CHAPTER 9: Monitoring Vital Signs

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. List the vital signs that are used to help determine a patient's status

2. Explain the importance of monitoring each of the vital signs

3. Describe the signs and symptoms that would warrant an assessment of the vital signs

4. List some of the variables that can affect the accuracy of the vital signs

5. Describe the correct techniques to assess heart rate

6. Describe the correct techniques to assess respiration rate

7. Describe the correct techniques to assess blood pressure

8. Describe the correct techniques to assess temperature

9. List the various tools that are available for the assessment of pain

10. Describe how to respond to an emergency situation

OVERVIEW

The triad of pulse, respiration rate, and blood pressure is often considered as a baseline indicator of a patient's health status, which is why each is called a vital or cardinal sign. All four practice patterns in the Guide to Physical Therapist Practice¹ include the measurement of pulse, blood pressure, and respiration as a routine part of any physiologic examination. Temperature is not included in the practice patterns because it is not routinely assessed by physical therapists. However, as temperature can often provide an important clue to the severity of the patient's illness, particularly the presence of infection, it is discussed in this chapter. Additional measurements of physiologic status, which are not universally considered vital signs, include the assessment of perceived exertion ratings, pain, and pulse oximetry.

Depending on the health history and familiarity with a patient, the taking of vital signs should be a standard procedure for all patients. Clinical indicators that highlight the need for an assessment of vital signs include dyspnea, hypertension, fatigue, syncope, chest pain, irregular heart rate, cyanosis, intermittent claudication, nausea, diaphoresis, and pedal edema. Certain patient populations also warrant a vital sign assessment, including elderly patients (older than 65 years), very young patients (younger than two years), debilitated patients, patients with a history of physical inactivity, and patients recovering from recent trauma. The measurement of vital signs can be used to establish goals and to assess a patient's response to activity.

It is worth remembering that a number of variables can influence the results of the vital signs measurements. These include caffeine consumption, alcohol consumption, tobacco use, physical activity level, medications, and the use of illegal drugs.² The other variables that can influence the results are outlined in Table 9-1.