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Vital signs (aka “vitals”) include the measurement of temperature, respiratory rate, pulse, blood pressure, and oxygen saturation. These numbers provide critical information (hence the name “vitals”) about a patient’s state of health. In particular, vital signs:
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Can point to the existence of an acute medical problem.
Are a means of rapidly quantifying the magnitude of an illness and how well the body is coping with the resultant physiologic stress. Often, the more deranged the vitals, the sicker is the patient.
Are a marker of chronic disease states. For example, hypertension is defined as chronically elevated blood pressure.
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Most patients will have had their vital signs measured by a nurse or healthcare assistant before you see them. However, these values are of such great importance that you should get in the habit of repeating them yourself if they are very abnormal. As noted later in this chapter, there is significant potential for measurement error, so repeat determinations can provide critical information.
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In the outpatient/elective visit setting, the patient should have had the opportunity to rest for approximately 5 minutes so that the values are not affected by the exertion required to walk to the exam room. All measurements are made while the patient is seated (or lying in bed if hospitalized or presenting with acute symptoms).
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Start by looking at the patient in their entirety, if possible, from an out-of-the-way perch. Do they seem anxious, in pain, or upset? What about their dress and hygiene? Remember, the exam begins as soon as you lay eyes on the patient.
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This can be done via oral, ear, rectal, or nontouch sensors.
Temperature is measured in either Celsius or Fahrenheit, with a fever defined as greater than 38 to 38.5°C or 101 to 101.5°F.
Temperature measurement is of greatest importance when there is concern about infection or other acute inflammatory states.
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Respirations are recorded as breaths per minute.
They should be counted for at least 30 seconds because the total number of breaths in a 15-second period is small and any miscounting can result in relatively large errors when multiplied by 4.
Try to measure the respiratory rate as surreptitiously as possible so that the patient does not consciously alter their rate of breathing, which can happen if they feel they are being watched. This can be done by observing the rise and fall of the patient’s chest area while you appear to be taking their pulse.
Normal respiratory rate (RR) is between 12 and 20 breaths per minute.
In general, RR is not relevant information for the routine examination. However, particularly in the setting of acute illness, it can be a useful marker of disease severity and compensation. Increases in RR measured over time help to identify ...