Obtaining Vital Signs and
Measurements
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37-2
Learning Outcomes
37.1 Recognize common terminology and abbreviations
used in documenting and discussing vital signs.
37.2 Describe the instruments used to measure vital
signs and body measurements.
37.3 Explain the procedure used to measure vital signs
and body measurements.
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Introduction
Vital signs
Temperature
Pulse
Respirations
Blood pressure
Body measurements
Height
Weight
Head circumference
Vital signs and body measurements are used
to evaluate health problems.
Accuracy is essential.
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Vital Signs
Provide information about patient’s overall
condition
Taken at each visit and compared to baseline
Use Standard Precautions
Protected health information – HIPAA
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Vital Signs: Temperature
Febrile – body temperature above patient’s
normal range
Fever – sign of inflammation or infection
Hyperpyrexia – extremely high temperature
Afebrile – normal body temperature
Body temperature varies with time of day
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Vital Signs: Temperature (cont.)
Tympanic
Oral
Measurements
Temperature
Routes
Rectal
Axillary
Temporal
Degrees Fahrenheit (°F)
Degrees Celsius
(centigrade; °C)
Normal adult oral
temperature
98.6°F
37°C
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Vital Signs: Temperature (cont.)
Measured using either electronic or disposable
Electronic digital
Accurate, fast, easy to read
Comfortable for the patient
Tympanic
Temporal
Disposable
Single use
Less accurate
Disposable sheaths are used with electronic thermometers
to prevent cross-contamination.
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Vital Signs: Temperature (cont.)
Route
Normal Range ºF / ºC
Sites
Oral
98.6 ºF / 37.0 ºC
Mouth
Tympanic
99.6 ºF / 37.6 ºC
Ear
Rectal
99.6 ºF / 37.6 ºC
Rectum
Axillary
97.6 ºF / 36.6 ºC
Axilla (armpit)
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Vital Signs: Taking Temperatures
Measure to nearest tenth of a
degree
Oral temperatures
Wait at least 15 minutes
after eating, drinking, or
smoking
Place under tongue in either
pocket just off-center in
lower jaw
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Vital Signs: Taking Temperatures (cont.)
Tympanic temperatures
Proper technique essential
Adult – pull ear up and back
Child – pull ear down and back
Fast, easy to use, and preferred in
pediatric offices
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Vital Signs: Taking Temperatures (cont.)
Rectal remperatures
Standard precaution – gloves
Patient is positioned on side (left side preferred) or stomach
Lubricate tip of thermometer
Slowly and gently insert tip into anus
½ inch for infants
1 inch for adults
Hold thermometer in place while temperature is taken
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Vital Signs: Taking Temperatures (cont.)
Axillary temperatures
Place patient in seated or
lying position
Place tip of thermometer
in middle of axilla with
shaft facing forward
Probe must touch skin on
all sides
Temporal temperatures
Temporal scanner
Noninvasive, quick
Stroke scanner across
forehead, crossing over
the temporal artery
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Vital Signs: Taking Temperatures (cont.)
Children
Take temperature last if
child cries or becomes
agitated
Agitation will cause
pulse, respiration, and
blood pressure to elevate
Oral not appropriate for
children under 5 years old
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Vital Signs: Pulse and Respiration
Circulatory
Respiratory
Pulse
Respirations
Pulse and respirations are related because the heart and lungs
work together. Normally, an increase or decrease in one causes the
same effect on the other.
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Vital Signs: Pulse
Pulse – number of times the heart beats in
1 minute
Respiration – number of times a patient breaths
in 1 minute
One breath = one inhalation and one exhalation
Ratio of pulse to respirations is 4:1
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Vital Signs: Pulse (cont.)
Indirect measurement of
cardiac output
Sites of measurement
Problems if
Tachycardia
Bradycardia
Weak
Irregular
Adults – radial artery
Children – brachial artery
(antecubital space)
Apex of heart
5th intercostal space
directly below center of
left clavical
Apical pulse taken with a
stethoscope
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Vital Signs: Pulse (cont.)
Locate pulse by pressing
lightly with index and middle
finger pads at the pulse site
Count the number of beats
felt in 1 minute
If regular – may count beats
for 30 seconds and multiply
by 2
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Vital signs: Pulse (cont.)
