Vital signs (often shortened to just vitals) are a group of the 4 to 6 most important signs that indicate the status of the body’s vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery.^[1][2] The normal ranges for a person’s vital signs vary with age, weight, gender, and overall health.^[3]

There are four primary vital signs: body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate), often notated as BT, BP, HR, and RR. However, depending on the clinical setting, the vital signs may include other measurements called the 'fifth vital sign' or 'sixth vital sign'. Vital signs are recorded using the LOINC internationally accepted standard coding system.^[4][5]

Early warning scores have been proposed that combine the individual values of vital signs into a single score. This was done in recognition that deteriorating vital signs often precede cardiac arrest and/or admission to the intensive care unit. Used appropriately, a rapid response team can assess and treat a deteriorating patient and prevent adverse outcomes.^[6][7][8]

• 1Primary vital signs
• 2Other signs

Primary vital signs[edit]

There are four primary vital signs which are standard in most medical settings:

1. Heart rate or Pulse

The equipment needed is a thermometer, a sphygmomanometer, and a watch. Though a pulse can be taken by hand, a stethoscope may be required for a patient with a very weak pulse.

Temperature[edit]

Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body.

Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions. The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 38.5 °C/101.3 °F or sustained temp > 38 °C/100.4 °F), or elevated significantly above the individual's normal temperature. Other causes of elevated temperature include hyperthermia.

Temperature depression (hypothermia) also needs to be evaluated. It is also noteworthy to review the trend of the patient's temperature. A fever of 38 °C is not necessarily indicate an ominous sign if the patient's previous temperature has been higher.

Pulse[edit]

The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm). It may also be called 'heart rate'. The pulse is commonly taken at the wrist (radial artery). Alternative sites include the elbow (brachial artery), the neck (carotid artery), behind the knee (popliteal artery), or in the foot (dorsalis pedis or posterior tibial arteries). The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse varies with age: a newborn or infant can have a heart rate of 130–150 bpm, a toddler of 100–120 bpm, an older child of 60–100 bpm, an adolescent of 80–100 bpm, and an adult of 50–80 bpm.

Respiratory rate[edit]

Average respiratory rates vary between ages, but the normal reference range for people age 18 to 65 is 16–20 breaths per minute.^[9] The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it is of limited value. Respiratory rate is a clear indicator of acidotic states, as the main function of respiration is removal of CO₂ leaving bicarbonate base in circulation.

Blood pressure[edit]

The blood pressure is recorded as two readings: a high systolic pressure, which occurs during the maximal contraction of the heart, and the lower diastolic or resting pressure. A normal blood pressure would be 120 being the systolic over 80, the diastolic. Usually the blood pressure is read from the left arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure. The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer. The classic measurement device is a mercury sphygmomanometer, using a column of mercury measured off in millimeters. In the United States and UK, the common form is millimeters of mercury, whilst elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Therefore, elevated blood pressure (hypertension) is variously defined when the systolic number is persistently over 140–160 mmHg. Low blood pressure is hypotension. Blood pressures are also taken at other portions of the extremities. These pressures are called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb (see Ankle brachial pressure index).

Other signs[edit]

In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and body mass index.^[10] Unlike the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.

The definition of vital signs may also vary with the setting of the assessment. EMTs (Emergency Medical Technicians), in particular, are taught to measure the vital signs of: respiration, pulse, skin, pupils, and blood pressure as 'the 5 vital signs' in a non-hospital setting.^[11]

Fifth vital signs[edit]

The 'fifth vital sign' may refer to a few different parameters.

• Pain is considered a standard fifth vital sign in some organizations such as the U.S. Veterans Affairs.^[12] Pain is measured on a 0-10 pain scale based on subjective patient reporting and may be unreliable.^[13] Some studies show that recording pain routinely may not change management.^[14][15][16]
• Menstrual cycle^[17][18]
• Oxygen saturation (as measured by pulse oximetry)^[19][20][21]
• Blood Glucose level ^[22]

Sixth vital signs[edit]

There is no standard 'sixth vital sign'; its use is more informal and discipline-dependent than the above.

