1. Observing & Measuring Vital Signs
NATCEP Day Twenty-Five through Twenty-Seven

2. Why measure Vital Signs
• Means of getting information about
the body’s condition
• Vital signs include
– Temperature
– Pulse
– Respirations
– Blood Pressure

3. Objectives: Temperature
• Identify
– Cause of body temperature
– “Normal” range or average body temperature
• List situations that may cause the thermometer
reading to vary from “normal or average”
• Identify types of thermometers and situations in
which they are used
• Demonstrate how to care for thermometers
• Describe each method of checking temperature

4. Temperature is. . . . .
• A measurement of the amount of heat
in the body, a balance between heat
created and lost
• Created as the body changes food to
energy
• Lost from the body to the environment
by contact, perspiration, breathing and
other means

5. Normal Ranges (Fahrenheit)
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Oral: 97.5 – 99.5
Rectal: 98.5 – 100.5
Axillary: 96.6 – 98.6
Tympanic: 96.4 – 100
Temporal: 99.6
Baseline: range varies from person to
person
• Peak: 6pm; Low: 6am
• Normal decreases with age

6. Variations High & Low: Causes
• Higher than normal
– Eating warm food
– Time of day
– Infection
– Disease
• Lower than normal
– Eating cold food
– Time of day
– Dry mouth
– Disease processes

7. Types of Thermometers
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Electronic
Digital
Chemically treated paper
Tympanic: eardrum/ear
Temporal: temporal artery/forehead

8. Care of Thermometers
• Probe Covers
• Follow Manufacturer’s Instructions
– Electronic or Digital
– Tympanic
– Temporal

9. Taking an Oral Temperature
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Most common temperature
Under tongue
Mouth and lips closed
Beeping indicates done
Electronic/Digital

10. Taking an Axillary Temperature
• Least accurate
– Safety prohibits other sites
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Under the arm
Tip placed in center of underarm
Arm should hold in place
Beeping indicates done
Electronic/Digital

11. Taking an Tympanic Temperature
• Open ear canal by gently lifting the ear
up and back
• Gently insert tip inside ear canal
• Beeping indicates done

12. Taking an Temporal Temperature
• Follow manufacturer’s instructions
– Typical moved from center of forehead to
temporal artery site
• Beeping indicates done

13. Taking a Rectal Temperature
• Infants
• Children & Adults
– Used when other methods unavailable or
inaccurate
• Lubricate and insert about 1 inch with
resident on their side – hold in place
• Beeping indicates done
• Electronic/Digital

14. Recording Temperature
• Use “ax” to indicate axillary
• Use “r” to indicate rectal
• Notify nurse
– Above or below normal range
– Difficulty obtaining temperature

15. Practice
• Follow my instructions to practice on
your peers

16. Objectives: Pulse
• State the “normal” or average pulse
rate
• Identify variations from the “normal”
pulse that should be reported
• Demonstrate the accurate taking of a
radial pulse
• Discuss how to record and report pulse
measurements

17. Pulse
• A measurement of the number of
times the heart beats per minute
• Normal/average
– 60-100 minute (adult)
– Regular in rate, rhythm, strength/force

18. Variations in Pulse: Force
• Abnormal force can be distinguished by
– Bounding pulse
• Cannot be occluded (blocked) by mild
pressure
– Feeble, weak and thready
• Occluded (blocked) by slight pressure
• Thready: usually fast

19. Variations in Pulse: Rate
• Abnormal rate distinguished by
– Rate under 60 per minute: Bradycardia
– Rate over 100 per minute: Tachycardia
• Can be caused by
– Exercise/activity
– Fever

20. Variations in Pulse: Rhythm
• Abnormal rhythm distinguished by
– Irregularity of beats
– Feeling that beats are “skipped” when
pulse counted for one full minute