Regular Pulse Rhythm
Irregular Pulse Rhythm
Count for 30 seconds,
Count for one full minute
then multiply by 2
(a rate of 35 beats in 30
seconds equals a pulse
rate of 70 beats/minute)
Click for Sound
May use stethoscope to
listen for apical pulse and
count for a full minute
Click for Sound
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Vital Signs: Pulse (cont.)
Electronic devices
Blood pressure machines
Pulse oxymetry
Infrared light measures pulse
and oxygen levels
Report oxygen level below
92% not improved by deep
breathing
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Vital Signs: Respiration
Respiratory rate – indication of how well the body
provides oxygen to the tissues
Check by watching, listening, or feeling movement
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Vital Signs: Respiration (cont.)
Normal Respiratory Rates
(26-40)
40
35
(20-30)
30
(18-24)
25
(12-24)
(16-24)
(12-20)
20
15
10
5
0
0-1 yrs
6-11 yrs
ADULT
NOTE: Ranges reflect breaths per minute
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Vital Signs: Respiration (cont.)
Check respirations
Look, listen, and feel for
movement of air
Count for one full
minute
Count with a stethoscope
Rate
Rhythm – regular
Effort (quality) – normal,
shallow, or deep
NOTE: If patients are aware that you are counting
respirations, they may unintentionally alter their
breathing.
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Vital Signs: Respiration (cont.)
Irregularities – indication of possible disease
Hyperventilation – excessive rate and depth
Dyspnea – difficult or painful breathing
Tachypnea – rapid breathing
Hyperpnea – abnormally rapid or deep breathing
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Vital Signs: Respiration (cont.)
Other irregularities
Rales (noisy)
Cheyne-Stokes respirations
Constriction or blockage of bronchial passages
Pneumonia, bronchitis, asthma, or other pulmonary
disease
Periods of increasing and decreasing depth of respiration
between periods of apnea
Strokes, head injuries, brain tumors, congestive heart
failure
Apnea – absence of breathing
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Vital Signs: Blood Pressure
The force at which blood is pumped against the
walls of the arteries (mmHg)
Two pressure measurements
Systolic pressure – measure of pressure when left
ventricle contracts
Diastolic pressure
Measure of pressure when heart relaxes
Minimum pressure exerted against the artery walls at all
times
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Vital Signs: Blood Pressure (cont.)
120/80
Systolic Pressure
Diastolic Pressure
Contraction of left
ventricle
Top or first number
Heart at rest
Bottom or second
number
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Vital Signs: Blood Pressure (cont.)
Low blood pressure
Hypertension
Normal for some
people
Severely low blood
pressure readings occur
with:
Shock
Heart failure
Severe burns
Excessive bleeding
High blood
pressure readings
Major contributor
to heart attacks and
strokes
Hypotension
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Vital Signs: Blood Pressure (cont.)
Equipment
Sphygmomanometer
Inflatable cuff
Pressure bulb or other
device for inflating cuff
Manometer
Types of
sphygmomanometers
Aneroid
Electronic
Mercury
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Vital Signs: Blood Pressure (cont.)
Aneroid sphygmomanometers
Circular gauge for registering pressure
Each line 2 mmHg
Very accurate
Must be checked,
serviced, and
calibrated every
3 to 6 months
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Vital Signs: Blood Pressure (cont.)
Electronic sphygmomanometers
Provides a digital readout of the
blood pressure
No stethoscope is needed
Easy to use
Maintain equipment according to
manufacturer’s instructions
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Vital Signs: Blood Pressure (cont.)
Mercury sphygmomanometers
A column of mercury rises with an
increased pressure as the cuff is
inflated
No longer available for purchase
If in use, must be checked,
serviced, and calibrated every
6 to 12 months
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Vital Signs: Blood Pressure (cont.)
Stethoscope
Amplifies body sounds
Earpieces
Binaurals and tubing
Chestpiece
Bell – low-pitched
sounds
Diaphragm –
high-pitched sounds
Earpieces
Binaurals
Rubber or plastic
tubing
Bell
Chestpiece
Diaphragm
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Vital Signs: Blood Pressure (cont.)
Measuring blood pressure
Place cuff on the upper arm above the brachial pulse site
Inflate cuff about 30 mmHg above palpatory result or
approximately 180 mmHg to 200 mmHg
Release the air in cuff and listen for the first heartbeat
(systolic pressure) and the last heartbeat (diastolic pressure)
Record results with systolic as the top number and diastolic
as the bottom number (i.e., 120/76)
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Vital Signs: Blood Pressure (cont.)