• End-tidal CO
  2.^[23][24]
• Functional status^[25]
• Shortness of breath^[26]
• Gait speed^[27]
• Delirium ^[28]

Variations by age[edit]

Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table:

Monitoring[edit]

Monitoring of vital parameters most commonly includes at least blood pressure and heart rate, and preferably also pulse oximetry and respiratory rate. Multimodal monitors that simultaneously measure and display the relevant vital parameters are commonly integrated into the bedside monitors in intensive care units, and the anesthetic machines in operating rooms. These allow for continuous monitoring of a patient, with medical staff being continuously informed of the changes in general condition of a patient.

While monitoring has traditionally been done by nurses and doctors, a number of companies are developing devices which can be used by consumers themselves. These include Scanadu and Azoi.

See also[edit]

References[edit]

1. ^'Vital Signs'.
2. ^http://www.emergencycareforyou.org/VitalCareMagazine/ER101/Default.aspx?id=500
3. ^'Vital Signs Table - ProHealthSys'.
4. ^'Logical Observation Identifiers Names and Codes'.
5. ^'LOINC - A Lingua Franca Critical for Electronic Medical Records and Health Information Exchange'.
6. ^National Early Warning Score Development and Implementation Group (NEWSDIG) (2012). National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. London: Royal College of Physicians. ISBN978-1-86016-471-2.
7. ^National Institute for Health and Clinical Excellence. Clinical guideline 50: Acutely ill patients in hospital. London, 2007.
8. ^'Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient'(PDF). Royal College of Physicians of London. May 2013.
9. ^(RCP 2012)^{[clarification needed]}
10. ^'What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov'.
11. ^Emergency Care, 11th edition, pp. 226–244.
12. ^http://www.va.gov/painmanagement/docs/toolkit.pdf
13. ^Lorenz, Karl A.; Sherbourne, Cathy D.; Shugarman, Lisa R.; Rubenstein, Lisa V.; Wen, Li; Cohen, Angela; Goebel, Joy R.; Hagenmeier, Emily; Simon, Barbara; Lanto, Andy; Asch, Steven M. (1 May 2009). 'How Reliable is Pain as the Fifth Vital Sign?'. J Am Board Fam Med. 22 (3): 291–298. doi:10.3122/jabfm.2009.03.080162. PMID19429735 – via www.jabfm.org.
14. ^'Tips From Other Journals - American Family Physician'.
15. ^Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L (2006). 'Measuring pain as the 5th vital sign does not improve quality of pain management'. J Gen Intern Med. 21 (6): 607–12. doi:10.1111/j.1525-1497.2006.00415.x. PMC1924634. PMID16808744.
16. ^http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf
17. ^American College of Obstetricians and Gynecologists. (2015). 'Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651'. Obstet Gynecol. 126: 143–6.
18. ^American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. (2006). 'Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign'. Pediatrics. 118 (5).CS1 maint: Multiple names: authors list (link)
19. ^Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). 'Pulse oximetry as a fifth vital sign in emergency geriatric assessment'. Acad Emerg Med. 5 (9): 858–65. doi:10.1111/j.1553-2712.1998.tb02813.x. PMID9754497.
20. ^Mower W, Sachs C, Nicklin E, Baraff L (1997). 'Pulse oximetry as a fifth pediatric vital sign'. Pediatrics. 99 (5): 681–6. CiteSeerX10.1.1.575.2200. doi:10.1542/peds.99.5.681. PMID9113944.
21. ^Neff T (1988). 'Routine oximetry. A fifth vital sign?'. Chest. 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID3396392.
22. ^'Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning'. University of Hull. Retrieved 2016-05-14.
23. ^Vardi A, Levin I, Paret G, Barzilay Z (2000). 'The sixth vital sign: end-tidal CO₂ in pediatric trauma patients during transport'. Harefuah. 139 (3–4): 85–7, 168. PMID10979461.
24. ^Holcomb JB, Salinas J, McManus JM, Miller CC, Cooke WH, Convertino VA (2005). 'Manual vital signs reliably predict need for life-saving interventions in trauma patients'. J Trauma. 59 (4): 821–8, discussion 828–9. doi:10.1097/01.ta.0000188125.44129.7c. PMID16374268.
25. ^Bierman A (2001). 'Functional Status: The Sixth Vital Sign'. J Gen Intern Med. 16 (11): 785–6. doi:10.1111/j.1525-1497.2001.10918.x. PMC1495293. PMID11722694.
26. ^'Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD)'. National Guideline Clearinghouse. Archived from the original on 2009-01-17. Retrieved 2009-01-16.
27. ^Studenski S, Perera S, Wallace D, et al. (2003). 'Physical performance measures in the clinical setting'. J Am Geriatr Soc. 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x. PMID12588574.
28. ^https://www.jamda.com/article/S1525-8610(08)00072-8/fulltext
29. ^ ^abcdefghijPEDIATRIC AGE SPECIFIC, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System
30. ^Emergency Care, Page 214
31. ^Emergency Care, Page 215
32. ^Vorvick, Linda. 'Pulse'. MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011.

