INTRODUCTION/OBJECTIVES FOR MODULE

Phlebotomists are not only responsible for taking blood, but as part of a health care staff
they may also be responsible for monitoring the vital signs of the patients. They may often
have to check blood pressure and heart rate as part of their responsibilities. They must
update patient records with very detailed information.
In this module, we will:
 Define vital signs and understand the importance of obtaining vital signs
 Perform accurate assessment of patient
 State and describe the different types of equipment needed to effectively measure
vital signs
 Demonstrate technique for obtaining vital signs
 Demonstrate safety and security of patient, equipment and environment when
performing procedure
 Demonstrate appropriate documentation in accordance with hospital policy
 Discuss and demonstrate appropriate communication skills
What are vital signs?
Vital signs are measurements of the body's most basic functions. The four main vital signs
routinely monitored by medical professionals and health care providers indicate the health
status of the client. They include:
 Body temperature
 Pulse rate
 Respiration rate (rate of breathing)
 Blood pressure (Blood pressure is not considered a vital sign but is often measured
along with the vital signs.)

Duties of Phlebotomist
Duties differ by doctor office, hospital and laboratory but may include:
• Drawing blood from patients or donors in hospitals, blood banks, clinics, doctor offices,
laboratories or similar facility for medical purposes
• Assembles equipment (such as needles, blood collection devices, gauze, tourniquet,
cotton, and alcohol)
• Verifies or records identity of patient or donor
• Converses with patients to allay fear of procedure
• Applies tourniquet to arm, locates vein, swabs area with disinfectant, and inserts needle
into vein to draw blood into collection tube. (May also prick finger instead of inserting
needle.)
• Labels and stores blood container for processing
• May conduct interview, take vital signs and test blood samples to screen donors at a
blood bank
• Be able to analyse information and make appropriate recommendations

When taking vital signs, the phlebotomist should:

 Check that the equipment is functional and appropriate
 Know the acceptable range for all vital signs
 Know the client’s usual range
 Know the client’s medical history and mediation
 Control or minimise environmental factors that may affect the vital signs analyse the
result of the vital sign measurement
 Be able to take the vital signs, interpret their significance and make decisions about
client care
 Verify and communicate significant results to Registered Nurse or Medical Doctor

ASSESSING BODY TEMPERATURE

What is body temperature?
Body temperature is a measure of the body's ability to make and get rid of heat. The human
body is warm blooded, with a built-in mechanism that maintains a balance between heat
production and heat loss. As a result, the internal or core temperature is stable. Measuring
body temperature provides allows for an objective assessment of the body’s ability to
maintain temperature regulation and identify deviations from the acceptable range
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 degrees F (or Fahrenheit, equivalent to 36.5
degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for a healthy adult.
The normal body temperature for a child is about 98.6°F (37°C) when taken orally and
99.6°F (37.5°C) when taken rectally.
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
to 0.7 degrees F higher than when taken by mouth.
Axillary. Temperatures can be taken under the arm using a glass or digital thermometer.
Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those
temperatures taken by mouth.
Tympanic (ear). Temperature of the ear drum, which reflects the body's core temperature
(the temperature of the internal organs).
Skin. A special thermometer can quickly measure the temperature of the skin on the
forehead.
Groin. Temperature measured by placing the thermometer in the client’s groin area.
Types of thermometers
1. Digital thermometers
You can get the fastest and most accurate results with a digital thermometer. Be sure to
read the instructions given to with the thermometer. There is a sensor on the end of the
thermometer that touches the body part and reads the body’s temperature. Can be used 3
ways:
 Oral (in the mouth)
 Rectal (in the bottom)
 Axillary (under the arm)
Do not use the same thermometer for both oral and rectal readings. Be sure to label your
thermometer either “oral” or “rectal” to know the difference.
Plastic “fever” strip thermometers
If you are looking for an exact temperature this is NOT what you should use. They come in
small plastic strips and you place them on the forehead. You cannot rely on these for taking
a temperature, especially for infants and young children.
Pacifier thermometer
When an infant is younger than 3 months you cannot use a pacifier thermometer to take
their temperature. The baby must be still for a few minutes with the pacifier in their mouth.
It is generally very hard for babies to stay very still and this may make the reading on the
thermometer wrong.
2. Glass and mercury thermometers
This is a glass tube with mercury inside of the tube. The tube goes underneath the tongue
and the body temperature will cause the mercury to rise inside the tube. The point where
the mercury stops will be what your temperature is. Once, a very popular way to take a
temperature. But according to the Environmental Protection Agency, mercury is a toxic
substance that poses a threat to the health of humans, as well as to the environment.
Because of the risk of breaking, glass thermometers containing mercury should be removed
from use and disposed of properly in accordance with state laws. that these thermometers
now create the risk of exposure to mercury.
ASSESSING PULSE
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 (bpm). 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.

