1. Chapter 19
Vital Signs

2. Vital Signs
Vital Signs are measurements reflecting the patient’s physical well-being and condition.
Vital Signs include the following:
Pulse
Respiration
Blood pressure
Temperature

3. When do we take vital signs?
Upon admission
When ordered by MD or outlined in plan of care
Any time there is a change in the patient’s condition or c/o pain
Patient falls or incident occurs
Monitoring the patient’s response to a new medication
At check up or physical examination

4. What could affect vital signs?
Caffeine
Medications
Emotions
Exercise
Age

5. Temperature
Body temperature is the measurement of the amount of heat in the body
Measured in Fahrenheit or Celsius
Normal body temperature is 98.6ºF or 37ºC
Variations in temperature are caused by individual differences, time of day, part of body

6. Four Ways to Take Temperature
Glass thermometer
Battery-operated electronic thermometer
Other electronic thermometers (ear, forehead)
Chemically treated plastic/paper thermometer

7. Oral Temperature (O) Measured in the mouth
Most common, comfortable and convenient method
May be inaccurate if the patient has had anything to eat or drink

8. Axillary Temperature (A)
Temperature measured under the armpit
Less accurate reading because measures external temperature
Record an A by the reading

9. Rectal Temperature Measured in the rectum
Most accurate because it is an internal temperature
Use red rectal thermometer
Record R by reading

10. Pulse
Pulse is the rhythmic expansion and contraction of the arteries caused by the beating of the heart; the expansion and contraction show how fast, how regular, and with what force the heart is beating.

11. Normal Pulse Rates (per minute)
Before birth/birth
4 weeks to 1 year
Childhood years
Adult years

12. Terms Rate: the number of pulse beats per minute
Rhythm: used to describe the regularity of the pulse beats
Force: strength or power; used to describe the beat of the pulse
Bradycardia: heart rate below 60
Tachycardia: heart rate over 100

13. Pulse Points Carotid Apical Brachial Radial Femoral Popliteal
Dorsalis pedis/posterior tibial

14. Radial Pulse Pulse at the wrist
Patient’s arm should be well supported and resting comfortably.
Find the pulse by placing the tips of your first three fingers on the palm side of the patient’s wrist in a line with the thumb, next to wrist bone.
If you press too hard, you will stop the flow of blood and not feel the pulse.
Never use your thumb
Note the rhythm and force

15. Radial Pulse
Look at the position of the second hand on your watch. Start counting the pulse beats that you feel until the second hand comes back to the same number on the clock.

16. Apical Pulse
Apical pulse is a measurement of the heartbeats at the apex of the heart, located just under the left breast.
Uncover the patient’s chest
Place the diaphragm of the stethoscope under the left breast. Listen for the heart sounds.
Count the heart sounds for a full minute.

17. finishing up Report to immediate supervisor the following:
The pulse rate
If the pulse was regular or not
Report anything unusual.

18. Apical Pulse Deficit
The difference between the apical and radial pulse
The heart is contracting but the pulse is not reaching the extremities. (A-Fib)
Best obtained by having 2 people count the radial and apical pulses at the same time.