Vital Signs and Measurements

Objectives
37-1 Recognize common terminology and abbreviations used in
documenting and discussing vital signs.
37-2 Describe the instruments used to measure vital signs and
body measurements.
37-3 Explain the procedure used to measure vital signs and body
measurements.
37-4 Demonstrate the procedures for measuring vital signs and
body measurements.
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Introduction
 Vital Signs
 Temperature
 Pulse
 Respirations
 Blood Pressure

Vital signs are used to evaluate health problems, therefore,

accuracy is essential.
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Vital Signs

Temperature Pulse Respirations Blood Pressure

3
Temperature
 Determines febrile
versus afebrile states Tympanic Oral
 Measured in degrees
Fahrenheit (ºF) or
Celsius (centigrade; Temperature
ºC) Routes
 Four locations can be
used to measure
temperatures Rectal Axillary

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Temperature (cont.)

 A thermometer is used to obtain

temperature measurements.
 Types of thermometers include:
 Electronic Digital
 Tympanic
 Disposable

Disposable sheaths are used to prevent cross-contamination.

5
Temperature (cont.)

Route Normal Range Sites

ºF / ºC
Oral 98.6 ºF / 37.0 ºC mouth

Tympanic 99.6 ºF / 37.6 ºC ear

Rectal 99.6 ºF / 37.6 ºC rectum

Axillary 97.6 ºF / 36.6 ºC Axilla (armpit)

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Taking Temperatures
 Tympanic
Temperatures
 Pull ear up and back for
adults, then insert
thermometer
 Pull ear down and back for
children
 Fast, easy to use, and
preferred in pediatric
offices 7
Taking Temperatures (cont.)
 Oral
Temperatures
 Must wait at least 15
minutes if patient has
been eating, drinking
or smoking
 Thermometer is placed
under tongue in either
pocket just off-center
in lower jaw
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Taking Temperatures (cont.)
 Rectal Temperatures
 Gloves are donned
 Patient is positioned on side (left side
preferred) or stomach
 Lubricated tip of thermometer is slowly
and gently inserted into anus ½ inch for
infants and 1 inch for adults
 Hold thermometer in place while
temperature is taken
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Taking Temperatures (cont.)
 Axillary Temperatures
 Place patient in seated or lying position
 Tip of thermometer is placed in middle of
axilla with shaft facing forward
 Patient’s upper arm is pressed against
side and lower arm should be crossed
over stomach to hold thermometer in
place

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Pulse and Respiration

Circulatory Respiratory

Pulse and respirations are related since heart and

lung functioning work together. Normally, increases
or decreases with one causes the same effect on the
other.
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Pulse
 An indirect gauge of cardiovascular functioning
Is measured using fingers not your thumb since



the thumb has a pulse of its own
 The radial artery is the common pulse site to
locate in adults, and the brachial artery is used
in young children.
 A stethoscope is used to listen to the apical
pulse.
 Electronic devices are also used to measure
pulse rates.
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Taking Pulse Rates
 Press lightly with your index
and middle finger pads at the
pulse site to locate the pulse.
 Count the number of beats
you feel against your fingers in
one minute.
 If the pulse rate is regular your
office policy may be to count
the number of beats for 30
seconds and multiply this
number by 2 to obtain the
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beats per minute.
Taking Pulse Rates (cont.)

Regular Pulse Rhythm Irregular Pulse Rhythm

 Count for 30 seconds  Count for one full minute

then multiply by 2 (i.e. rate  May also use stethoscope
of 35 beats in 30 seconds to listen for apical pulse
equals a pulse rate of 70 located in the 5th intercostal
beats/minute). space and count for a full
minute.
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Respiration
 Respiratory rate is an indication of how well
the body is providing oxygen to the tissues.
 One respiration consists of both inhaling and
exhaling air also referred to as breathing in and
breathing out.
 Respiratory rates are higher in infants and
children than in adults.