1. 1. Operating Caregiving Equipment, Tools and Paraphernalia
2. 2. Blender 1. Choose a flat, dry surface on which to operate your blender. 2. Make sure that all the parts are placed in their appropriate places before operating. 3. Put the pitcher onto the base and plug the blender.
3. 3. 4. Place the ingredients in the pitcher and put the lid on firmly. 5. Start operating by choosing the setting appropriate for the task you are going to do. 6. You may add food or ingredients through the secondary lid while the blender is running. 7. Clean the blender after use.
4. 4. Coffee Maker 1. Fill the carafe with water according to the number of cups of coffee you need to make. 2. Pour the water from the carafe into the reservoir of the coffee maker, and place the carafe back into position. 3. Place a coffee filter into the filter basket. The amount of coffee you'll need to add depends on how strong or weak your clients like it. Then, add the coffee into the filter using a spoon. 4. Turn on the coffee maker and wait for your coffee to brew
5. 5. Electric Can Opener 1. Plug the electric can opener into an outlet. 2. Lift up the lever that raises the cutting wheel into the air. Place the lip of the can under the wheel. Put the lever down and press hard enough so that the wheel gets into the can. 3. Turn on the opener while holding the bottom of the can and it will automatically turn as the wheel slices through the can.
6. 6. 4. Remove the can from the opener when it reaches the end and you feel a slight drop of the can. The lid will remain attached to the magnet on the opener and the can is ready to dump. 5. Unplug the opener from the outlet
7. 7. Food Processor 1. Remove the food processor from its box container. 2. Place it on a stable, flat surface. 3. Plug it on the electrical outlet safely. 4. Remove the cover and put the food ingredients to be processed. 5. Put back the cover and turn on the processor to start with the procedure. 6. As soon as you have reached the desired size or texture for your food ingredients, remove the cover and pour the ingredients into your bowl or plate. 7. Unplug the food processor and clean it based on the manufacturers instructions.
8. 8. Microwave Oven Microwave oven is a very useful tool specially during mealtime, but you should exercise special care when using it to cook or reheat food to ensure that it is prepared safely.
9. 9. Position evenly the food items in a covered dish. You may add some liquid if necessary. Cover the dish with a lid or plastic wrap, but make sure not to cover it completely to let steam come out. The moist heat that is created will help destroy harmful bacteria and ensure uniform cooking.
10. 10. It is better to cook large cuts of meat on medium power for longer periods than on high power. This way, heat reaches the center without overcooking outer areas.
11. 11. Mix or rotate food midway through the microwaving time. This is important so as to eliminate cold spots where harmful bacteria can survive, and for more even cooking.
12. 12. When partially cooking food in the microwave oven to finish cooking on the grill or in a conventional oven, it is important to transfer the microwaved food to the other heat source immediately. Never partially cook food and store it for later use.
13. 13. Use a food thermometer or the oven's temperature probe to verify the food has reached a safe minimum internal temperature. Cooking times may vary because ovens vary in power and efficiency. Always allow standing time, which completes the cooking, before checking the internal temperature with a food thermometer.
14. 14. Microwave Defrosting Remove food from the package before defrosting. Do not use foam trays and plastic wraps because they are not heat stable at high temperatures. Melting or warping may cause harmful chemicals to migrate into food. Immediately after defrosting meat and poultry in microwave oven, they should be cooked since some areas of the frozen food may begin to cook during the defrosting time.
15. 15. Bottle Sterilizer 1. Place the recommended amount of water as specified in the manufacturers instructional manual. Then, plug in the unit. 2. Place the bottle upside down (use the prongs to support them individually). Place the nipples, nipple rings and caps in such a way that they do not touch each other. Either prop them between the lower prongs, or place them on the supplied surface.
