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 checked by healthcare providers include:

 Body temperature
 Pulse rate
 Breathing rate (respiration)
 Blood pressure

Vital signs help detect or monitor medical problems. They 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 a digital thermometer that

uses an electronic probe to measure body temperature.
 Rectally. Temperatures taken rectally tend to be 0.5°F to 0.7°F higher than when
taken by mouth. This is more common in babies because their body doesn't
regulate temperature the way an older child or adult's body does.
 Armpit (axillary). Temperatures can be taken under the arm using a 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
eardrum, 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. Some thermometers don't require contact with the skin to get a
temperature reading.
  Internally. This method is common in people who are critically ill in an intensive
care unit. The temperature can be measured by probes that are placed in the
esophagus, heart, or bladder.

Body temperature may be abnormal due to fever (high temperature) or hypothermia

(low temperature). A fever is indicated when body temperature rises about 1 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

Exposure to mercury can be toxic and poses a threat to a person's health, as well as to
the environment. Don't use glass thermometers with mercury, as they can break. If you
have a mercury thermometer, dispose of it correctly in accordance with local, state, and
federal laws. Contact your local health department, waste disposal authority, or fire
department for information on how to correctly dispose of mercury thermometers.

What is the pulse rate?

The pulse rate is a measurement of the heart rate. This is 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 with 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's easiest to take the pulse at the wrist. If you
use the lower neck, be sure not to press too hard. Never press on the pulses on both
sides of the lower neck at the same time. This can block 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.
 Start counting the pulse when the clock's second hand is on the 12.
 Count your pulse for 60 seconds (or for 30 seconds and then multiply by 2 to
calculate beats per minute).
 When counting, don't 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 healthcare provider has asked you to check your own pulse and you are having
trouble finding it, consult your provider or nurse for additional instruction. Many types of
monitoring devices can help check your pulse. These include fitness tracker devices to
help track your pulse rate.

What is the respiration rate?

The respiration rate is the number of breaths you take each minute. The rate is usually
measured when you are at rest. It simply involves counting the number of breaths for
one minute by counting how many times your chest rises. Respiration rates may
increase with exercise, fever, illness, and with other medical conditions. When checking
respiration, it's important to also note whether you have any trouble breathing.

Normal respiration rates for an adult person at rest range from 12 to 20 breaths per
minute.

What is 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. It results 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 is
called systolic pressure. It refers to the pressure inside the artery when the heart
contracts and pumps blood through the body. The lower number is called diastolic
pressure. It refers to the pressure inside the artery when the heart is at rest and is filling
with blood. Both pressures are recorded as "mm Hg" (millimeters of mercury).

High blood pressure 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. This causes the heart to work 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 does not necessarily mean there is a problem.
Your healthcare provider will want to see multiple blood pressure measurements over
several days or weeks before making a diagnosis of high blood pressure and starting
treatment. Ask your provider when to contact him or her if your blood pressure readings
are not within normal range.

Why should I monitor my blood pressure

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

What special equipment do I need 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 you can use a digital monitor, in which the blood pressure reading flashes
on a small screen. Whichever device you use, make sure the cuff fits your arm. Having
a cuff that is too large or too small can lead to inaccurate readings.

Don't take your blood pressure on an arm or leg that has been severely injured, has had
surgery on the blood vessels, or has injury to the tissue.

Before you measure your blood pressure

The American Heart Association recommends the following guidelines for home blood
pressure monitoring:

 Don't smoke, have caffeinated drinks, or exercise for 30 minutes before taking
your blood pressure.
 Go to the bathroom before the test.
 Relax for 5 minutes before taking the measurement.
 Sit with your back supported (don't sit on a couch or soft chair). Keep your feet
on the floor uncrossed. Place your arm on a solid flat surface (like a table) with
the upper part of the arm at heart level. Place the middle of the cuff directly
above the bend of the elbow. Check the monitor's instruction manual for an
illustration.
 Take multiple readings. When you measure, take 2 to 3 readings one minute
apart and record all the results.
 Take your blood pressure at the same time every day, or as your healthcare
provider recommends.
 Record the date, time, and blood pressure reading.
 Take the record with you to your next medical appointment. If your blood
pressure monitor has a built-in memory, simply take the monitor with you to your
next appointment.
 Call your provider if you have several high readings. Don't be frightened by a
single high blood pressure reading, but if you get several high readings, check in
with your healthcare provider.
 If your blood pressure reaches a systolic (top number) of 180 or higher OR
diastolic (bottom number) of 110 or higher, seek emergency medical treatment.

