CHAPTER
6
Obtaining Vital
Signs and
Measurements
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6-2
Learning Outcomes
6.1 Describe vital signs and common body
measurements.
6.2 Differentiate measurement systems.
6.3 Identify the instruments used to measure vital
signs and body measurements.
6.4 Carry out vital signs and body measurements
of infants, children, and adults.
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6-3
Learning Outcomes (cont.)
6.5 Recognize abnormal vital signs and body
measurements.
6.6 Write vital signs and body measurements
using accurate terminology and
abbreviations.
6.7 Implement growth charts.
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6-4
Introduction
• Vital signs
– Temperature
– Pulse
– Respirations
– Blood pressure
– Pain assessment
• Body
measurements
– Height
– Weight
– Head
circumference
Vital signs and body measurements are used
to evaluate health problems.
Accuracy is essential.
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6-5
Vital Signs
• Provide information about patient’s overall
condition
• Taken at each visit and compared to
baseline
• Protected health information – HIPAA
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6-6
Temperature
• Febrile – body temperature above
patient’s normal range
– Fever – sign of inflammation or infection
– Hyperpyrexia – extremely high temperature
• Afebrile – normal body temperature
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6-7
Temperature (cont.)
• Measurements
Ear
Mouth
Temperature
Routes
Rectal
Axilla
Temporal
Artery
– Degrees Fahrenheit
(°F)
– Degrees Celsius
(centigrade; °C)
• Normal adult oral
temperature
– 98.6°F
– 37°C
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Thermometers
• Electronic digital
thermometer
– Accurate, fast, easy to read
– Comfortable for the patient
• Tympanic thermometer
• Temporal scanner
• Disposable thermometer
– Single use
– Less accurate
Disposable sheaths are used with electronic thermometers
to prevent cross-contamination.
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6-9
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 offcenter in lower jaw
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6-10
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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6-11
Taking Temperatures (cont.)
• Rectal temperatures
– Use Standard Precautions – 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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6-12
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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6-13
Taking Temperatures (cont.)
• Children
– Take temperature last
if child cries or
becomes agitated
– Agitation will cause
pulse, respiration, and
blood pressure to
elevate
– Oral route is not
appropriate for
children under 5 years
old
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6-14
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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6-15
Pulse
• Pulse – number of times the heart beats in
1 minute
• Respiration – number of times a patient
breathes in 1 minute
– One breath = one inhalation and one
exhalation
• Ratio of pulse to respirations is 4:1
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6-16
Pulse (cont.)
• Indirect measurement
of cardiac output
• Problems if
–
–
–
–
Tachycardia
Bradycardia
Weak
Irregular
• Sites of
measurement
– Adults – radial artery
– Children – brachial
artery (antecubital
space)
– Apex of heart
• 5th intercostal space
directly below center of
left clavicle
• Apical pulse taken with
a stethoscope
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6-17
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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6-18
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)
 May use stethoscope to
listen for apical pulse and
count for a full minute
Click for sounds
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6-19
Pulse (cont.)
• Electronic
measurement devices
– Blood pressure
machine
– Pulse oximetry unit
• Infrared light measures
pulse and oxygen levels
• Report oxygen level
below 92% not
improved by deep
breathing
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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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6-21
Normal Respiratory Rates
(26-40)
(20-30)
(18-24)
(12-24)
(16-24)
(12-20)
NOTE: Ranges reflect breaths per minute
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6-22
Respiration (cont.)
• Check respirations
– Look, listen, and feel
for movement of air
– Count with a
stethoscope
• Count for one full
minute
– 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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6-23
Respiration Irregularities (cont.)
• 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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6-24
Respiration Irregularities (cont.)
• Rales (noisy)
– Constriction or blockage of bronchial passages
– Pneumonia, bronchitis, asthma, or other pulmonary
disease
• Cheyne-Stokes respirations
– 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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6-25
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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6-26
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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Factors Affecting Blood Pressure
• Internal
– Cardiac output
– Blood volume
– Vasoconstriction
– Viscosity
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6-28
Factors Affecting Blood Pressure (cont.)
