Vital Signs and Measurements

Overview:

Vital signs are foundational assessments used to evaluate a person’s general physical health. They include temperature, pulse, respirations, and blood pressure. These measurements vary with age, weight, gender, and overall health.

1. Temperature

Methods of Measurement:

• Oral – by mouth

• Tympanic – ear

• Temporal – forehead

• Axillary – underarm

• Rectal – rectum

Thermometers:

• Electronic/Digital: Commonly used; displays digital readout.

• Non-mercury manual: Silver line replaces mercury; read the end of the silver column.

• Disposable: One-time use (e.g., temp dots).

Reading a Manual Thermometer:

• Large lines = 1°F

• Small lines between = 0.2°F

• Example: Between 98° and 99°, lines read 98.2, 98.4, 98.6, 98.8.

Temperature Indicators:

• Afebrile: Without fever (normal range: 97.8–99.1°F)

• Febrile: Fever (above average)

• Hyperpyrexia: Exceptionally high fever; potentially dangerous

• Hypothermia: Body temperature below 95°F

Factors Affecting Temperature:

• Stress, dehydration, exercise

• Environmental temperature

• Hot or cold drinks

• Thyroid disorders

• Older adults: May have infection without fever due to poor temperature regulation.

2. Pulse

Definition: Number of heartbeats per minute.

Normal Range: 60–80 bpm

• Tachycardia: >100 bpm (stress, fever, anxiety, infection, dehydration, etc.)

• Bradycardia: <60 bpm (may be normal in athletes or caused by certain meds like beta-blockers and digoxin)

Common Pulse Points:

• Temporal – side of forehead

• Carotid – neck

• Brachial – inner elbow

• Radial – wrist (thumb side)

• Femoral – groin

• Popliteal – behind knee

• Pedal (Dorsalis pedis) – top of foot

• Apical – heart (chest)

3. Respirations

Definition: Number of breaths per minute.

Normal Range (Adult): 12–20 bpm

Abnormal Terms:

• Tachypnea: >25 bpm (resting)

• Bradypnea: <12 bpm

• Hyperventilation: Deep and rapid breathing

• Dyspnea: Difficult or painful breathing

• Apnea: Temporary cessation of breathing

Conditions Affecting Breathing:
Asthma, pneumonia, heart failure, lung disease, anxiety, narcotic use, overdose.

Abnormal Breath Sounds:

• Rhonchi: Deep, snoring/rattling (asthma, bronchitis)

• Rales (Crackles): Crackling sound (fluid in lungs; pneumonia, pulmonary edema)

4. Blood Pressure

Definition: Force of blood against arterial walls.

Components:

• Systolic: Pressure when heart contracts

• Diastolic: Pressure when heart rests
  Example: 120/80 mmHg

Remember: Systolic/Diastolic = South Dakota (SD)

Normal Adult BP: 120/80 mmHg

Abnormal Conditions:

• Hypertension: High BP – damages arteries, increases risk for stroke, heart failure

• Hypotension: Low BP – usually less serious unless symptomatic

Classification Chart:

Category	Systolic	Diastolic
Normal	<120	<80
Prehypertension	120–139	80–89
Stage 1 Hypertension	140–159	90–99
Stage 2 Hypertension	≥160	≥100
Hypertensive Crisis	>180	>120

Pediatric BP: Lower than adults; use pediatric reference charts.

5. Measuring Blood Pressure

Equipment:

• Sphygmomanometer (BP cuff)

• Stethoscope

Methods:

1. Palpatory: Palpate radial pulse; measures only systolic pressure.

2. Auscultatory: Use stethoscope over brachial artery; first sound = systolic, disappearance = diastolic.

Cuff Placement:

• Arrow marked “artery” over brachial artery

• Stethoscope placed 1–2 inches above pulse point

• Hold stethoscope with index and middle fingers (not thumb)

Reading the Dial:

• Large lines = 10 mmHg

• Small lines = 2 mmHg

• Manual readings are always even numbers (electronic may show odd).

6. Orthostatic (Postural) Vital Signs

Definition: Vitals taken lying, sitting, and standing.

Indicators:

• Drop in BP >20 mmHg

• Pulse increase >10 bpm
  Suggests orthostatic hypotension (common with dehydration, blood loss, prolonged bed rest).

7. Body Measurements

• Adults/Older Children: Height and weight before provider visit.

• Infants: Weight, length, and head circumference each visit.

• Rounding: Weight to nearest ¼ pound.

• Height: Measured at first visit, then annually.

• BMI: Calculated using height and weight (CDC chart used).

The Takeaways

• Vital signs are the first indicators of physiological change.

• Always compare with baseline values and age norms.

• Accuracy in measurement and reporting is essential for safe care.

• Reassess abnormal findings, report to provider, and document promptly.