{"id":1004,"date":"2015-03-07T03:30:15","date_gmt":"2015-03-07T03:30:15","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=1004"},"modified":"2021-05-20T19:36:41","modified_gmt":"2021-05-20T19:36:41","slug":"vital-signs","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/vital-signs\/","title":{"raw":"2.3 Vital Signs","rendered":"2.3 Vital Signs"},"content":{"raw":"Temperature, pulse, respiration, blood pressure (BP),\u00a0and\u00a0oxygen saturation, are measurements that\u00a0indicate a person's hemodynamic status.\u00a0These\u00a0are the five vital signs most frequently\u00a0obtained by health care practitioners (Perry, Potter, & Ostendorf, 2014).\u00a0Vital signs will\u00a0potentially\u00a0reveal sudden changes in a patient's condition and will also measure\u00a0changes that occur progressively over time. A difference between patients' normal baseline vital signs\u00a0and their present vital signs may indicate the need for intervention\u00a0(Perry et al., 2014). Checklist 15\u00a0outlines the steps to take when checking vital signs.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 15: Vital Signs<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Temperature:\r\n\r\n\"DSC_2218\"<\/a><\/td>\r\nNormal (oral) = 35.8\u00baC to 37.3\u00baC\r\n\r\nOral temperature:\u00a0Place the thermometer in the mouth under the tongue and instruct patient to keep mouth closed. Leave the thermometer in place for as long as is indicated by the device manufacturer.\r\n\r\nAxillary temperature:\u00a0Usually 1\u00baC lower than oral temperature. Place the thermometer in patient's armpit and leave it in place for as long as is indicated by the device manufacturer.\r\n\r\nTympanic membrane (ear) temperature: Usually 0.3\u00b0C to 0.6\u00b0C higher than an oral temperature. The tympanic membrane shares the same vascular artery that perfuses the hypothalamus. Do not force the thermometer into the ear and do not occlude the ear canal.\r\n\r\nRectal temperature:\u00a0Usually\u00a01\u00baC higher than oral temperature. Use only when other routes are not available.<\/td>\r\n<\/tr>\r\n
2. Pulse:\r\n\r\nNormal resting heart rate = 60 to 100 beats per minute\r\n\r\n[caption id=\"attachment_6781\" align=\"aligncenter\" width=\"150\"]\"Radial<\/a> Radial pulse[\/caption]\r\n\r\n[caption id=\"attachment_6778\" align=\"aligncenter\" width=\"150\"]\"Apical<\/a> Apical pulse[\/caption]<\/td>\r\nRadial pulse:\u00a0Use the pads of your first three fingers to gently palpate the radial pulse at the inner lateral wrist.\r\n\r\nApical pulse:\u00a0Taken as part of a focused cardiovascular assessment and when the pulse rate is irregular. Apical heart rate should be used as the parameter indicated in certain cardiac medications (e.g., digoxin). Apical pulse rate should be taken for a full minute for accuracy, and is located at the fifth intercostal space in line with the middle of the clavicle in adults.\r\n\r\nCarotid pulse:\u00a0May be taken when radial pulse is not present or is difficult to palpate.<\/td>\r\n<\/tr>\r\n
3. Respiration rate:\r\n\r\nNormal resting respiratory rate = 10 to 20 breaths per minute\r\n\r\n[caption id=\"attachment_6410\" align=\"aligncenter\" width=\"150\"]\"DSC_2220\"<\/a> Respiratory rate[\/caption]<\/td>\r\nCount respiratory rate unobtrusively while you are taking the pulse rate so that the patient is not aware that you are taking the respiration rate. Count for 30 seconds or for a full minute if irregular.<\/td>\r\n<\/tr>\r\n
4. Blood pressure (BP):\r\n\r\n[caption id=\"attachment_6407\" align=\"aligncenter\" width=\"150\"]\"DSC_2215\"<\/a> Blood pressure cuff[\/caption]\r\n\r\nThe average BP for an adult is 120\/80 mmHg, but variations are normal for various reasons.<\/td>\r\nThe systolic pressure\u00a0is the maximum pressure on the arteries during left ventricular contraction.\r\n\r\nThe diastolic pressure\u00a0is the resting pressure on the arteries between each cardiac contraction.\r\n\r\nThe patient may be sitting or lying down with the bare arm at heart level. Palpate the brachial artery just above the antecubital fossa medially.\u00a0Wrap\u00a0the BP cuff around the upper arm about 2.5 cm above the brachial artery.\r\n\r\nPalpate the radial or brachial artery, and inflate the BP cuff until the pulse rate is no longer felt. Then inflate 20 to 30 mmHg more.\r\n\r\nPlace the bell of the stethoscope over the brachial artery, and deflate the cuff slowly and evenly, noting the points at which you hear the first appearance of sound (systolic BP), and the disappearance of sound (diastolic BP).<\/td>\r\n<\/tr>\r\n
5. Oxygen saturation (SpO2<\/sub>):\r\n\r\nA healthy patient will have an SpO2\u00a0<\/sub>of\u00a0\u2265 97%.\r\n\r\n[caption id=\"attachment_6406\" align=\"aligncenter\" width=\"150\"]\"DSC_2214\"<\/a> Pulse oximeter sensor[\/caption]<\/td>\r\nA pulse oximeter sensor attached to the patient's finger or earlobe measures light absorption of hemoglobin and represents arterial SpO2<\/sub>.<\/td>\r\n<\/tr>\r\n
Data source:\u00a0Jarvis et al., 2014; Stephen, Skillen, Day, & Jensen, 2012<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n

Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n

\r\n
    \r\n \t
  1. Which type of thermometer is the best\u00a0example of a non-invasive, safe, and efficient tool for measuring temperature?<\/li>\r\n \t
  2. A 40-year-old male patient has a blood pressure of 140\/100 mmHg.\u00a0Is this\u00a0normal for this patient? What additional data would you need to collect before making a decision about care for this patient?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"

