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Monitoring Vital Signs


     Your blood pressure has two numbers:

  • Systolic blood pressure (top number)- The top number of the blood pressure represents the amount of pressure the heart needs to push blood out of the heart against the resistance of the artery walls when the heartbeats.
  • Diastolic blood pressure (bottom number)-The bottom number of the blood pressure represents how much pressure remains in those same blood vessels once the heartbeat has finished, and the heart has relaxed and is resting between beats.

      Normal blood pressure fluctuates throughout the day as we conduct activities going up with physical exertion and dropping when we sleep and rest but should always return to a resting range below 120/80 mm Hg at rest.


Considerations when taking a Blood Pressure:
  • The cuff size matters. The cuff should encircle at least 80% of the upper arm. A cuff that is significantly larger or smaller may give you a false reading.
  • Do not take a blood pressure reading in an arm that has an IV running below where the cuff would be applied.
  • Do not take a blood pressure reading in the same arm as the side of a mastectomy or lumpectomy.
  • Do not take a blood pressure reading on the same side as the location of a dialysis fistula or shunt.   

Normal Body Temperature

     Most people consider average body temperature to be 98.6oF (37oC). Normal, however, is a range throughout the day based on your activity and can also be influenced by things like menstrual and sleep cycles. In healthy adults, their normal body temperatures may fluctuate by as much as 0.9oF-1.8oF (0.5oC to1oC).

     Many external factors can cause a person’s body temperature to change. Being in a room with hot lights, or air conditioning can cause your family member’s body temperature to go up or down a degree or two. If they have a fever, putting cold compressing against pulse points, may help to lower the fever, or helping them to take a bath in room temperature water. If they are cold, drinking warm liquids can help to warm them up, along with adding warm blankets.

Tips for Taking Temperatures

     Body temperature can be taken orally, rectally, under the arm, in the ear, against the forehead, using chemical dots, or internally using specialized equipment.

  • Apply a covering to the rectal thermometer and lubricate it before inserting them into the rectum. Hold them in place for the duration of time it takes to record the temperature. Taking a rectal temperature should be avoided in anyone who has blood clotting issues due to the possibility of the thermometer causing bleeding when inserted. It can also be a means of spreading infection if it encounters fecal material due to improper cleaning afterward.
  • When taking an oral temperature, you must wait 15 minutes after the person eats or drinks anything hot or cold, smokes, or chews gum to get an accurate temperature reading. The thermometer then goes into a pocket under the tongue toward the back. It should not lie in front of the mouth.
  • When using an ear thermometer, make sure the lens is clean before using it. Wait 20 minutes for the internal temperature of the ear to return to normal if the person has been lying on that ear. If there is much ear wax in the ear canal, you may get an inaccurate reading.



LippincottNursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 736.

Monitoring Oxygen Levels

     One of the primary functions of the blood is to carry oxygen to all parts of the body. That is one of the reasons why it is so essential to understand what is happening with the pulse. If blood is not circulating, then oxygen is not being delivered where it needs to go, and the organs of the body are not receiving essential oxygen necessary to survive. Organs have a limited time frame; they can survive without oxygen before permanent damage occurs. The amount of damage and the impact differs amount organs, but it is best to try to keep blood circulating everywhere effectively to be on the safe side.


     Hemoglobin in the blood attaches to oxygen and carries it to areas of the body needing supplies. Knowing blood pressure and a pulse is often not enough to have a complete picture of the person’s wellbeing. Those readings only tell us how well the heart is making the blood available. It does not tell us how well the body is working with the lungs to receive oxygen for use throughout the body. Using pulse oximetry (pulse ox) along with the other readings, helps to provide a better overall picture of your family member’s condition. They are easy to use and affordable. Most of them work by slipping them over the end of a finger allowing infrared light to penetrate the skin and read the color of the arterial blood. The color of the blood denotes the amount of oxygen in the blood. Readings of 95-100% are typical. Readings below 92% indicate a low level of oxygen in the blood, and a need to inform your doctor is this is a new development.

What Your Pulse Can Tell You

     Most people know that if you do not have a pulse that you are not alive, but the pulse can tell you a lot more than that. The pulse tells us how hard the heart is working, and if it is working correctly. Therefore, it is an excellent indicator of overall wellbeing.


Ten Pulse Points

     The heart makes a pulse sound as it pumps blood into the aorta. We have ten strong pulse points located on the body: temporal (temple of the head), carotid (neck), the apex of the heart (over the heart),  brachial (bend of the elbow), radial (wrist in-line with thumb), ulnar (wrist in-line with pinky finger), femoral (groin), popliteal (behind the knee), posterior tibialis (behind ankle), or dorsalis pedis (top of the foot near toes). Some of these are weaker to feel with your fingers than others.

     The ones we primarily use include the radial (wrist near thumb), carotid (neck), and apex of the heart. Due to the difficulty in getting to the other sites as quickly or easily, use them only for specific medical evaluations when requested. However, any pulse point works to check the heart rate, and the number obtained at one site should be the same at all other sites unless a problem exists at that location.


How Does a Healthy Pulse React?

      A healthy pulse has a regular rhythm, i.e., a steady beating pattern that responds correctly to changes in your activity level and your environment. It speeds up when you increase activities and slows down when you rest. If you become overly warm, your body temperature rises; if you become excessively cold, it drops.

