	Data	Observations/Interventions
1015	HR 67, BP 108/62, O 98, RR 14	Patient sleepy; arrived to unit
1030	HR 72, BP 112/68, O 98, RR 18	Wife at bedside
1045	HR 82, BP 120/74, O 98, RR 20	Patient reporting pain; pain meds given
1100	HR 64, BP 102/58, O 94, RR 12	Patient resting with lower O and RR; order obtained for 2 L O via nasal cannula
1115	HR 66, BP 108/62, O 95, RR 14	Patient resting comfortably
1145	HR 76, BP 112/68, O 95, RR 16	Patient reporting pain; nonpharmacological interventions done
1215	HR 72, BP 110/68, O 95, RR 16	Patient resting comfortably
1245	HR 70, BP 108/64, O 92, RR 14	Patient encouraged to use incentive spirometer/cough and deep breathe
1315	HR 76, BP 112/64, O 92, RR 12	Practitioner made aware of O saturation; nasal cannula increased to 4 L O
1415	HR 74, BP 110/62, O 94, RR 14	Reinforced the importance of incentive spirometer use; raised the head of the bed for better lung expansion
1515	HR 78, BP 112/62, O 96, RR 16	Encouraged continuation of incentive spirometer use; nasal cannula decreased to 2 L O
1615	HR 76, BP 107/62, O 96, RR 16	Encouraged continuation of incentive spirometer use
1715	HR 78, BP 110/68, O 97, RR 16	Encouraged continuation of incentive spirometer use

Through vital sign monitoring, the nurse was able to identify possible postoperative atelectasis (partial collapse of the lung from anesthesia) and begin interventions to halt progress into possible pneumonia .

Different settings and their protocols may also affect the frequency of the vital signs. In intensive care units, which are those units where the patients are in critical condition, even more frequent assessment may be necessary depending on patient condition and medications. In long-term care settings, vital signs are obtained every eight to twelve hours. In home health environments or when individuals are instructed to monitor their vital signs at home, they are typically done once each day and at the same time each day. Doing them at the same time each day helps the individual to make monitoring vital signs a habit. Another reason to do them at the same time each day is to prevent fluctuations due to the individual’s normal routine and time of day. Heart rate would be expected to be lower first thing in the morning and higher as the day progresses.

If there is a change in a patient’s condition, the nurse must obtain another set of vital signs, even if the last set was obtained only one hour prior. Changes in the patient’s condition refer to something experienced by the patient or observed by the nurse or family members—that is, anything that is concerning to any of the parties. The checked vital signs can help to alleviate the patient’s or family’s fears, but they may also provide the data that need to be conveyed to the healthcare provider to determine the next actions.

Validating Data

After the nurse obtains vital signs, it is imperative to compare these against the normal ranges for the patient’s age and the patient’s trends. Generally, if the results fall within both ranges, the vital signs are documented according to protocol. If the results fall outside of the normal ranges or the patient’s trends, the nurse will need to validate them, that is, to repeat the measurement of the vital sign in question. At times, these abnormal results reflect the clinical situation of the patient, but at other times, the abnormalities may be a result of operator or equipment error.

When an abnormal vital sign is obtained, whether outside of the normal ranges or outside of the patient’s trends, the nurse should recheck that vital sign. If the temperature reading is abnormal, the nurse may try another thermometer or use another route. Changing equipment will allow the nurse to ensure that the abnormal reading was not caused by equipment malfunction. If the equipment malfunction is noted, the nurse should report it, take the equipment out of use, notify biomed/tech to check the equipment, and label the equipment as “do not use.”

The nurse may also just have to verify that the steps were completed accurately in obtaining the temperature. For an abnormal blood pressure reading, it may be necessary to recheck on the opposite arm. Automatic and digital vital sign equipment has preset limits for results it is able to provide. For example, some digital thermometers will give an error screen if the result is greater than 105°F (40.5°C). If a patient’s results are outside of these limits, a manual method for obtaining that vital sign will be necessary. Any abnormal results warrant a reassessment of that vital sign. The nurse must also assess the patient for any signs of distress or deterioration. There are times when abnormal results do not indicate an emergency or need for intervention. Vital signs may be abnormally high when the patient is excited, nervous, or has experienced physical activity, such as physical therapy. They also may be lower due to the comforting presence of family or friends.

