Vitals Signs - Nursing
VITAL SIGNS
NUR 102
What are Vital Signs?
• Temperature
• Pulse
• Respirations
• Blood Pressure
• Pain (considered the 5th vital sign)
When to measure vital signs?
• On admission to health care facility
• In a hospital on regular hosp schedule or as MD ordered (q8hours, q4 hours, etc)
• Before and after procedures (surgery, invasive diagnostic procedures)
• Before, during, and after blood transfusions
• When patient’s general condition changes (nursing judgment)
GUIDELINES FOR ASSESSMENT
• Taken by nurse giving care
• Equipment should be in good condition
• Know baseline VS and normal range for pt and age group
• Know pt’s medical history
• Minimize environmental factors
GUIDELINES CONTINUED
• Be organized in approach
• Increase frequency of VS as condition worsens
• Compare VS readings with the whole picture
• Record accurately
• Describe any abnormal VS
VS MUST BE ACCURATE
• Both measuring and recording
• VS vary according to pt’s illness/condition
• Compare results with pt’s normal
• Results are used to determine treatments, medications, diagnostic work, etc
REPORTING ABNORMAL VS
• WHEN—grossly abnormal, return to normal, noted change for that pt
• WHY—indicates change in metabolism or physiological function within the body
• WHO—student reports to instructor, then TL, RN, Dr (follow chain of command)
• HOW—orally to appropriate person, then document on chart
Body Temperature
• Difference between heat produced by body processes and the heat lost to the external environment
• Range 96.8 – 100.4 F (36 – 38 degree C)
• Average for healthy young adults 98.6F or 37degrees C
• No single temp is normal for all people
HEAT IS PRODUCED BY:
• Metabolism
• Increased muscle activity
• Vasoconstriction
• External sources
HEAT IS LOST BY:
• Vasodilation
• Convection
• Radiation
• Conduction
• Evaporization
TEMP or FEVER?
• TEMPERATURE—the measurement of heat in the body
• FEVER—the measurement of heat in the body
NUR 102
What are Vital Signs?
• Temperature
• Pulse
• Respirations
• Blood Pressure
• Pain (considered the 5th vital sign)
When to measure vital signs?
• On admission to health care facility
• In a hospital on regular hosp schedule or as MD ordered (q8hours, q4 hours, etc)
• Before and after procedures (surgery, invasive diagnostic procedures)
• Before, during, and after blood transfusions
• When patient’s general condition changes (nursing judgment)
GUIDELINES FOR ASSESSMENT
• Taken by nurse giving care
• Equipment should be in good condition
• Know baseline VS and normal range for pt and age group
• Know pt’s medical history
• Minimize environmental factors
GUIDELINES CONTINUED
• Be organized in approach
• Increase frequency of VS as condition worsens
• Compare VS readings with the whole picture
• Record accurately
• Describe any abnormal VS
VS MUST BE ACCURATE
• Both measuring and recording
• VS vary according to pt’s illness/condition
• Compare results with pt’s normal
• Results are used to determine treatments, medications, diagnostic work, etc
REPORTING ABNORMAL VS
• WHEN—grossly abnormal, return to normal, noted change for that pt
• WHY—indicates change in metabolism or physiological function within the body
• WHO—student reports to instructor, then TL, RN, Dr (follow chain of command)
• HOW—orally to appropriate person, then document on chart
Body Temperature
• Difference between heat produced by body processes and the heat lost to the external environment
• Range 96.8 – 100.4 F (36 – 38 degree C)
• Average for healthy young adults 98.6F or 37degrees C
• No single temp is normal for all people
HEAT IS PRODUCED BY:
• Metabolism
• Increased muscle activity
• Vasoconstriction
• External sources
HEAT IS LOST BY:
• Vasodilation
• Convection
• Radiation
• Conduction
• Evaporization
TEMP or FEVER?
• TEMPERATURE—the measurement of heat in the body
• FEVER—the measurement of heat in the body