    Temperature, pulse, respiration, blood pressure (BP),\u00a0and\u00a0oxygen saturation, are measurements that\u00a0indicate a person’s hemodynamic status.\u00a0These\u00a0are the five vital signs most frequently\u00a0obtained by health care practitioners (Perry, Potter, & Ostendorf, 2014).\u00a0Vital signs will\u00a0potentially\u00a0reveal sudden changes in a patient’s condition and will also measure\u00a0changes that occur progressively over time. A difference between patients’ normal baseline vital signs\u00a0and their present vital signs may indicate the need for intervention\u00a0(Perry et al., 2014). Checklist 15\u00a0outlines the steps to take when checking vital signs.<\/p>\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 15: Vital Signs<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/h5>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Temperature:<\/p>\n

    \"DSC_2218\"<\/a><\/td>\n

    		Normal (oral) = 35.8\u00baC to 37.3\u00baC<\/p>\n

    Oral temperature:\u00a0Place the thermometer in the mouth under the tongue and instruct patient to keep mouth closed. Leave the thermometer in place for as long as is indicated by the device manufacturer.<\/p>\n

    Axillary temperature:\u00a0Usually 1\u00baC lower than oral temperature. Place the thermometer in patient’s armpit and leave it in place for as long as is indicated by the device manufacturer.<\/p>\n

    Tympanic membrane (ear) temperature: Usually 0.3\u00b0C to 0.6\u00b0C higher than an oral temperature. The tympanic membrane shares the same vascular artery that perfuses the hypothalamus. Do not force the thermometer into the ear and do not occlude the ear canal.<\/p>\n

    Rectal temperature:\u00a0Usually\u00a01\u00baC higher than oral temperature. Use only when other routes are not available.<\/td>\n<\/tr>\n

    2. Pulse:<\/p>\n

    Normal resting heart rate = 60 to 100 beats per minute<\/p>\n

    \"Radial<\/a>
    Radial pulse<\/figcaption><\/figure>\n
    \"Apical<\/a>
    Apical pulse<\/figcaption><\/figure>\n<\/td>\n
    		Radial pulse:\u00a0Use the pads of your first three fingers to gently palpate the radial pulse at the inner lateral wrist.<\/p>\n

    Apical pulse:\u00a0Taken as part of a focused cardiovascular assessment and when the pulse rate is irregular. Apical heart rate should be used as the parameter indicated in certain cardiac medications (e.g., digoxin). Apical pulse rate should be taken for a full minute for accuracy, and is located at the fifth intercostal space in line with the middle of the clavicle in adults.<\/p>\n

    Carotid pulse:\u00a0May be taken when radial pulse is not present or is difficult to palpate.<\/td>\n<\/tr>\n

    3. Respiration rate:<\/p>\n

    Normal resting respiratory rate = 10 to 20 breaths per minute<\/p>\n

    \"DSC_2220\"<\/a>
    Respiratory rate<\/figcaption><\/figure>\n<\/td>\n
    		Count respiratory rate unobtrusively while you are taking the pulse rate so that the patient is not aware that you are taking the respiration rate. Count for 30 seconds or for a full minute if irregular.<\/td>\n<\/tr>\n
    4. Blood pressure (BP):<\/p>\n
    \"DSC_2215\"<\/a>
    Blood pressure cuff<\/figcaption><\/figure>\n

    The average BP for an adult is 120\/80 mmHg, but variations are normal for various reasons.<\/td>\n

    		The systolic pressure\u00a0is the maximum pressure on the arteries during left ventricular contraction.<\/p>\n

    The diastolic pressure\u00a0is the resting pressure on the arteries between each cardiac contraction.<\/p>\n

    The patient may be sitting or lying down with the bare arm at heart level. Palpate the brachial artery just above the antecubital fossa medially.\u00a0Wrap\u00a0the BP cuff around the upper arm about 2.5 cm above the brachial artery.<\/p>\n

    Palpate the radial or brachial artery, and inflate the BP cuff until the pulse rate is no longer felt. Then inflate 20 to 30 mmHg more.<\/p>\n

    Place the bell of the stethoscope over the brachial artery, and deflate the cuff slowly and evenly, noting the points at which you hear the first appearance of sound (systolic BP), and the disappearance of sound (diastolic BP).<\/td>\n<\/tr>\n

    5. Oxygen saturation (SpO2<\/sub>):<\/p>\n

    A healthy patient will have an SpO2\u00a0<\/sub>of\u00a0\u2265 97%.<\/p>\n

    \"DSC_2214\"<\/a>
    Pulse oximeter sensor<\/figcaption><\/figure>\n<\/td>\n
    		A pulse oximeter sensor attached to the patient’s finger or earlobe measures light absorption of hemoglobin and represents arterial SpO2<\/sub>.<\/td>\n<\/tr>\n
    Data source:\u00a0Jarvis et al., 2014; Stephen, Skillen, Day, & Jensen, 2012<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n
    \n

    Critical Thinking Exercises<\/p>\n<\/header>\n

    \n
      \n
    1. Which type of thermometer is the best\u00a0example of a non-invasive, safe, and efficient tool for measuring temperature?<\/li>\n
    2. A 40-year-old male patient has a blood pressure of 140\/100 mmHg.\u00a0Is this\u00a0normal for this patient? What additional data would you need to collect before making a decision about care for this patient?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1004","chapter","type-chapter","status-publish","hentry"],"part":253,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1004","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":27,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1004\/revisions"}],"predecessor-version":[{"id":10111,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1004\/revisions\/10111"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/253"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/1004\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=1004"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=1004"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=1004"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=1004"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}