Documenting Data

After vital signs are obtained and validated, the nurse must document these results. Most healthcare facilities use the electronic health record for patients, but some facilities still use paper flowsheets. Documentation is required to track the patient’s trends and response to treatments and to communicate with the healthcare team. For temperature, the nurse will chart the degrees in Fahrenheit or Celsius (according to agency policy) and the method used to obtain the temperature (i.e., oral, axilla, tympanic). When charting the pulse, the result will be in beats per minute. The nurse will also document the site or method used for the pulse (i.e., radial pulse or continuous pulse oximeter). The respiratory rate will be documented in breaths per minute, and the method of assessment should be noted (i.e., visual or stethoscope). Blood pressure requires two numbers to be documented, the systolic and the diastolic pressures. The nurse will also specify which extremity was used and if the blood pressure was manually or automatically obtained. For an abnormal result, whether the charting system flags the vital sign or not, the action should be documented. For example, the action may be that a medication was administered, that the patient’s position was changed, or that the healthcare provider was alerted.

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Book URL: https://openstax.org/books/clinical-nursing-skills/pages/1-introduction
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Earthly Signs

Moscow diaries, 1917-1922, by marina tsvetaeva , translated from the russian by jamey gambrell.

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Marina Tsvetaeva ranks with Anna Akhmatova, Osip Mandelstam, and Boris Pasternak as one of Russia’s greatest twentieth-century poets. Her suicide at the age of forty-eight was the tragic culmination of a life buffeted by political upheaval. The essays collected in this volume are based on diaries she kept during the turbulent years of the Revolution and Civil War. In them she records conversations of women in the markets, soldiers and peasants on the train traveling from the Crimea to Moscow in October 1917, fighting in the streets of Moscow, a frantic scramble with co-workers to dig frozen potatoes out of a cellar, and poetry readings organized by a newly minted Soviet bohemia. Alone in Moscow with two small children, no income, and a missing husband, Tsvetaeva struggled to feed her daughters (one of whom died of malnutrition in an orphanage), find employment in the Soviet bureaucracy, and keep writing poetry. Her keen and ruthless eye observes with compassion and humor—bringing the social, economic, and cultural chaos of the period to life. These autobiographical writings not only give a vivid eyewitness account of Russian history but provide vital insights into the workings of Tsvetaeva’s unique poetics.

Includes black and white photographs.

Additional Book Information

Series: NYRB Classics ISBN: 9781681371627 Pages: 288 Publication Date: December 5, 2017

Is there prose more intimate, more piercing, more heroic, more astonishing than Tsvetaeva’s? Was the truth of reckless feelings ever so naked? So accelerated? Voicing gut and brow, she is incomparable. Clad in the veil of translation, expert translation, her recklessness commands, her nakedness flames. —Susan Sontag

When it comes to the Russian poetry of the last century, Osip Mandelstam, Anna Akhmatova, and Boris Pasternak are reasonably familiar names, but not Marina Tsvetaeva, who is their equal.... Is she as good as Eliot or Pound, one may ask for the sake of comparison. She is as good as they are, and may have more tricks up her sleeve as a poet.... A marvelous selection from her diaries and essays in an exceptionally fine translation by Jamey Gambrell. They give us a view of the times not very different from that found in Isaac Babel’s stories. Tsvetaeva is an excellent reporter.... Tsvetaeva’s autobiographical writings and her essays are filled with memorable descriptions and beautifully turned out phases.... Gambrell sums up well the difficulties of Tsvetaeva’s work in her concise and extremely perceptive introduction. —Charles Simic, The New York Review of Books

This style of bold, passionate and innovative thought is much in evidence in Earthly Signs , writings by the Russian Modernist poet Marina Tsvetaeva, in this extraordinary translation by Jamey Gambrell. —Carol Muske Dukes, Los Angeles Times Book Review