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Normal Respiration Rates
(26-40)
40
35 (20-30)
30
(18-24) (16-24) (12-24)
25
(12-20)
20
15
10
5
0
0-1 yrs 1-6 yrs 6-11 yrs 11-16 yrs ADULT ELDERLY

NOTE: Ranges reflect breaths per minute 16

Taking Respirations
 Most reliable method for measuring
respirations is with a stethoscope to count the
number of breaths heard per minute.
 Other methods include:
 Look, listen and feel for movement of air
by placing your hand over the patient’s
chest, shoulders or abdomen.
NOTE: If patients are aware that you are counting their
respirations they may unintentionally alter their breathing 17
Respiration

Apnea Temporary absence of breathing

Rapid breathing Tachypnea

Dyspnea Difficult or painful breathing

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Blood Pressure
 The force at which blood is pumped against
the walls of the arteries yields blood pressure.
 Two pressure measurements are obtained with
blood pressure readings:
 Systolic pressure (measurement of pressure
during contraction of left ventricle) is the top
number.
 Diastolic pressure (measurement of minimal
amount of pressure against vessel walls at all
times) is the bottom number.
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Blood Pressure (cont.)

120/80
Systolic Pressure Diastolic Pressure
• Left ventricle of • Heart is at rest
heart is contracting • Bottom or second
• Top or first number number
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Blood Pressure (cont.)
Hypertension  High blood pressure
readings
 Major contributor to heart
attacks and strokes
 Physicians often request a
re-check of patient’s blood
pressure within two months
or less when readings are
elevated 21
Blood Pressure (cont.)
 Low blood pressure reading
 Is generally not a chronic
health problem and may be
normal for some patients
 Severe low blood pressure
readings occur with:
 Shock
 Heart failure
 Severe burns
Hypotension  Excessive bleeding
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Blood Pressure Equipment
 A sphygmomanometer is the
instrument used to measure blood
pressures consisting of a cuff, pressure
bulb, and manometer.
 Three types of sphygmomanometers:
 Mercury
 Aneroid
 Electronic
23
Blood Pressure Equipment (cont.)
 Mercury Sphygmomanometers
 Consists of a column of mercury that rises
to reflect increased pressure as the cuff is
inflated
 Very accurate, yet mercury has an ill
effect on the environment, so these are no
longer manufactured
 Require calibration every 6 to 12 months
 When properly calibrated the column of
mercury will rest on “zero” when viewed
at eye level
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Blood Pressure Equipment (cont.)
 Aneroid
Sphygmomanometers
 Consists of a circular gauge with
needle dial that measures pressure
 Each line on the circular dial
represents 2 mmHg
 Considered to be very accurate
 Must be checked, serviced, and
calibrated every 3 to 6 months
 When properly calibrated, the
needle on the dial rests within the
small square at the bottom of the
dial.
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Blood Pressure Equipment (cont.)
 Electronic
Sphygmomanometers
 Provides a digital readout of
the blood pressure on a lit
display
 Unlike mercury and aneroid
devices, no stethoscope is
needed
 Considered to be the least
accurate, yet are easy to use 26
Stethoscope Earpieces

 Amplifies body Binaurals

sounds
 Consists of
earpieces, Rubber or plastic
binaurals, tubing tubing

and a chestpiece Bell

(bell and Chestpiece

diaphragm) Diaphragm

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Stethoscope (cont.)
 Bell  Diaphragm
 Cone-shaped side of  Larger flat side of the
chestpiece chestpiece
 Amplifies low-  Amplifies high-pitched
pitched sounds such sounds like bowel and
as heart sounds lung sounds
 Must be held lightly  Must be held firmly
against skin for proper
against skin for
amplification
proper amplification

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Measuring Blood Pressure
 The cuff must be placed on the upper arm above the
brachial pulse site.
 Palpate the brachial pulse then place stethoscope
over this site.
 Inflate cuff about 30 mmHg above palpatory result
or approximately 180 mmHg to 200 mmHg.
 Release the air in cuff and listen for the first
heartbeat (systolic pressure) and the softest or last
heartbeat (diastolic pressure).
 Record results with systolic being top number and
diastolic being bottom number (i.e. 120/76).
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Measuring Blood Pressure (cont.)
 Wait 15 minutes before taking readings if patient has
been engaged in strenuous exercise or has
ambulatory disabilities.
 Be sure cuff is properly fitted and placed on the
extremity or inaccurate readings may result.
 DO NOT TAKE BP’s IN AN EXTREMITY IF:
 Injury or blocked artery is present
 History of mastectomy on that side
 Implanted device is under the skin

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End of Chapter

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