Ask your healthcare provider 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
healthcare provider's office. It's 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. Monitors will
have to be replaced now and then. Check that your device is working correctly.

Proper use of your blood pressure monitor will help you and your healthcare provider in
monitoring your blood pressure.
There are 4 ways to take (measure) a temperature:

 Under the armpit (axillary method)

 In the mouth (oral method)
 In the ear (tympanic method)
 In the rectum/bum (rectal method)

What type of thermometer should I use?

A digital thermometer is best for taking temperatures by the armpit and mouth.

Fever strips and pacifier thermometers do not give an accurate temperature. Do not use
a mercury thermometer. Mercury is toxic and the thermometer could break.

Over the forehead (temporal artery method)

Non-contact infrared thermometers (NCITs) measure body temperature from a specific
distance by sensing the energy emitted by humans. NCITs offer a way to take your
temperature without touching, unlike traditional thermometers that require physical
contact. NCITs are considered more susceptible to inaccurate measurements than
other thermometers (for example, oral and rectal thermometers, well-calibrated
tympanic thermometers). Several factors influence the ability of NCITs to detect fever
accurately, including:

 Relative humidity
 Significant perspiration
 Positioning on forehead
 Exposure to cold or hot weather before temperature measurement

Follow the best practices and the manufacturer's instructions when using NCITs.
Remember that many factors affect NCIT accuracy and that NCIT readings do not
themselves rule in or rule out the presence of infection. NCIT’s are not the
recommended temperature taking method for children.

Speak to a pharmacist if you have any questions when buying a thermometer. A

pharmacist can help you select the best type of thermometer for the method you choose
to use.

Whichever type of thermometer you use, make sure to clean them (except ear
thermometers) with cool, soapy water and rinse off before and after use.

How should I take a child’s temperature?

From birth to age 5, the most common way to take a temperature is under the armpit.
For children older than 2, temperatures can also be taken by ear or, if the child is able to
sit still long enough, by mouth. The most accurate way to take a temperature is in the
bum (rectal method). See the section on the rectal method to learn how safely take a
rectal temperature.

Always wash your hands before and after taking your child’s temperature. For more
information on hand washing, see HealthLinkBC File #85 Hand Washing: Help Stop the
Spread of Germs.

Make sure to read and follow the manufacturer’s instructions each time you use a
different type or brand of thermometer.

Axillary method (under the armpit)

The armpit method is usually used to check for fever in newborns and young children.

 Place the tip of the thermometer in the centre of the armpit

 Tuck your child’s arm snugly (closely) against their body
 Leave the thermometer in place for about 1 minute, until you hear the “beep”
 Remove the thermometer and read the temperature

Oral method (in the mouth)

The mouth method can be used for children who are older than 5 years of age. It is not
recommended for children younger than 5 years of age, because it is hard for them to
hold the thermometer under their tongue long enough.

 Carefully place the tip of the thermometer under your child’s tongue
 With your child’s mouth closed, leave the thermometer in place for about 1
minute until you hear the “beep”
 Remove the thermometer and read the temperature

Tympanic method (in the ear)

The ear method is recommended for children older than 2 years old. Though quick to
use, the ear method can produce temperature readings that are incorrect, even when
the manufacturer’s directions are followed.

 Use a clean probe tip each time, and follow the manufacturer’s instructions
carefully
 Gently tug on the ear, pulling it back. This will help straighten the ear canal, and
make a clear path inside the ear to the ear drum
 Gently insert the thermometer until the ear canal is fully sealed off
  Squeeze and hold down the button for 1 second
 Remove the thermometer and read the temperature

Rectal method (in the rectum or bum)

The rectal method can be used to check for fevers in newborns and young children. Use
a rectal thermometer only if you are comfortable doing so and a health care provider
has shown you how to do it safely.

 Cover the silver tip with petroleum jelly (such as Vaseline)

 Place your baby on their back with their knees bent
 Gently insert the thermometer in the rectum, about 2.5 cm (1 inch), holding it in
place with your fingers
 Leave the thermometer in place for about 1 minute until you hear the “beep”
 Remove the thermometer and read the temperature

For more detailed instructions on how to take a temperature using the rectal method,
speak to your health care provider.

