Obtaining Vital Signs and Measurements

Obtaining Vital Signs and
Measurements
© 2009 The McGraw-Hill Companies, Inc. All rights reserved

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.

37-3
Introduction
 Vital signs  Body measurements
 Temperature  Height
 Pulse  Weight
 Respirations  Head circumference
 Blood pressure
Vital signs and body measurements are used

to evaluate health problems.
Accuracy is essential.

37-4
Vital Signs
 Provide information about patient’s overall
condition
 Taken at each visit and compared to baseline
 Use Standard Precautions
 Protected health information – HIPAA

37-5
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

37-6
Vital Signs: Temperature (cont.)

Tympanic
 Measurements
Oral
 Degrees Fahrenheit (°F)
 Degrees Celsius
Temperature (centigrade; °C)
Routes
 Normal adult oral
Rectal Axillary temperature
Temporal  98.6°F
 37°C

37-7

 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.
37-8

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)

37-9
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

37-10
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

37-11

 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

37-12

 Axillary temperatures  Temporal temperatures
 Place patient in seated or  Temporal scanner
lying position  Noninvasive, quick
 Place tip of thermometer  Stroke scanner across
in middle of axilla with forehead, crossing over
shaft facing forward the temporal artery
 Probe must touch skin on
all sides

37-13

 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

37-14
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.

37-15
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

37-16
Vital Signs: Pulse (cont.)

 Indirect measurement of  Sites of measurement
cardiac output  Adults – radial artery
 Children – brachial artery
 Problems if (antecubital space)
 Tachycardia  Apex of heart
 Bradycardia  5th intercostal space
directly below center of
 Weak left clavical
 Irregular  Apical pulse taken with a
stethoscope

37-17

 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

37-18
Vital signs: Pulse (cont.)
Regular Pulse Rhythm Irregular Pulse Rhythm
 Count for 30 seconds,  Count for one full minute

then multiply by 2  May use stethoscope to
(a rate of 35 beats in 30 listen for apical pulse and
seconds equals a pulse count for a full minute
rate of 70 beats/minute)
Click for Sound Click for Sound

37-19

 Electronic devices
 Blood pressure machines
 Pulse oxymetry
 Infrared light measures pulse
and oxygen levels
 Report oxygen level below
92% not improved by deep
breathing

37-20
Vital Signs: Respiration

 Respiratory rate – indication of how well the body
provides oxygen to the tissues
 Check by watching, listening, or feeling movement

37-21
Vital Signs: Respiration (cont.)

Normal Respiratory Rates
(26-40)
(20-30)
(18-24) (16-24) (12-24)
(12-20)
NOTE: Ranges reflect breaths per minute

37-22

 Check respirations  Count for one full
 Look, listen, and feel for minute
movement of air  Rate
 Rhythm – regular
 Count with a stethoscope  Effort (quality) – normal,
shallow, or deep
NOTE: If patients are aware that you are counting

respirations, they may unintentionally alter their
breathing.

37-23

 Irregularities – indication of possible disease
 Hyperventilation – excessive rate and depth
 Dyspnea – difficult or painful breathing
 Tachypnea – rapid breathing
 Hyperpnea – abnormally rapid or deep breathing

37-24

 Other irregularities
 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

37-25
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

37-26
Vital Signs: Blood Pressure (cont.)
120/80
Systolic Pressure Diastolic Pressure
 Contraction of left  Heart at rest
ventricle  Bottom or second
 Top or first number number

37-27

 Low blood pressure
Hypertension  High blood
 Normal for some people
 Severely low blood
pressure readings
pressure readings occur  Major contributor
with:
to heart attacks and
 Shock
 Heart failure strokes
 Severe burns
 Excessive bleeding
Hypotension
37-28

 Equipment
 Sphygmomanometer  Types of
 Inflatable cuff sphygmomanometers
 Pressure bulb or other  Aneroid
device for inflating cuff  Electronic
 Manometer  Mercury

37-29

 Aneroid sphygmomanometers
 Circular gauge for registering pressure
 Each line 2 mmHg
 Very accurate
 Must be checked,
serviced, and
calibrated every
3 to 6 months
37-30

 Electronic sphygmomanometers
 Provides a digital readout of the
blood pressure
 No stethoscope is needed
 Easy to use
 Maintain equipment according to
manufacturer’s instructions

37-31

 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

37-32

 Stethoscope Earpieces
 Amplifies body sounds Binaurals
 Earpieces
 Binaurals and tubing
 Chestpiece Rubber or plastic
 Bell – low-pitched tubing
sounds
Bell
 Diaphragm – Chestpiece
high-pitched sounds
Diaphragm

37-33

 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)

37-34

 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

37-35

 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

37-36
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

37-37
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.
37-38
Correct!
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.
37-39

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!
37-40
Body Measurements
 Adults and older  Infant measurements
children  Length
 Height  Weight
 Weight  Head circumference
Provide baseline values for current condition and enable

monitoring of growth and development of children.

37-41
Body Measurements (cont.)

 Adult weight  Height of adults
 Taken at each office  Taken on initial visit
visit and yearly thereafter
 Record to nearest
quarter of a pound  Height bar on scale
 Record to nearest
quarter of an inch

37-42

 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

37-43

 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

37-44

 Head circumference of infants
 An important measure of growth and development
 Tape measure is placed around head at its largest
circumference to obtain measurement

37-45

 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

37-46

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.

37-47
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

37-48
End of Chapter
One way to get

high blood
pressure is to
go mountain
climbing over
molehills.
~ Earl Wilson

Obtaining Vital Signs and Measurements

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Obtaining Vital Signs and

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

37.2 Describe the instruments used to measure vital

37.3 Explain the procedure used to measure vital signs

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital signs and body measurements are used

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

 Taken at each visit and compared to baseline

 Use Standard Precautions

 Protected health information – HIPAA

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Temperature

 Afebrile – normal body temperature

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Temperature (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Temperature (cont.)

Vital Signs: Temperature (cont.)

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)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Taking Temperatures

after eating, drinking, or

pocket just off-center in

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Taking Temperatures (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Taking Temperatures (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Taking Temperatures (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Taking Temperatures (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Pulse and Respiration

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Pulse

 Respiration – number of times a patient breaths

 Ratio of pulse to respirations is 4:1

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Pulse (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Pulse (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital signs: Pulse (cont.)

Regular Pulse Rhythm Irregular Pulse Rhythm

 Count for 30 seconds,  Count for one full minute

Click for Sound Click for Sound

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Pulse (cont.)

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Respiration

 Check by watching, listening, or feeling movement

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Respiration (cont.)

NOTE: Ranges reflect breaths per minute

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Respiration (cont.)

NOTE: If patients are aware that you are counting

© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Vital Signs: Respiration (cont.)

 Dyspnea – difficult or painful breathing

 Tachypnea – rapid breathing