Vital Signs

Vital Signs

Each time you call a doctor to report a concern about your family member’s health, expect a question about their blood pressure, breathing, or temperature. Vital signs tell the doctor a lot about what’s happening inside the patient’s body, where the eyes can’t see.  The five primary vital signs combined paint a picture of the patient’s immediate health status – crisis, stable, somewhere in-between. Therefore, developing the ability to competently take and respond to vital signs changes is an essential skill for caregivers.

 

 

What Do You Need to Know?

     Most healthcare professionals consider the following five measures as the primary vital signs: blood pressure, pulse, breathing (respiration), body temperature, and oxygen saturation. As a caregiver, it’s good to know

  • when you should take vital signs,
  • the type of equipment needed,
  • how to correctly take vital signs,
  • what the readings mean that you obtain, and
  • when you need to report your findings to the doctor.
Why is Monitoring Vital Signs Helpful?

Vital signs provide direct evidence of how the body organs are responding to whatever is assaulting them. We can’t see underneath the skin, but we find out how the body’s most important organs are holding up when we take vital signs. The brain, circulatory and respiratory systems are THE most important systems in our body.  Without any one of them, we cannot function. See below what we learn from each of them.

  • An electrical impulse, created by chemicals that stimulate the heart, generates a pulse. For example, a pulse may be fast or slow, pounding or thread, regular or irregular, present, or absent.
  • The blood vessels create a blood pressure reading based on the heart’s effort to push blood out of its chambers and how much it relaxes between beats. Blood pressure readings may be high, low, narrow, wide, bounding, or faint.
  • Respirations measure the volume of air brought into or exhaled out of the lung. Breaths can be full, shallow, normal, congested, noisy, rapid, shallow, irregular, slow, and many others.
  • Body temperature reflects the body’s response to environmental conditions and internal triggers like infections and trauma. Body temperatures go up and down.
  • Oxygen saturation reflexes the amount of oxygen used by the body. If there is a problem, doctors must narrow down the cause with several potential systems as options. Low oxygen saturation could mean slow or congested breathing, low iron count reducing the blood’s ability to create hemoglobin to transport oxygen, rapid heart rates using up oxygen, and many other possible concerns.

 

Knowing How to Take Vital Signs Correctly is Essential     

 

     Caregivers should know how to take vital signs the correct way, not how it’s performed on TV. People learn in different ways.  Some learn by reading, others by watching, and some need a combination.  I’ve tried to provide a combination of ways for you to learn how to take vital signs.  I collected videos from YouTube so that you can see it performed correctly but also written out some of the steps for some of the more complex procedures.

Managing the Process

     Once you know how to perform the process, you need to know how to manage it.

 

     How often do you need to take vital signs? There is no set rule. The answer varies based on what’s happening with your family member.  If they are currently healthy, you don’t need to check vital signs often–maybe every few months or when something changes.

 

     If you notice a change in how your family member looks for the worse, check vital signs to see if one or more of them have changed from what is normal for them.  Notice, I said, “what is normal for them.”  When you see a table that says “normal ranges,” that’s an average for the US. However, each person has their own normal based on how their body works. When you consistently get the same numbers grouped close together several times in a row, that’s usually your family member’s normal. If you take their vital signs and the results vary a lot on any vital signs, it’s worth watching for other signs.

 

     I should also mention that you may need to monitor vital signs for medication side effects. Some medications can harm the body. Taking vital signs may be a way of detecting that harm early.

Vital Signs - BLOOD PRESSURE

Monitoring Your Vital Signs and Understanding Your Blood Pressure 

   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 artery walls’ resistance 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 (1)  once the heartbeat has finished, (2) the heart has relaxed, and (3) it is resting between beats.

Blood Pressure Changes with Activity

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

Consider the Following Before Taking a Blood Pressure:
  1. The cuff size matters. The cuff should go around at least 80% of the upper arm. A cuff that is significantly larger or smaller may give you a false reading. Use an adult cuff on an adult and a pediatric cuff on a child.
  2. Do not take a blood pressure reading
    • in an arm that has an IV running or central line inserted below where the cuff would be applied,
    • in the same arm as the side of a mastectomy or lumpectomy; or
    • the same side as the location of a dialysis fistula or shunt.   

Vital Signs - Body Temperature

Monitoring Vital Signs and Understanding Core 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. The normal body temperatures may fluctuate in healthy adults by as much as 0.9oF-1.8oF (0.5oC to1oC).

 

Environment Affects Body Temperature    

      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 a fever is present, putting a cold compress against pulse points may lower it. A lukewarm bath or room temperature bath may also be helpful.   If they are cold, drinking warm liquids can help to warm them up, along with adding warm blankets.

 

     One word of caution, some individuals have medical conditions where their body temperatures do not self-regulate. That means that their bodies take on their surroundings’ temperature and do not adjust internally to make them warmer or cooler. My husband has MS, and his body is like that.  I must carry extra layers of clothing with me and things to cool him off for extremes in temperature in either direction to bring his body temperature back to where it needs to be at times.