Special considerations in adults
Post exercise, ambulatory disabilities, obese, known blood
pressure problems
Anxiety or stress
Avoid measurement in an arm
Injury or blocked artery is present
History of mastectomy on that side
Implanted device is under the skin
Proper cuff size – improper size results in inaccurate
reading
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Vital Signs: Blood Pressure (cont.)
Special considerations in children
Not routinely taken on each visit
Take before other tests or procedures
Cuff size important
Palpatory method not used with
children
Heartbeat may be heard to zero; record diastolic when strong
heartbeat becomes muffled
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Vital Signs:
Orthostatic or Postural Hypotension
Orthostatic or postural hypotension
Blood pressure becomes low and pulse increases
when the patient moves from lying to standing
Indicates fluid loss or malfunction of cardiovascular
system
Vital signs are taken in different positions
Positive tilt test – increase in pulse > 10 bpm and a
drop in BP > 20 mmHg
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Correct!
Apply Your Knowledge
1.
You are about to take the temperature of a 6-month-old
infant being seen at the pediatrician’s office for vomiting
and diarrhea. Which route will you use and why? What
special considerations do you need to keep in mind with
this specific patient situation and why?
Answer: Route would be either tympanic or temporal since a
6-month-old would not be able to hold the thermometer
under his/her tongue. Special considerations include: Taking
the temperature after the pulse and respirations. For the
tympanic thermometer, use proper technique and pull the
ear down and back. Use Standard Precautions to prevent the
spread of microorganisms.
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Correct!
Apply Your Knowledge
2. A 26-year-old athlete visits the medical office for a routine
checkup. The medical assistant takes T-P-R and obtains the
following: Temperature 98.8°F, Pulse 52 beats/minute, and
Respirations 18/minute. What should the medical assistant
do about these results?
ANSWER: The temperature and pulse are within the
normal range. The pulse of 52 is below the normal range.
Check the patient’s previous vital sign results. Some
patients, especially athletes, normally have a low pulse
rate, so these results may be within normal limits for this
patient.
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Apply Your Knowledge
3. A 67-year-old patient is in the medical office
complaining of a headache. The blood pressure
reading is 212/142. What should the medical
assistant do in this situation?
ANSWER: This blood pressure reading is very high and
should be reported to the physician at once. The complaint
of headache should also be reported to the physician.
Hypertension is a major contributor to stroke and heart
attacks.
3 FOR 3! Very Good!
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37-40
Body Measurements
Adults and older
children
Height
Weight
Infant measurements
Length
Weight
Head circumference
Provide baseline values for current condition and enable
monitoring of growth and development of children.
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Body Measurements (cont.)
Adult weight
Taken at each office
visit
Record to nearest
quarter of a pound
Height of adults
Taken on initial visit
and yearly thereafter
Height bar on scale
Record to nearest
quarter of an inch
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Body Measurements (cont.)
Weight of children and infants
Children
Adult scales if able to stand
Held by an adult using the adult scale, and subtract
adult weight from total to yield child’s weight
Infants
Infant scales
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Body Measurements (cont.)
Height of children and infants
Children
Height bar on scale
Wall charts
Infants
Length measured at each visit
Built-in bar on exam table
Tape measure or yardstick
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Body Measurements (cont.)
Head circumference of infants
An important measure of growth and development
Tape measure is placed around head at its largest
circumference to obtain measurement
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Body Measurements (cont.)
Other measurements
Diameter of limb – measure both to determine
difference in size
Wound, bruise, or other injury – length and width
to evaluate healing process
Chest circumference in infants
Abdominal girth in adults
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Apply Your Knowledge
The medical assistant is about to weigh a 6-month-old infant using
the infant scale. When the medical assistant places the infant on the
scale she notices the diaper is very soiled. What should the medical
assistant do?
ANSWER: The diaper could be changed prior to weighing.
However, if the infant is weighed with the soiled diaper, the
medical assistant should weigh the diaper after weighing the
infant and subtract the difference to obtain the infant’s
accurate weight.
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In Summary
Medical assistant
Measure and record vital signs, weight, and height
Information is important to patient outcomes
Accuracy of data
Proper technique
Same equipment for each measurement
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End of Chapter
One way to get high blood
pressure is to go mountain
climbing over molehills.
~ Earl Wilson
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