• The five vital signs are pain, respiration, blood

pressure, temperature and pulse.

• There are standard orders for vital signs once per
shift. These vital signs indicate if a person is doing
poorly or is getting better.
• 120/80 is the standard blood pressure. Normal
blood pressure is always what is normal for you.
• We need to take a baseline vital signs when a
new patient comes in. We need to look at vital
signs over time but you have to know what the
patient’s baseline vitals are.
• Temperature is a balance between the heat the body
produces and loses.
• Temperature is a measurement of heat inside the body.
• The different types of thermometers are oral, rectal,
battery-operated and glass as they have mercury
inside. (Mercury is poisonous.)
• Ivac electronic thermometer is not used in the nursing
home. Blue thermometers are oral thermometers that
go in the mouth and red thermometers are rectal
thermometers that go in the rectum.
• Tympanic thermometer goes into the ear and is used in
some ambulatory settings.
• An “Ax” must be placed near the number if the temperature was
taken axillary or under the arm.
• An “R” should be placed near the number if the temperature was
taken rectally or in the rectum.
• Problems can occur if the correct method is not identified: you
must let them know if you took the temperature oral, axillary or
rectal.
• An “O” if you took the temperature orally.
• A “T” if you took the temperature tympanic. This is usually done in
pediatrics.
• An oral temperature would be 37.0 Celsius and 98.6 Fahrenheit.
• An axillary temperature would be 36.4 Celsius and 97.6 Fahrenheit.
• In infants temperature regulation is defective in newborns
especially poor in premature babies. A fit of screaming
raises the body temperature and warm and cold baths can
alter their temperature more so than an adult.
• In elderly persons, the temperature usually is subnormal.
The body is less active, the circulation feeble and there is
less power of compensation for changes in external
temperature and there is less tolerance to extremes of
temperature.
• Elderly with acute (meaning quick onset) infections may
have subnormal temperatures as low as 95F. They may
become easily dehydrated with increased temperatures so
if their temp is going up it may mean they are getting
dehydrated.
• Pulse vibration of the blood through the arteries as the heart beats
is measured by rate and rhythm. There are the radial, apical, apical-
radial, pedal, popliteal, and carotid artery pulse vibrations to
account for.
• Why don’t we take a blood pressure on an artery and not a vein?
The blood in the arteries is under pressure. The blood comes from
the heart to the arteries to the capillaries to the veins then the
most pressure is coming out of the heart which is the arteries.
• There is more pressure in the arteries because the blood is being
carried away from the heart with pressure.
• Why do we take the pulse in the wrist?
• You take two fingers and palpate your pulse and in the wrist the
artery is being compressed into the bone and that’s why you need
to take the radial (radial bone) pulse.
• The apical pulse is the PMI the point of maximum impulse which is the apex of your heart. This apex is at the fifth
intercostal space of the body.
• The radial pulse is in the wrist.
• The apical-radial pulse is to compare the apical pulse to the radial pulse.
• The pedal pulse is in the foot really on top of the foot.
• We take pulses on arteries.
• Why take a pedal pulse? If the person has an open fracture cast on the leg then you take a pedal pulse. The elderly
have feet that look bluish.
• So as you look at their feet compare one pedal pulse to another and then compare the right foot to the left foot’s
pulse.
• Note: You don’t count the pedal pulses, you are just comparing right to left.
• Polpliteal pulse is behind the knee where the knee bends.
• Carotid pulse never compare both carotid pulses at the same time because you will stop blood flow to the brain. I
just saw a great tape called “Fierce and Female by Dr. Ruthless” and she was talking about hitting an attacker in
the carotid artery and that there are lots of nerves and things in the carotid artery that if you hit it repeatedly
would tell a person to stop attacking. Plus it could get lethal.
• Temporal pulses are up top at the forehead.
• Femoral pulse is by the groin.
• Apical is midclavicular or the middle of your clavicle. The intercostal space is between your ribs so that is between
the breasts and that is the apical pulse.
• The radial pulse is taken for a full 60 seconds especially on an older person.
• All images on this article are from Photobucket.com.