How to Check Vital Signs | Checking Vitals Nursing Assessment
How to Check Vitals
Checking vitals is an essential part of monitoring a person's health. Whether you're a nurse checking vitals in a hospital, a parent checking your child's vitals, or you're checking your own vitals, accuracy is important to tell you how the person is doing. The four main vital signs are temperature, respiratory rate, pulse rate, and blood pressure. Subjective pain on a scale of 0-10 is often considered along with vital signs, as are weight and oxygen saturation.
Pick a thermometer.To take someone's temperature, you have several options when it comes to thermometers. Digital thermometers can be used orally, rectally, and under the armpit. Special thermometers can be used on the forehead (skin) or in the ear.
- For babies under 3 months, always use a digital thermometer to take a rectal reading. For children under 4-years-old, you should take their temperature under their armpits, rectally, or on their forehead.
Wash your hands.Before using a thermometer on yourself or someone else, your hands need to be clean. Wash them with soap and warm running water, scrubbing for at least 20 seconds.
Clean the thermometer.If you don't know if a thermometer is clean, start by washing it in cold water. Apply rubbing alcohol to the thermometer, and then wash the alcohol off in cold water.
Use a thermometer orally or under the armpit.Next, you will need to insert the thermometer into the patient, going by your chosen route. For an oral thermometer, insert it under the tongue, and have the patient hold it there for at least 40 seconds. Most digital thermometers will beep when done.
- For the armpit, the tip of thermometer goes in the armpit. It should touch the skin (not cloth). Hold it for 40 seconds or until it beeps.
Take a rectal reading.For a rectal reading, have the patient lay on their back and lift their thighs. Apply a bit of petroleum jelly to the end of the thermometer before pushing it in the anus. Don't go past an inch. Half an inch is usually enough. Make sure you don't push past any resistance. Leave it in for 40 seconds or until it beeps.
Apply an ear or forehead thermometer.For an ear canal thermometer, insert the thermometer gently into the person's ear. Wait until it beeps before pulling it out to read the temperature. Always read the manual that comes with the thermometer, as it will give special instructions on how that particular thermometer should be inserted.
- For a forehead thermometer, also called a Temporal Artery thermometer, turn it on and slide it across the forehead of the patient. It should read the temperature immediately.
- Anyone with a temperature over 100.4 degrees Fahrenheit (38 degrees Celsius) should be seen by a doctor.
Taking Respiratory Rate and Pulse
Read the person's pulse manually.To read a person's pulse, place your index and middle fingers on the person's radial artery. This artery is on the inside of the wrist, closest to the thumb. When pressing, you should be able to feel the heartbeat using a firm but light pressure. Pressing to hard may only complicate your reading. Count the number of heartbeats in 30 seconds and multiply by 2 for beats per minute.
- You can also count the beats over 60 seconds, if you prefer.
Use other methods to take a pulse.Instead of feeling for a pulse, you can also listen with a stethoscope to the heartbeat, still counting the beats in 30 seconds. Each "lub-dub" of the heart counts for a single beat, not 2. In addition, blood pressure machines also read pulse, and most clinics and hospitals also have a finger monitor that can check pulse rates.
- For a typical adult, the pulse should be between 60 and 80 beats per minute.
Count breaths for the respiratory rate.To check for the respiratory rate, count the number of times a person breathes in a minute. One full cycle of inhaling and exhaling counts as a single breath. If you're doing it on someone else, you can simply watch how many times their chest rises and count.
- Normal respiration is generally 12 to 16 breaths per minute for an adult.
Check for a pulse and breathing in an emergency.If you come upon a person in a emergency, you'll need to check to see if the person is breathing and if they have a heartbeat. To check for breathing, watch the person's chest, listen close to the person's mouth, and feel their chest to see if they are breathing. To check for a pulse, place your index finger and middle finger on their carotid artery, which is in the middle of the neck between the neck muscle and windpipe. Hold your fingers there to see if you feel a pulse.
- If the person isn't breathing or doesn't have a heartbeat, you'll need to begin CPR. If the person isn't breathing and they're on their back, first try to tilt their head back, which may move the tongue out of the way.
Checking Blood Pressure
Have the person sit quietly.Before you take blood pressure, the patient should be sitting for a few minutes (about 5 minutes) beforehand. Blood pressure readings should be taken while the patient is at rest with their legs and arms uncrossed.
Try an automatic machine.Place the cuff on the upper arm (above the elbow), tightening it well. A mark on the cuff will indicate where it needs to be placed in relation to the artery. The wired part of the machine should be on the inside of the arm. If it's a wrist cuff, place it so the monitor is on the inside of the wrist. Once secured, turn the machine on, and start the reading. Try to remain still or have the patient remain still while it's reading. You can take more than one reading for better accuracy.
- A reading of less than 120/80 is considered normal. Any higher starts getting into prehypertension (pre-high blood pressure).
Set up a manual blood pressure cuff.Apply the cuff to just above the elbow, tightening enough that you can just fit two fingertips underneath. Slip the stethoscope between the skin and the cuff in the middle of the antecubital fossa, or elbow pit, and put the earpieces in your ears. The gauge for the machine should sit in your cuffed hand, if you're taking your own measurements, or you can just hold it if you're taking someone else's measurements.
Inflate the cuff on a manual blood pressure cuff.Squeeze the pump quickly (with the opposite hand if you're reading yourself). When you get to 30 points above what your systolic pressure (high end) normally is, you can stop. If you are working on someone else, inflate it to the 160 to 180 range, though if you immediately hear heartbeats, you'll need to go higher.
Release the air to read blood pressure.Begin letting the air out by turning the knob counterclockwise. It should only drop the gauge 2 to 3 points a second. Make sure deflation shows steady on the gauge. When you hear the first heartbeat, note where the gauge is, as that's the systolic pressure. When the heartbeat stops, note where the gauge is again, which is the diastolic pressure. You can deflate and remove the cuff.
Checking Other Vitals
Observe the patient.Don't forget to observe the patient while taking readings to see if they seem worried. Have them sit in a relaxed position with their legs uncrossed. Pay attention to see if they are in obvious distress or if they have something wrong with them that's visible to the naked eye.
Weigh the patient.Sometimes, weight is included in vital signs. To weigh a patient, ask them to get on a scale, and then write down the number. Make no judgment on the person's weight, whether by comment, facial expression, or body language.
Discuss pain levels.For this vital, you'll need to ask the person how they are feeling and to rate their pain on a scale from 0-10. Of course, everyone's pain scale will be different, but if you can get a good idea of what level of pain the person is having, that helps assess their overall condition.
- First say, "Are you in any pain?" If the answer is "yes," ask "Can you rate your pain on a scale of 0-10, with 0 being no pain and 10 being the worst pain you've ever felt?"
Take a reading of oxygen saturation.Oxygen saturation is how much oxygen is in your blood. It is an important indicator of whether the patient is breathing properly and/or pumping blood to the body properly. A simple device that fits over the patient's fingernail will give you a reading for oxygen saturation, which normally is at 95 to 100 percent.
Video: Vital Signs- For Beginners
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