 

     Another oddity for him is that his temperature does not go up with infections; it goes down.  Rather than spike (increase) a fever, he becomes hypothermic (his body temperature becomes lower than normal). When he is ill, I must watch his temperature to see if it starts to drop.  He normally has a body temperature of 97.6. Once it starts dropping into the 96 range, I have to keep a close eye on it because if it hits 95, he needs to be in the hospital on a heating blanket to get his internal core temperature heated up. It probably means he is septic (has a blood infection) and needs antibiotics). His skin usually feels cold, but he may be alert until the point he hits 95. 

 

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 one into the rectum. Hold it in place for the duration of time it takes to record the temperature. Taking a rectal temperature should be avoided in anyone with 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.
  • 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 ear’s internal temperature 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

Monitoring Vital Signs and Understanding the Pulse

     One of the blood’s primary functions is to carry oxygen to all parts of the body and remove waste products on the way back. If blood is not circulating, then oxygen is not being delivered where it needs to go. The organs of the body are not receiving the essential oxygen necessary to survive. Organs have a limited time frame that they can survive without oxygen before permanent damage occurs. The amount of damage and the impact differs among the organs, but it is best to try to keep blood circulating everywhere effectively to be on the safe side.

 

The Role of Hemoglobin with Oxygen

 

   Oxygen in the blood attaches to hemoglobin on the red blood cells and carries it throughout the body. While having adequate blood pressure and pulse are necessary to distribute oxygen to the body’s distant parts, it takes more than the heart and lungs to get oxygen to where it needs to go. Oxygen distribution relies mainly on the blood, maintaining enough iron, ferritin, hemoglobin, and red blood cells.  Without these essential elements, the oxygen can’t stick and travel as it should, and most will flow past its destination unused.

 

Pulse Ox

    Using pulse oximetry (pulse ox) and the other readings help 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 arterial blood’s color. The color of the blood denotes the amount of oxygen in the blood. Readings of 95-100% are typical, with readings below 92% indicating a problem.  Let your doctor know if you are consistently getting readings below 92%, which is new and unexpected.

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.

Vital Signs - Respiratory Rate

Monitoring Vital Signs and Understanding the 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 may show signs of confusion or mental health changes. Signs may include agitation, increased sleepiness, anxiety, and changes in sleeping patterns.

 

     I can always tell when my husband’s oxygen levels are off. Normally, Lynn’s mental status is clear.  He could win almost any trivial pursuit challenge and remembers numbers and detail much better than me. However, if his oxygen is low or he has an infection, he is disoriented when he first awakens from sleep. He may or may not know where he is or who I am, but he almost always sees things in the room that are not there, including people. These people are often known to him (i.e., family members, TV characters, former co-workers), and he sincerely believes them to be present. The longer it takes him to recognize his surroundings or to believe me when I tell them they are not in our house, the more I know he struggles with his oxygen levels.

 

What to Check      

     When evaluating respirations, consider not only how often (the rate) someone breathes but also how it sounds, the rhythm, and how deeply they inhale. Gather these details before you call the doctor because he’s likely to ask you about them.

 

     The video, Abnormal Lung Sounds, allows you to listen to the differences in abnormal lung sounds and provides pointers on how to describe them.

 

Describing Breathing   

     When you write down how your family member is breathing, think about the following as you describe what you’re seeing. 

  • Discretely watch the chest rise and fall. Try not to be obvious that you are watching and counting. If you are, the person will unconsciously hold their breath or breathe irregularly, and you will not get an accurate count. It is often easiest to count respirations while taking a pulse rate (either before or after). The way to hide what you are doing is to hold the wrist while counting both. Count the pulse for 30 seconds and the respirations for thirty.  The patient thinks you’re counting the pulse for a full minute, which occasionally happens when counting an irregular heartbeat.
  • As you count the breaths per minute, also watch for any unusual breathing patterns. They should be inhaling 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 rapid breaths followed by a gasp), note the change and inform the doctor of what you see.
  • When I mention the depth of breathing, I am referring to taking a deep breath or a shallow one. If your family member is only taking shallow breaths, they may have pain in their chest they are trying to avoid aggravating. While splinting their breathing may help, they will likely develop a carbon dioxide retention problem if they continue taking shallow breaths.
  • Finally, listen to how they sound when they are breathing. Refer to Abnormal Breath Sounds for help on how to describe the sound. Those videos were particularly useful. If you call the doctor and cannot remember the sound’s names, describe what you heard. That is good enough for them 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

Classification

Range

Risk

Normal Adult

120/80 mm Hg

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

Elevated

120-129/<80 mm Hg

Pre-high blood pressure warning sign

Hypertension Stage 1

130-139/80-89

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

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

Pulse Classifications, Patterns and Details

Classification

Rate

Sample Pattern

Details

Normal adult

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

x__x__x__x__x

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

xxxxxxxxxxxxxx

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

x_____x_____x_

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

x__x_____x_XX

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

Classification

Characteristic

Possible Cause

Apnea

a period where there is no breathing

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

Bradypnea

slow, regular respirations or equal depth

the normal pattern of breathe 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

Cheyne-Stokes

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

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

Eupnea

normal breathing

even up and down movement of the chest

Kussmaul

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

kidney failure or diabetic ketoacidosis

Tachypnea

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.