16. 16. 4. Unplug the unit. 5. Remove the feeding bottles from the sterilizer. 6. Clean the sterilizer based on the manufacturers specifications.
17. 17. 3. Cover the sterilizer and turn on the unit. Sterilization typically takes about 10 minutes with an automatic cycle that raises water temperature to a sufficient level to kill off any bacteria (212 degrees Fahrenheit). Once this cycle ends, the unit automatically begins to cool. Some models or units will not allow you to open the cover until the cooling cycle is completed.
18. 18. Common Equipment in Cleaning, Laundry, and Ironing
19. 19. Flat Iron 1. Check the label of every garment before ironing. This is necessary as some fabrics need special care instructions. 2. Unfold your ironing board near the outlet. Plug in your iron and choose the appropriate setting based on the material of the clothes you are ironing.
20. 20. 3. Preheating the flat iron should be done before starting. You will have to wait about 2-5 minutes to let the iron warm up. 4. Stretch the garment across the ironing board to make sure it is flat. 5. Run the iron over one part of the garment such as the hem just to be sure that it is not too hot.
21. 21. 6. Move the iron over the pants, blouse, or shirt and take note of pleats and pockets. For the shirts, start with the collar next to the sleeves, and then the shirt itself. For pants and shorts, start with the inside then the outside of the pants starting from the waistband down.
22. 22. Generally, skirts and dresses are ironed from the top to the hem. If there are pleats, iron from the bottom and work upward with fast strokes. Each pleat should be pressed individually. Hang each garment that you have ironed to keep it from wrinkling again.
23. 23. Washing Machine 1. The very first step in washing is sorting the clothes of your client. Separate white and light-colored from dark- colored clothes. Also, they should be sorted according to their material. Wash clothes with heavy fabrics together and clothes with light fabrics together. 2. Put detergent into thewashing machine. Let the detergent go to the bottom of the washing machine.
24. 24. 3. Put the clothes loosely into the washing machine. 4. Load the laundry as high as the manufacturer specifies or to the top row of holes in the tub. 5. Close the lid and choose the setting of the washing machine according to what you are washing.
25. 25. 6. Turn on the machine. Let the unit work through all of the cycles. Wait for the machine to turn off before you unload the washed laundry. 7. Load the next batch of clothes and do steps 5 and 6 again until you are done with the laundry. 8. Turn off and unplug the unit.
26. 26. Common Equipment in Taking the Vital Signs
27. 27. When caring for an infant, toddler, child, elderly or person with special needs, measuring the vital signs is of utmost concern. This is also a concern of your client. Hence, he/she has the right to know her vital signs.
28. 28. are bodily functions that reflect the bodys state of health and are easily measurable: Vital signs - body temperature, pulse rate, respiratory rate, and blood pressure. In some cases, the fifth vital sign is considered to be the pain that a person experiences
29. 29. Thermometer . Body temperature - is a measurement of the amount of heat in the body. The balance between heat produced and heat lost is the body temperature. The normal adult body temperature is 37 degrees Celsius. There is a normal range in which a persons body temperature may vary and still be considered normal.
30. 30. Oral : Rectal : Axillary : 36.4 to 37.2 degrees Celsius 37 to 37.8 degrees Celsius 35.9 to 36.7 degrees Celsius
31. 31. Clinical Thermometer may be inserted either into the rectum through the anus (rectal temperature), into the mouth under the tongue (oral or sub-lingual) or armpit (axillary temperature). It is made of glass with a narrowing above the bulb so that the mercury column stays in position even when the instrument is removed. The use of this type is now being eradicated as the mercury content is dangerous to people.
32. 32. Digital Thermometer may be inserted into the mouth under the tongue, under the armpit or into the anus. This thermometer displays the reading in the LCD. This type of thermometer does not use mercury which is hazardous to humans. That is why more and more people are using it now. Also, using this is simple, quick and effective.