• Hypertension
• Hypotension
– Benign – no risks to
other organs
– Not generally a
chronic health problem
– Malignant – with other
conditions such as
renal or heart failure
– Severe hypotension
may present with
shock, heart failure,
severe burns,
excessive bleeding
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6-29
BP Measurement Equipment (cont.)
• Sphygmomanometer
• Types
– Inflatable cuff
– Aneroid
– Pressure bulb or other
– Electronic
device for inflating cuff
– Manometer
– Mercury
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6-30
Measurement Equipment (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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6-31
Measurement Equipment (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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6-32
Measurement Equipment (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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6-33
Measurement Equipment (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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6-34
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
• Slowly release the air
in cuff and
simultaneously listen
for vascular sounds
– Korotkoff sounds – five
phases
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6-35
Measuring Blood Pressure (cont.)
• Korotkoff sounds
– Phase 1 – tapping sound represents the systolic
pressure
– Phase 2 – softer swishing sound
– Phase 3 – resumption of a crisp tapping sound
– Phase 4 – sound changes to muffled
– Phase 5 – sound disappears; represents the diastolic
pressure
• Record results with systolic as the top number
and diastolic as the bottom number (i.e., 120/76)
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6-36
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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6-37
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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6-38
Orthostatic or Postural Hypotension
• Blood pressure becomes low and pulse
increases when the patient moves from lying to
standing
• May indicate dehydration, heart disease,
diabetes, medications, or nervous system
disorder
• 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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6-39
Correct!
Apply Your Knowledge
1.
You are about to take the temperature of a 6-monthold 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 6month-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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6-40
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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6-41
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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6-42
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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6-43
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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6-44
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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6-45
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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6-46
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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6-47
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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6-48
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
6.1
Vital signs include temperature, pulse, respirations,
blood pressure and assessment of pain. The most
common body measurements are height, weight, and
head circumference.
6.2
Mathematical formulas used to convert between
Celsius and Fahrenheit and kilograms and pounds
are:
°F = ( °C X 9/5 + 32) [set fraction 9/5 on top]
°C = ( °F – 32) X 5/9 [set fraction 5/9 on top]
lbs = kb X 2.205
kg = lbs X 0.454
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6-50
In Summary (cont.)
6.3
Instruments used to measure vital signs and body
measurements include a thermometer, temporal
scanner, stethoscope, sphygmomanometer, scale,
and tape measure.
6.4
The procedure to measure vital signs and body
measurements is done with extreme care to ensure
accuracy. Standard Precautions and aseptic
technique must be utilized to prevent the spread of
infection. Document information according to your
facility policy.
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6-51
In Summary (cont.)
6.5
All vital signs have a normal range based upon the
patient. To recognize an abnormality, you must know
these ranges. In addition, recognizing any significant
change in the vital signs of a particular patient, even if
they are not outside of the normal range, is essential.
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6-52
In Summary (cont.)
6.6
Common terminology used when discussing vital
signs includes: afebrile, antecubital space, apnea,
apex, apical, auscultated blood pressure, axilla,
brachial artery, bradycardia, calibrate, Celsius
(centigrade), Cheyne-Stokes respirations, dyspnea,
Fahrenheit, febrile, hyperpnea, hyperpyrexia,
hypotension, meniscus, orthostatic hypotension,
palpatory method, positive tilt test, postural
hypotension, radial artery, rales, and tachycardia,
Common abbreviations used when documenting vital
signs include: T = temperature, BP = blood pressure,
P = pulse, R = respirations, and VS = vital signs.
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In Summary (cont.)
6.7
To maintain a growth chart, you must accurately
measure the height, weight, and head circumference
of the infant or child. These measurements are plotted
on a chart that will identify the growth progress and
compare the patient’s size to other children of the
same age.
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6-54
End of Chapter 6
One way to get high blood
pressure is to go mountain
climbing over molehills.
~ Earl Wilson
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