Jamey Gambrell’s excellently translated edition with its well-researched and informative introduction graciously fulfils Tsvetaeva’s desire to see these pieces of diaristic prose bound in a single volume. —Rachel Polonsky, The Times Literary Supplement

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Vital Signs
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Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood
The four main vital signs routinely monitored by medical professionals and health care providers include the following: Body temperature. Pulse rate. Respiration rate (rate of breathing) Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs.) Vital signs are useful in detecting or ...
Vital Sign Assessment
Vital signs are an objective measurement of the essential physiological functions of a living organism. They have the name "vital" as their measurement and assessment is the critical first step for any clinical evaluation. The first set of clinical examinations is an evaluation of the vital signs of the patient. Triage of patients in an urgent/prompt care or an emergency department is based on ...
Introduction to vital signs: Clinical skills notes
Measuring vital signs is a crucial component in taking care of a client's health. Vital signs help assess the general physical health of a person, provide clues to possible diseases, and help monitor the progress of the client's health status. As a nurse, you will measure and interpret vital signs. Figure 1: Commonly measured vital signs.
Vital Signs Assessment
Press firmly but gently on the arteries using your first or second finger until you feel the beat. Begin counting the pulse by keeping an eye on the clock. Count the pulse for 60 seconds (or for 15 seconds, and then multiply by four to calculate beats per minute). Focus on counting the beats.
Chapter 3: Measuring and Recording the Vital Signs
Measurement and recording of the vital signs. As described in the introduction of this chapter, the measurement and recording of the vital signs is a fundamental skill for nurses working in all clinical areas. The vital signs - blood pressure (BP), pulse or heart rate (HR), temperature (T°), respiratory rate (RR) and blood oxygen saturation ...
- Vital Signs assignment (1)
Vital Signs Assignment - DUE March 18 or 19, 2020. 10 points. Student name: Mariam K. Faculty name: Beth D. Purpose: To aid the student in becoming comfortable initiating a nurse-client relationship, utilize meaningful interview skills and assessing vital signs in clients of all ages.
Vital Sign Assessment Flashcards
Which vital sign measurements of adult patients would require the nurse to immediately notify the health care provider? Correct: 158 pulse rate. 8 respirations. 50/30 blood pressure. Which vital sign measurements are unexpected? Correct: 60 pulse rate for a 1-year-old. 35 respirations for a 6-year-old.
Vital signs quiz Flashcards
The four vital signs are. Temperature pulse respiration blood pressure. Practitioners use the results of vital signs to. Asses pt overall condition. Changes in vital signs can indicate what. Problems in overall health. When are vital signs usually measured. At every visit. What happens to pulse as we age.
Vital Signs Practice for NCLEX Questions Flashcards
Study with Quizlet and memorize flashcards containing terms like 1. A nurse assesses an oral temperature for an adult patient. The patient's temperature is 37.5°C (99.5°F). What term would the nurse use to report this temperature? a. Febrile b. Hypothermia c. Hypertension d. Afebrile, 2. A nurse is assessing the vital signs of patients who presented at the emergency department. Based on the ...
Chapter 3: Vital Signs
In particular, vital signs: + + Can point to the existence of an acute medical problem. Are a means of rapidly quantifying the magnitude of an illness and how well the body is coping with the resultant physiologic stress. Often, the more deranged the vitals, the sicker is the patient.
1.3 Vital Signs
1.3 Vital Signs - Nursing Skills - 2e
Vital Signs: Understanding What the Body Is Telling Us
The vital signs - heart rate, blood pressure, body temperature, respiration rate, and pain - communicate important information about the physiological status of the human body. ... Learners also have the option of earning Course Certificate by submitting all assignments for a grade and purchasing the course for $49. Financial aid is available.
15.3 Vital Signs
Vital signs include the body temperature, pulse, respiratory rate, and blood pressure. Vital signs are gathered during the initial encounter with the patient to establish a baseline and routinely thereafter, according to condition, to assess disease progression or resolution. When vital signs are abnormal, a patient's plan of care is ...
1.3: Vital Signs
Chippewa Valley Technical College via OpenRN. Vital signs are typically obtained prior to performing a physical assessment. Vital signs include temperature recorded in Celsius or Fahrenheit, pulse, respiratory rate, blood pressure, and oxygen saturation using a pulse oximeter. See Figure 1.3.1 1.3. 1 [1] for an image of a nurse obtaining vital ...
4Human Body
The purpose of Assignment 1 - Vital Signs is to introduce students to the core understanding and practice of obtaining vital signs on the human body ASSIGNMENT OBJECTIVES 1. Describe and understand the concepts of vital signs and how to obtain them within the scope of practice of a personal support worker 2. Clearly state and outline the ...
Health Assessment: Vital Signs (Exam 1) Flashcards
1. measuring tape and ruler. 2. supine position if possible. 3. Adjust the resident's foot into a vertical position, place a ruler at the person's heel. 4. Pull the tape alongside the person's body until it extends past the head. 5. Then place the ruler flat across the top of the head. Study with Quizlet and memorize flashcards containing terms ...
Upper Columbia Basin Network Vital Signs Monitoring Plan
NPS Vital Signs Monitoring Program. ..... 31 Table 3.3. UCBN vital signs not selected for monitoring but identified as possible future ... Field crew assignments based on parks and protocols. ..... 85 Table 10.1. Anticipated budget for the UCBN Vital Signs Monitoring Program for the first year of implementation after monitoring plan review and ...
PDF PATIENT INFORMATION SHEET
EMENT: I, the undersigned, authorize payment ofmedical benefi. to be made directly to Devlin & Huberty, P.S. I agree to p. my portion at the time services are rendered. I understand that my visit will be billed to my insurance. I have provided copies of my insurance cards. I understand and agree that (regardless of my insurance status) I am ...
ch. 2 quiz answers Flashcards
Study with Quizlet and memorize flashcards containing terms like The movement of headquarters of the Russian Empire to St. Petersburg allowed that city to become a(n):, Japanese investment in Russia's Far East has been held up by a longstanding dispute over:, Persistently frozen ground is known as: and more.
Earthly Signs
by Marina Tsvetaeva, translated from the Russian by Jamey Gambrell. Marina Tsvetaeva ranks with Anna Akhmatova, Osip Mandelstam, and Boris Pasternak as one of Russia's greatest twentieth-century poets. Her suicide at the age of forty-eight was the tragic culmination of a life buffeted by political upheaval. The essays collected in this volume ...