     The pulse goes up and down to adapt to the body’s need for energy, temperature control, fluid and chemical regulation in the body, and fight and flight signals in the brain. Therefore, your pulse number in association with your blood pressure number, and your body temperature tells your doctor a lot about your body’s stress.


LippincottNursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 651.

Respiratory Rate

     The purpose of the respiratory system is to bring in fresh oxygen and to eliminate discarded carbon dioxide. If there is too much of either oxygen or carbon dioxide in the system, the individual often shows signs of confusion or mental health changes. Often there is agitation, increased sleepiness, anxiety, and changes in sleeping patterns. I can always tell when my husband’s oxygen levels are off because he starts waking from sleep, talking to people in his room who are not there, and he does not recognize who I am. The longer it takes him to begin to recognize his surroundings, the more I know he is struggling with his oxygen levels.

     When evaluating respirations, you consider not only how often (the rate) they breathe but also how it sounds, the rhythm, and how deep they inhale. Rate, sound, rhythm, and depth of respiration tell a doctor much about the type of problem a person might be having if you call in with a respiratory issue. Therefore, you want to have this information ready before calling the doctor for advice. The video, Abnormal Lung Sounds, lets you hear what abnormal lung sounds are like so that you can tell the difference in them.  This page has videos that allow you to listen to the differences in actual abnormal lung sounds and give you pointers on how to describe them.

      When you are recording how your family member is breathing, here is how you will want to do it.

  • You want to be able to see the chest rise and fall. Count each time the chest rises to its highest peak. Try not to be obvious that you are watching and counting because if you are, the person will hold their breath or breathe irregularly, and you will not get an accurate count. It is often easiest to count respirations after you finish counting a pulse rate or before you count one by holding onto the wrist longer and counting both respiration and pulse while holding the wrist.
  • You are counting how many breaths they take per minute. You also want to see if they have any unusual breathing patterns. They should be taking breaths at fairly regular intervals, but if you see them adding or changing how they breath (such as having long gaps between breaths, taking great gulps of air in between breaths, taking a series of fast breaths followed by a gasp) then you want to describe those patterns to the doctor.
  • Watch to see how deep they are breathing. Are they taking shallow breaths or very deep ones, and how often is that happening? If they are only shallow breathing, it may be an indication of pain in their chest; they are trying to avoid aggravating. Still, if they continue with the breathing pattern, they will likely develop a carbon dioxide retention problem.
  • Finally, listen to how they sound when they are breathing. If you went to the webpage on Abnormal Breath Sounds, you probably heard these breath sounds. Those videos were particularly useful. If you call the doctor and cannot remember the names of the sound, just describe what you heard. That is good enough for them to be able to figure out basically what is going on until you can get to the hospital.

LippincottNursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 668.

Pulse Points on the Body

Blood Pressure ranges and Classifications




Normal Adult

120/80 mm Hg

Follow a heart-healthy, well-balanced diet and get regular exercise


120-129/<80 mm Hg

Pre-high blood pressure warning sign

Hypertension Stage 1


Medications may be added, at increased risk of heart attack or stroke

Hypertension Stage 2

140/90 mm hg or higher

Medication and lifestyle changes required.

Hypertensive crisis

>180/120 mm Hg plus chest pain, back pain, shortness of breath, numbness.

Seek immediate medical intervention; the risk is high for stroke, heart attack or other serious complication

Pulse Classifications, Patterns and Details



Sample Pattern


Normal adult

60-100 beats/min. (babies 120-140)


Normal rates vary per individual based on gender, age, physical fitness, and activity level. Men typically have lower pulse rates than women

Tachycardia – fast heart rate

More than 100 beats per minute


Occurs when someone is emotionally upset; medications may cause it, caffeine, etc. May also be caused by medical conditions like congestive heart failure, anemia, fever, or things like running and exercise

Bradycardia – slow heart rate

less than 60 beats per minute


Some medications can cause it, some medical conditions like heart block requiring a pacemaker. Some athletes have slow heart rates

Irregular heart rhythms

uneven time intervals between beats with beats and pauses


Indicates cardiac irregularity, maybe oxygen not getting to heart, drug dose may be off, potassium dose may be off, other arrhythmias related to heart complications, or could be nothing wrong.

LippincottNursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 651.

Types of Respiratory Breathing Patterns



Possible Cause


a period where there is no breathing

maybe airway obstruction or a problem in the brain like a stroke


slow, regular respirations or equal depth

the normal pattern of breathing while you’re asleep; also happens while under the influence of drugs or alcohol; may occur with medical conditions where the ability to breathing is becoming more difficult like a diabetic coma


rapid, deep respirations followed by periods of no breathing for as long as 20-60 seconds

Signifies a very serious development: increased brain pressure, heart failure, kidney failure, drug overdose, brain death, a person is often near death


normal breathing

even up and down movement of the chest


rapid, labored respirations without a pause   – taking 20 or so breaths per minute

kidney failure or diabetic ketoacidosis


rapid breathing: rate often increases to match an increase in body temperature about 4 inspirations for each degree increase in body temperature

pneumonia, cancer, aspirin poison, respiratory insufficiency, and other diseases of the lung

LippincottNursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer, 668.