21. Sites for Checking Pulse
• Apical
• Radial

22. Report
• Pulse varies from “normals”
• Difficulty obtaining pulse

23. Practice
• Follow my instructions to practice on
your peers
– Apical pulse
– Radial pulse

24. Objectives: Respirations
• State the average respiratory rate
• Describe how to measure respiratory
rate
• Describe variations of respirations
• Discuss how to record and report the
respiratory rate measurement

25. Respirations
• Inspiration and expiration of air
• Average rate is 12-20 per minute (adult)

26. How to Count Respirations
• Look at chest or abdomen
• Count for one full minute

27. Variations
• Rate
– Increased by
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Exercise/activity
Fever
Lung Disease
Heart Disease
– Report fewer than 12 or more than 20
breaths per minute

28. Variations
• Character
– Labored
• Difficulty breathing
– Noisy
• Sounds of obstruction or wheezing
– Shallow
• Small amounts of air exchange
– Irregular

29. Report
• Record in the appropriate area of the
worksheet per facility policy
• Variations from “normals” immediately

30. Practice
• Follow my instructions to practice on
your peers

31. Objectives: Blood Pressure
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Describe blood pressure (BP)
State the “normal” or average BP
Describe variations in BP
Identify instruments to check BP
Demonstrate correct procedure for
obtaining a BP
• Identify how to record and report BP
measurements

32. Blood Pressure
• Force of blood against artery walls
• Amount of pressure depends on
– Rate & strength of heart beat
– Ease with which blood flows through the
blood vessels
– Amount of blood within the system

33. Terms
• Systolic Pressure
– Force when the heart is contracted
– Top number of the BP
– First sound when measuring
• Diastolic Pressure
– Force when the heart is relaxed
– Lower number of the BP
– Level at which pulse sound change or
cease

34. Normal
• Adult is less than 120/80
– Less than 120 systolic
– Less than 80 diastolic

35. Variations
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May slightly increase with age
Hypertension: Higher than normal
Hypotension: Lower than normal
Postural Hypotension (Orthostatic)
– Elderly person’s body & blood pressure
unable to rapidly adjust when changing
positions = dizziness or feeling faint

36. Tools/Instruments
• Sphygmomanometer
– Cuff and gauge
• Cuff
– Correct size for the resident’s arm
– Placed correctly over the brachial artery
– Applied correctly
• Gauge: can be Aneroid: Dial or
Electronic: Digital
• Column of mercury
• Stethoscope

37. Tools/Instruments
• Stethoscope

38. Factors that Influence Reading
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Proper clothing
Avoid smoking
Empty bladder
Allow time to rest & relax
Position body correctly

39. Body Position
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Arm supported at heart level
Back supported
Feet flat on floor
No talking or movement

40. Cautions
• DO NOT TAKE in arm with:
– IV
– Cast
– Dialysis Shunt
– Breast surgery on that side

41. Report
• Higher or lower than his/her usual
range
• Difficulty obtaining

42. Blood Pressure – An Overview
CAUSE
SYSTOLIC BP
CORRECTIVE ACTION
Sit without back support
+ 6 to 10
Support back (sit in chair)
Full bladder
+ 15
Empty bladder before BP taken
Tobacco/caffeine use
+ 6 to 11
Don’t use before clinic appointment
BP taken when arm is:
Parallel to body
Unsupported
Elbow too high
Elbow too low
+ 9 to 13
+ 1 to 7
+5
False low
While seated in chair, patient’s arm
must be straight out and supported,
with elbow at heart level
“White coat” reaction
+ 11 to 28
Have someone else take the BP
Talking or hand gestures
+7
No talking or use of hands during BP
Cuff too narrow/small
+ 8 to 10
Cuff too wide/large
False low
Cuff not centered
+4
Cuff over clothing
+ 5 to 50
Right-sized cuff properly placed over
bare upper arm
(Pickering et al., 2005; Perry & Potter,

43. Practice
• Follow my instructions to practice on
your peers