33. 33. Ear digital Thermometer measures the heat coming from the eardrum. This release of heat is converted into a temperature and displayed on an LCD. It is very easy to use this. You just have to place the tip in the ear of a person, press the button and in a few seconds, the measurement is seen on the LCD.
34. 34. Infrared Thermometer with Laser Pointer Measures temperature using thermal radiation emitted by the body. It is also called laser thermometer if a laser is utilized to aid in aiming the thermometer. Others call it non-contact thermometer because of its ability to measure temperature from a distance. It provides temperature reading without physically touching the object. All you have to do is aim at the object (as in the forehead), pull the trigger and immediately, you can see the temperature reading on the LCD.
35. 35. Using a Digital Thermometer (armpit) 1. Wash your hands and take the thermometer from its holder. 2. Clean the probe (pointed end) of the thermometer with rubbing alcohol or soap and then rinse it in cool water.
36. 36. 3. Inform the client that you are going to take his temperature under the armpit. 4. Place the thermometer under the clients armpit. (You may have to hold the thermometer specially if your client is very sick and weak that he/she cannot even hold the thermometer with his/her armpit.) 5. Leave the thermometer in place until the thermometer signals it is finished. When the thermometer beeps, it means that it can be removed.
37. 37. 6. Remove the thermometer carefully and read the temperature on the digital display. Clean the tip of the thermometer with a cotton ball soaked in alcohol. Put the thermometers tip cover. Place the thermometer in its container. 7. Record the reading and wash your hands.
38. 38. BP Apparatus Another important measurement that you should learn to take is the blood pressure. Blood Pressure - is the force of the blood pushing against the walls of the blood vessels. The heart contracts as it pumps the blood into the arteries. When the heart is contracting, the pressure is highest. This pressure is what we know as the systolic pressure.
39. 39. When the heart is at its most relaxed state, the pressure is lowest. And we call this diastolic pressure. The following steps will help you measure blood pressure accurately.
40. 40. 1. Wash your hands and prepare the equipment you will use. 2. Introduce yourself and let the patient/client know the procedure to be done. 3. Sanitize the earpieces of the stethoscope with an antiseptic pad.
41. 41. 4. Ask your client to rest quietly. Have him/her lie down or sit on a chair whichever is more comfortable for him/her. 5. If you are using a mercurial apparatus, the measuring scale should be within the level of your eyes. 6. Expose the arm of your client by rolling the sleeves up. Have your clients arm from the elbow down to rest fully extended on the bed or the arm of a chair.
42. 42. 7. Unroll the cuff, loosen the screw and squeeze the cuff with your hands to remove air completely. 8. Wrap the cuff around your clients arm above the elbow, not too tight or too loose.
43. 43. 9. Find your clients brachial pulse at the inside of the elbow. Hold the diaphragm there and inflate the cuff until the pulse disappears. Take note of the reading and immediately deflate the cuff. This is the clients approximate systolic reading and is called the palpated systolic pressure.
44. 44. 10. Place the stethoscopes earpieces into your ears and place the diaphragm on the brachial pulse. 11. Turn the screw to close it. Inflate the cuff until the dial points to 30 mm above the palpated systolic pressure.
45. 45. 12. Turn the screw to open it. Let the air escape slowly until the sound of the pulse comes back. Take note of the calibration that the pointer passes as you hear the first sound. This indicates the systolic pressure.
46. 46. 13. You have to continue releasing the air from the cuff. When you hear the sounds change to something softer and faster and disappear, take note of the calibration. This is now the diastolic pressure.
47. 47. 14. Deflate the cuff complete. Remove it from the arm of your client and record the reading on the clients chart. 15. Wipe the earpieces of the stethoscope with an antiseptic pad and place the equipment back to their proper place and wash your hands.