Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)

What are vital signs?

Vital signs are measurements of the body's most basic functions. The 4 main vital signs routinely
monitored by healthcare providers include:

 Body temperature
 Pulse rate
 Breathing rate (respiration)
 Blood pressure (Blood pressure is not considered a vital sign, but is often measured along
with the vital signs.)

Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a
medical setting, at home, at the site of a medical emergency, or elsewhere.

What is body temperature?

The normal body temperature of a person varies depending on gender, recent activity, food and
fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body
temperature can range from 97.8° F (36.5°C) to 99°F (37.2°C) for a healthy adult. A person's body
temperature can be taken in any of the following ways:

 Orally. Temperature can be taken by mouth using either the classic glass thermometer, or
the more modern digital thermometers that use an electronic probe to measure body
temperature.
 Rectally. Temperatures taken rectally (using a glass or digital thermometer) tend to be 0.5°F
to 0.7°F higher than when taken by mouth.
 Arm pit (axillary). Temperatures can be taken under the arm using a glass or digital
thermometer. Temperatures taken by this route tend to be 0.3°F to 0.4°F lower than those
temperatures taken by mouth.
 By ear. A special thermometer can quickly measure the temperature of the ear drum, which
reflects the body's core temperature (the temperature of the internal organs).
 By skin. A special thermometer can quickly measure the temperature of the skin on the
forehead.

Body temperature may be abnormal due to fever (high temperature) or hypothermia (low
temperature). A fever is indicated when body temperature rises about one degree or more over the
normal temperature of 98.6°F, according to the American Academy of Family Physicians.
Hypothermia is defined as a drop in body temperature below 95°F.

Glass thermometers containing mercury

According to the Environmental Protection Agency (EPA), mercury is toxic and poses a threat to
the health of humans, as well as to the environment. Because of the risk of breaking, glass
thermometers with mercury should be not be used. If you have a mercury thermometer, dispose of
it properly in accordance with local, state, and federal laws. Contact your local health department,
waste disposal authority, or fire department for information on how to properly dispose of mercury
thermometers.

What is the pulse rate?

The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute.
As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the
blood. Taking a pulse not only measures the heart rate, but also can indicate the following:

 Heart rhythm
 Strength of the pulse

The normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may
fluctuate and increase with exercise, illness, injury, and emotions. Females ages 12 and older, in
general, tend to have faster heart rates than do males. Athletes, such as runners, who do a lot of
cardiovascular conditioning, may have heart rates near 40 beats per minute and experience no
problems.

How to check your pulse

As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries,
which are located close to the surface of the skin at certain points of the body. The pulse can be
found on the side of the neck, on the inside of the elbow, at the wrist, or in the groin. For most
people, it is easiest to take the pulse at the wrist. If you use the lower neck, be sure not to press too
hard, and never press on the pulses on both sides of the lower neck at the same time to prevent
blocking blood flow to the brain.

When taking your pulse:

 Using the first and second fingertips, press firmly but gently on the arteries until you feel a
pulse.
 Begin counting the pulse when the clock's second hand is on the 12.
 Count your pulse for 60 seconds (or for 15 seconds and then multiply by 4 to calculate beats
per minute).
 When counting, do not watch the clock continuously, but concentrate on the beats of the
pulse.
 If unsure about your results, ask another person to count for you.

If your doctor has ordered you to check your own pulse and you are having trouble finding it,
consult your doctor or nurse for additional instruction.

What is the respiration rate?

The respiration rate is the number of breaths a person takes per minute. The rate is usually measured
when a person is at rest and simply involves counting the number of breaths for one minute by
counting how many times the chest rises. Respiration rates may increase with fever, illness, and with
other medical conditions. When checking respiration, it is important to also note whether a person
has any trouble breathing.

Normal respiration rates for an adult person at rest range from 12 to 16 breaths per minute.

What is blood pressure?

Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse or other healthcare
provider, is the force of the blood pushing against the artery walls during contraction and relaxation
of the heart. Each time the heart beats, it pumps blood into the arteries, resulting in the highest
blood pressure as the heart contracts. When the heart relaxes, the blood pressure falls. You can't
take your own blood pressure unless you use an electronic blood pressure monitoring device.
Electronic blood pressure monitors may also measure the heart rate, or pulse.