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Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)

What is body temperature?

About glass thermometers containing mercury

What is the pulse rate?

How to check your pulse

What is the respiration rate?

What is blood pressure?

Why should I monitor my blood pressure at home?

What special equipment is needed to measure blood pressure?

About the aneroid monitor

About the digital monitor

About finger and wrist blood pressure monitors

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Vital Signs Assessment

What are Vital Signs?

Temperature

Blood pressure

Why do we check vital signs?

How to check the pulse

Respiratory rate or respirations

Hypertension

Categories of blood pressure

How to check blood pressure

Manual blood pressure measurement (palpatory method)

Nursing pearls for blood pressure measurement

Digital blood pressure measurement

How to assess pain?

P=Provocative

Q = Quality/Quantity

R = Region/Radiation

S = Severity Scale

Nursing pearls for Pain documentation

Oxygen Saturation

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Chapter 3: Measuring and Recording the Vital Signs

Learning objectives for this chapter

Important note

Measurement and recording of the vital signs

Measurement of blood pressure

Measurement of pulse or heart rate

Measurement of temperature

Measurement of respiratory rate

Measurement of blood oxygen saturation

Measurement of height, weight and body mass index (BMI)

Measurement of pain

Recording the vital signs

Interpreting the vital signs

Reference list

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Chapter 3: Vital Signs

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1.3 Vital Signs

Temperature

Oral Temperature

Tympanic Temperature

Axillary Temperature

Rectal Temperature

Temporal Temperature

Pulse Characteristics

Pulse Rhythm

Pulse Force

Pulse Equality

Radial Pulse

Carotid Pulse

Brachial Pulse