After a thermometer has been used to take a rectal temperature, do not use it to take an
oral temperature. Make sure that the rectal thermometer is clearly marked so that it is
not used orally. For example, you could label your rectal thermometer with an “R” and
your oral thermometer with an “O”.

How should I take an adult’s

temperature?
Take an adult’s temperature by mouth, in the ear or under the armpit. The armpit
method is less accurate and is normally only used if the person is extremely drowsy or
not clear mentally. Follow the same methods used for taking a child’s temperature.

What is a normal temperature?

The normal temperature range varies, depending on the method you use:

Method Normal temperature range

Armpit 36.5°C - 37.5°C (97.8°F - 99.5°F)
Mouth 35.5°C - 37.5°C (95.9°F - 99.5°F)
Ear 35.8°C - 38°C (96.4°F - 100.4°F)
 Method Normal temperature range
Rectal (Bum) 36.6°C - 38°C (97.9°F - 100.4°F)

Temperatures may vary throughout the day, rising as much as 1 degree in the morning
and reaching a maximum during the late afternoon. Mild increases may be caused by
exercising, too much clothing or bedding, taking a hot bath or being outside in hot
weather.

When a child is sick with an infection, it is normal to have a fever (temperature higher
than 38ºC (100.4ºF)). A fever is part of the normal process of fighting an infection.
Usually, it goes away after 3 days.

Thermometers are not always accurate so it is important to be watching for other signs
that your child might be ill. Also, the degree of a fever does not always indicate how
serious an illness is, but rather the child’s behaviour, overall appearance and other
symptoms such as headache, stiff neck, nausea, and vomiting are generally the most
important factors. A fever with other symptoms may mean a more serious illness.

What can I do if my child has a fever?

 Offer plenty of fluids
 Encourage your child to rest
 Remove extra blankets or extra clothing as long as the child does not become
too cold or shiver. Shivering can cause the body's temperature to rise
 Medicine to reduce a fever is not always needed
 Sponge baths, alcohol baths and rubs are not recommended

When should I take my child to see a

health care provider?
 Call your health care provider if your child:
o Has a fever for more than 3 days
o Is not eating or drinking well
o Is lethargic (low energy), excessively fussy or irritable
o Has a fever and signs of another illness (rash, cough, vomiting, diarrhea)
Babies younger than 3 months of age must be seen by a health care provider when
they have a fever. During the first 3 months of life, babies are not always able to fight
infections, so they need to be seen sooner than older babies and children with fevers.

For babies 3 to 6 months, the parents should speak with their health care provider.
 Systematic examination of pulses
Which and
Where and how? Why?
what order?
 To assess rate and rhythm.
 Radial side of wrist.  Simultaneously with
1. Radial  With tips of index and middle femoral to detect delay.
artery fingers.  Not good for pulse
character.

 Medial border of humerus at elbow

medial to biceps tendon.
2. Brachial  Either with thumb of examiner's right  To assess
artery hand or index and middle of left
hand.

 Press examiner's left thumb

 Best for pulse character
against patient's larynx.
and, to some extent, left
 Press back to feel carotid artery
ventricular function.
against precervical muscles.
3. Carotid artery  To detect carotid
 Alternatively from behind,
stenosis.
curling fingers around side of
 At resuscitation (CPR).
neck.

 To assess cardiac
 Patient lying flat and undressed.
output.
 Place finger directly above pubic
 To detect radiofemoral
ramus and midway between
4. Femoral artery delay.
pubic tubercle and anterior
 To assess peripheral
superior iliac spine.
arterial disease.

 Deep within the popliteal fossa.  Mainly to assess

 Compress against posterior of peripheral arterial
5. Popliteal artery distal femur with knee slightly disease.
flexed.  In people with diabetes.

 Lateral to extensor hallucis

6. Dorsalis pedis (DP) longus (DP).
 As above.
and tibialis posterior  Posterior to medial malleolus
(TP) arteries (foot) (TP).

7. The abdominal  With the flat of the hand per  In peripheral arterial
aorta abdomen, as body habitus disease.
  To detect aneurysmal
allows.
swelling.