Two numbers are recorded when measuring blood pressure. The higher number, or systolic
pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through
the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the
heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm
Hg" (millimeters of mercury). This recording represents how high the mercury column in an old-
fashioned manual blood pressure device (called a mercury manometer or sphygmomanometer) is
raised by the pressure of the blood. Today, your doctor's office is more likely to use a simple dial for
this measurement.

High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart
attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased
resistance against the flow of blood, causing the heart to pump harder to circulate the blood.

According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of
Health, high blood pressure, stage 1 for adults is defined as:

 140 mm Hg to 159 mm HG systolic pressure

or
 90 mm Hg to 99 mm Hg diastolic pressure

In an update of NHLBI guidelines for hypertension, high blood pressure, stage 2 for adults is
defined as:

 160 mm Hg – or higher systolic pressure

or
 100 mm Hg – or higher diastolic pressure

Prehypertension is defined as

 120 mm HG to 139 mmHG systolic pressure

or
  80 mmHg to 89 mm Hg diastolic pressure

The NHLBI guidelines now define normal blood pressure as follows:

 Less than 120 mm Hg systolic pressure

and
 Less than 80 mm Hg diastolic pressure

These numbers should be used as a guide only. A single elevated blood pressure measurement is not
necessarily an indication of a problem. Your doctor will want to see multiple blood pressure
measurements over several days or weeks before making a diagnosis of hypertension (high blood
pressure) and initiating treatment. A person who normally runs a lower-than-usual blood pressure
may be considered hypertensive with lower blood pressure measurements than 140/90.

Why should I monitor my blood pressure at home?

For people with high blood pressure, home monitoring allows your doctor to monitor how much
your blood pressure changes during the day, and from day to day. This may also help your doctor
determine how effectively your blood pressure medicine is working.

What special equipment is needed to measure blood

pressure?
You can use either an aneroid monitor, which has a dial gauge and is read by looking at a pointer, or
a digital monitor, in which the blood pressure reading flashes on a small screen.

Aneroid monitor

The aneroid monitor is less expensive than the digital monitor. The cuff is inflated by hand by
squeezing a rubber bulb. Some units even have a special feature to make it easier to put the cuff on
with one hand. However, the unit can be easily damaged and become less accurate. Because the
person using it must listen for heartbeats with the stethoscope, it may not be appropriate for the
hearing-impaired or for single person use.

Digital monitor

The digital monitor is automatic, with the measurements appearing on a small screen. Because the
recordings are easy to read, this is the most popular blood pressure measuring device. It is also easier
to use than the aneroid unit, and since there is no need to listen to heartbeats through the
stethoscope, this is a good device for hearing-impaired patients. One disadvantage is that body
movements or an irregular heart rate can change the accuracy. These units are also more expensive
than the aneroid monitors.

Finger and wrist blood pressure monitors

Tests have shown that finger and/or wrist blood pressure devices are not as accurate in measuring
blood pressure as other types of monitors. They are also more expensive than the other monitors.

Before you measure your blood pressure

 Rest for 3 to 5 minutes without talking before taking a measurement.
 Sit in a comfortable chair, with your back supported and your legs and ankles uncrossed.
 Sit still and place your arm, raised level with your heart, on a table or hard surface.
 Wrap the cuff smoothly and snugly around the upper part of your arm. The cuff should be
sized to fit smoothly, while still allowing enough room for one fingertip to slip under it.
 Be sure the bottom edge of the cuff is at least one inch above the crease in your elbow.
 If using a digital blood pressure monitor, you may be asked to place your arm in the center
of the chest before taking a reading. This helps the monitor account for cuff reading height
relative to the location of your heart.

It is also important, when taking blood pressure readings, that you record the date and time of day
you are taking the reading, as well as the systolic and diastolic measurements. This will be important
information for your doctor to have. Ask your doctor or another healthcare professional to teach
you how to use your blood pressure monitor correctly. Have the monitor routinely checked for
accuracy by taking it with you to your doctor's office. It is also important to make sure the tubing is
not twisted when you store it and keep it away from heat to prevent cracks and leaks.

Proper use of your blood pressure monitor will help you and your doctor in monitoring your blood
pressure.

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