Brigham and Women's Hospital

Clinical Research Coordinator

Skills Program

Vital Signs

Brigham and Women's Hospital

This Skill Requires

• Provider direction

• Standard Precautions

• Using purell before and after contact with

the patient or the patient’s environment

• Two patient identifiers

• An explanation of procedure to the patient

• Patient Privacy

Brigham and Women's Hospital

Vital Signs

• Temperature (T)

• Pulse (P)

• Respiration (R)

• Blood Pressure (B/P)

Brigham and Women's Hospital

Temperature

• Measurement of body heat

• Normal range: 96°F to 100°F

• Varies in different parts of the body

• Inform provider when temperature is >100°F

• Thermometer is the instrument used to measure temperature

– Oral/axillary thermometer thermometer

Brigham and Women's Hospital

Oral or Axillary Temperature

• Placement/route

• Oral (po): under the tongue, on the side of the mouth

• Axillary (ax): in the center of the armpit against the skin

• Hold thermometer in place until it sounds “beep”

• Remove and read display

• Document on appropriate form

Brigham and Women's Hospital

Helpful Hints

• Do not take an oral temperature if patient:

– has just had a hot or cold drink (wait 10

minutes)

– has an injured mouth or nose

– has a mask over his/her face

– is confused or uncooperative

Brigham and Women's Hospital

Pulse

• Measurement of heart rate

• Normal adult range: 60 to 100 beats per

minute (higher in infant or child)

• Note the rhythm

• Regular: beats follow one after another in the

same pattern

• Irregular: extra time or less time between beats

Brigham and Women's Hospital

Counting the Pulse: Radial Artery

• Locate the radial artery (most common) in the inner aspect of the wrist on the thumb side

• Feel for the pulse by placing the second and third fingers on the radial artery

• Count the number of beats for one full minute, or count for 30 seconds and multiply by two (if pulse is irregular, count for a full minute)

• Record

Brigham and Women's Hospital

Respiration

• Measurement of the rise and fall of the

chest/abdomen

• Normal adult range: 12 to 24 breaths per

minute (higher in infant or child)

• Note the pattern

• Regular: even amount of time between breaths

• Irregular: slow or fast

Brigham and Women's Hospital

Respiration

• Methods

• Observe or place your hand on patient’s chest

to see or feel the patient’s chest rise and fall

• One rise (inspiration) and one fall (expiration)

is counted as one respiration

• Count for a full minute

• Record

Brigham and Women's Hospital

Respiration

• Patient with dyspnea (difficulty breathing)

• Signs and symptoms

• May state that he/she is having trouble breathing

• Breathing is irregular, fast, or slow

• May have cyanosis (blue color) around the mouth, lips, skin or fingernails

• May be restless, disoriented, or confused

• Can be life-threatening

• Always notify the provider

Brigham and Women's Hospital

Blood Pressure (BP)

• Measurement of blood pressing or pushing

against the walls of the artery

• Measures two different values

• Systolic number (upper number): pressure in

the heart and blood vessels as the heart

contracts and blood is pumped into the aorta

• Diastolic number (lower number): pressure as

the heart relaxes and fills with blood

Brigham and Women's Hospital

Brigham and Women's Hospital

Brigham and Women's Hospital

Blood Pressure (BP)

• Normal adult range: 90/60 to 140/90

• Two methods to measure blood pressure

non-invasively

– Sphygmomanometer

– Automated monitor

Brigham and Women's Hospital

Sphygmomanometer

• Blood pressure cuff

attached to a gauge

• Bulb to inflate cuff

• Use with a stethoscope

Brigham and Women's Hospital

Blood Pressure Cuffs

• Cuffs come in different sizes

• Accurate blood pressure measurement

requires correct cuff size to fit the patient’s

arm

• Do not use B/P cuff on an arm with any

injury, surgery, weakness, swelling or

intravenous (IV) line

Brigham and Women's Hospital

Blood Pressure via

Sphygmomanometer• Wrap the cuff around the

patient’s arm above the elbow with the arrow over the brachial pulse

• Feel for the brachial pulse with your fingers (antecubital space located at the bend in the elbow on the small finger side of the arm)

• Review chart for previous BP readings and go 20 points higher

Brigham and Women's Hospital

Blood Pressure via

Sphygmomanometer

• Once inflated, control the screw with your thumb and index fingers

• Open the screw SLOWLY to deflate the cuff with your thumb and index fingers

• Listen and note the number on the dial or column of the first strong beat (systolic)

• Then listen and note the last strong beat (diastolic)

Brigham and Women's Hospital

Blood Pressure via

Sphygmomanometer

• When no more sound is

heard, open the screw to

completely deflate the cuff

• Record the systolic and

diastolic pressures

Brigham and Women's Hospital

Blood Pressure via

Sphygmomanometer: Helpful Hints• Wipe the earpieces of the stethoscope with an alcohol wipe

before putting them in your ears (less often if it’s a personal stethoscope)

• Turn the tips of the earpieces so that they point toward the tip of your nose (hear the sounds more clearly)

• Always read the gauge at eye level

• Never leave an inflated cuff on a patient more than a few minutes (prevents blood from circulating to the lower arm)

• Always deflate the cuff completely after taking the blood pressure

• Do not try to get a measurement more than 2 times on the same arm (try the other arm)

Brigham and Women's Hospital

Conclusion

• Taking and recording Vital signs in a

careful and accurate manner provides

important information about the patient’s

overall condition

• Questions?