 New-borns 0 to 1 month old: 70 to 190 beats per minute.
 Infants 1 to 11 months old: 80 to 160 beats per minute.
 Children 1 to 2 years old: 80 to 130 beats per minute
 Children 3 to 4 years old: 80 to 120 beats per minute.
 Children 5 to 6 years old: 75 to 115 beats per minute.
 Children 7 to 9 years old: 70 to 110 beats per minute.
 Children 10 years and older, and adults (including seniors): 60 to 100 beats per
minute.
The pulse rate may fluctuate and increase with exercise, illness, injury, body size, sudden
increase in blood volume, certain diseases 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.
ASSESSING RESPIRATION

The respiration rate is the number of breaths a person takes per minute (rpm). 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 and falls. Normal rates

 New-borns- 30-60/min
 Infants- 28-40/min
 Child- 20-28 /min
 Adults 12-29/min
Respiration rates may increase with fever, illness, and with other medical conditions.
In addition to the rate of breathing, it is important t note
The Rhythm – pattern and regularity. Normal is evenly spaced
The Depth- volume of air inhaled or exhaled. My be normal, shallow or deep.

When checking respiration, it is important to also note for

 Cyanosis- bluish discoloration of the skin and mucus membrane due to inadequate
oxygenation
 Signs of hypoxia- volume or air entering lungs is limited. Signs include, elevated
blood pressure and pulse rate, shortness of breath and fatigue, cyanosis, use of
accessory muscles during breathing, flaring of nares, retraction of sternum and
intercostal muscles, apprehension and agitation, confusion, visible perspiration.

Respiration is assessed without client knowledge. If the person is aware they may
unintentionally change their breathing patterns.

Procedure
 Explain to the patient what you are about to do - even if the patient is unconscious;
  Ensure the patient is comfortable;
 Make sure the patient is as relaxed as possible;
 Observe if the patient is distressed in any way;
 It is best to monitor and record the respirations immediately after taking the pulse;
this will aid in a more accurate recording, as the patient will not be aware that you
are observing respirations. Awareness that respirations are being recorded can make
people alter their breathing;
 Observe the rise and fall of the chest (inspiration and expiration) - this count as one
breath;
 The respirations should be counted for a full minute in order to have an accurate
recording;
 Note the pattern of breathing and the depth of the breaths;
 Document your findings on the patient’s observation chart, note any changes and
report to the medical team;
 Before leaving, ensure the patient is comfortable.

Pulse Oximetry
Pulse oximetry is the non- invasive measurement of arterial blood oxygen saturation, i.e. the
extent to which haemoglobin is loaded in the blood. A pulse oximeter is a probe with a light
emitting diode (LED). The light waves emitted by the LED are absorbed then reflected by the
blood. The reflected light is processed by the oximeter, which calculates pulse oxygen
saturation (Sp02 ). This normal percentage should be between 94 percent and 100 percent,
which indicates a healthy level of haemoglobin carrying oxygen through the blood. A
percentage less than 90 should be reported.
Assessing blood pressure
Blood pressure 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.

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,
a simple dial for this measurement or digital is used. Blood pressure is thus written for
example 120/60 mmHg

High blood pressure, or hypertension, directly increases the risk of heart attack, heart
failure, and stroke. 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.

Blood pressure is categorized as normal, elevated, or stage 1 or stage 2 high blood pressure:
 Normal blood pressure is systolic of less than 120 and diastolic of less than 80
(120/80)
 Elevated blood pressure is systolic of 120 to 129 and diastolic less than 80
 Stage 1 high blood pressure is systolic is 130 to 139 or diastolic between
80 to 89
 Stage 2 high blood pressure is when systolic is 140 or higher or the
diastolic is 90 or higher

These numbers should be used as a guide only. A single blood pressure measurement that is
higher than normal is not necessarily an indication of a problem. Multiple blood pressure
measurements over several days or weeks is needed before making a diagnosis of high
blood pressure and starting treatment.

Equipment needed to measure blood pressure?

An aneroid monitor, which has a dial gauge and is read
by looking at a pointer. The aneroid monitor is less
expensive than the digital monitor. The cuff is inflated
by hand by squeezing a rubber bulb. Because the
person using it must listen for heartbeats with the
stethoscope, it may not be appropriate for the hearing-
impaired.

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.

Tests have shown that finger and/or wrist blood pressure devices are not as accurate in
measuring blood pressure as other types of monitors. In addition, they are more expensive
than the other monitors.
Before you measure your blood pressure:
The American Heart Association recommends the following guidelines for home blood
pressure monitoring:
 Don't smoke or drink coffee for 30 minutes before taking your blood pressure.
 Go to the bathroom before the test.
 Relax for 5 minutes before taking the measurement.
https://familydoctor.org/condition/fever-in-infants-and-children/
https://www.hopkinsmedicine.org/healthlibrary/conditions/cardiovascular_diseases/vital_s
igns_body_temperature_pulse_rate_respiration_rate_blood_pressure_85,P00866