Vital Signs in Patient Assessment

Vital signs

Vital signs

General

General

Vital signs

Vital signs

Vital sign

Vital sign



Vital sign

Vital sign



Temperature

Temperature



respiratory

respiratory



Pulse

Pulse



Blood pressure

Blood pressure



orientation

orientation



Pain

Pain



oxygen saturation

oxygen saturation

.

.

Vital sign

Vital sign



These signs may be

These signs may be

observed, measured,

observed, measured,

and monitored

and monitored

 to

 to

assess an individual's

assess an individual's

level of physical

level of physical

functioning.

functioning.

Vital sign

Vital sign



All measurements

All measurements

are made while the

are made while the

patient is 

patient is 

seated.

seated.

Vital sign

Vital sign



Prior 

Prior 

to measuring

to measuring

vital signs, the patient

vital signs, the patient

should have had the

should have had the

opportunity to 

opportunity to 

sit for

sit for

approximately five

approximately five

minutes.

minutes.

O

O

b

b

s

s

e

e

r

r

v

v

a

a

t

t

i

i

o

o

n

n



Before diving in

Before diving in

,

,

take a 

take a 

minute

minute

 or so

 or so

to look at the

to look at the

patient in 

patient in 

their

their

entirety

entirety

.

.

O

O

b

b

s

s

e

e

r

r

v

v

a

a

t

t

i

i

o

o

n

n



Does the patient

Does the patient

seem 

seem 

anxious

anxious

, in

, in

pain, upset? What

pain, upset? What

about their dress and

about their dress and

hygiene? Remember,

hygiene? Remember,

the 

the 

exam begins

exam begins

 as

 as

soon as you

soon as you

 lay 

 lay 

eyes

eyes

on the patient.

on the patient.

Temperature

Temperature

Vital signs

منبع تولید گرما در بدن متابولیسم است.



ا

خ‍

‍ت‍

‍لا

ف

م‍

‍ی‍

‍ا

ن

گ‍

‍ر

م‍

‍ا

ی

ت‍

‍و

ل‍

‍ی‍

‍د

ش‍

‍د

ه

و

گ‍

‍ر

م‍

‍ا

ی

ه‍

‍د

ر

ر

ف‍

‍ت‍

‍ه

گ‍

‍ر

م‍

‍ا

ی

ب‍

‍د

ن

م‍

‍ی

ب‍

‍ا

ش‍

‍د

.



د

م‍

‍ا

ی

م‍

‍ر

ک‍

‍ز

ی

ت‍

‍و

س‍

‍ط

م‍

‍ر

ک‍

‍ز

ت‍

‍ن‍

‍ظ‍

‍ی‍

‍م

د

ر

ج‍

‍ه

ح‍

‍ر

ا

ر

ت

د

ر

ه‍

‍ی‍

‍پ‍

‍و

ت‍

‍ا

لا

م‍

‍و

س

ت‍

‍ن‍

‍ظ‍

‍ی‍

‍م

م‍

‍ی

ش‍

‍و

د

.



د

ر

ج‍

‍ه

ح‍

‍ر

ا

ر

ت

ط‍

‍ب‍

‍ی‍

‍ع‍

‍ی

ب‍

‍د

ن

9

8

/

6

د

ر

ج‍

‍ه

ف‍

‍ا

ر

نه‍

‍ا

ی‍

‍ت

ب‍

‍ین

3

5

/

9

د

ر

ج‍

‍ه

س‍

‍ل‍

‍س‍

‍ی‍

‍و

س

ی‍

‍ا

9

6

/

6

د

ر

ج‍

‍ه

ف‍

‍ا

ر

ن‍

‍ه‍

‍ا

ی‍

‍ت

و

3

7

/

4

د

ر

ج‍

‍ه

س‍

‍ل‍

‍س‍

‍ی‍

‍و

س

ی‍

‍ا

9

9

/

6

د

ر

ج‍

‍ه

ف‍

‍ا

ر

ن‍

‍ه‍

‍ا

ی‍

‍ت

ا

س‍

‍ت

.

درجه حرارت



م‍

‍ر

ک‍

‍ز

ی



مح‍

‍ی‍

‍ط‍

‍ی



م‍

‍ر

ک‍

‍ز

ی

ا

ز

ط‍

‍ر

ی‍

‍ق

ر

ک‍

‍ت‍

‍و

م

و

تم‍

‍پ‍

‍ا

ن

م‍

‍ر

ی

،

ش‍

‍ر

یا

ن

ر

ی‍

‍و

ی

و

م‍

‍ث‍

‍ا

ن‍

‍ه



مح‍

‍ی‍

‍ط‍

‍ی

ا

ز

ط‍

‍ر

ی‍

‍ق

ز

ی‍

‍ر

آ

گ‍

‍ز

ی‍

‍لا

ر

ی

و

ا

و

ر

ا

ل

Rectal Thermometer

Rectal Thermometer

مکانیسم های افزایش متابولیسم



ه‍

‍و

ر

م‍

‍و

نه‍

‍ا

م‍

‍ث‍

‍ل

ا

پ‍

‍ی

ن‍

‍ف‍

‍ر

ی‍

‍ن

و

ن‍

‍و

ر

ا

پ‍

‍ی

ن‍

‍ف‍

‍ر

ی‍

‍ن

(

ا

ن‍

‍ت‍

‍ق‍

‍ا

ل

د

ه‍

‍ن‍

‍د

ه

ه‍

‍ا

ی

ش‍

‍ی‍

‍م‍

‍ی‍

‍ا

ی‍

‍ی

د

س‍

‍ت‍

‍گ‍

‍ا

ه

ع‍

‍ص‍

‍ب‍

‍ی

س‍

‍م‍

‍پ‍

‍ا

ت‍

‍ی‍

‍ک

)

و

ت‍

‍ی‍

‍ر

و

ئ‍

‍ی‍

‍د

پ‍

‍س

ا

ز

آ

ز

ا

د

ش‍

‍د

ن

ب‍

‍ا

ع‍

‍ث

ا

ف‍

‍ز

ا

ی‍

‍ش

ت‍

‍و

ل‍

‍ی‍

‍د

گ‍

‍ر

م‍

‍ا

و

ک‍

‍ا

ه‍

‍ش

ت‍

‍و

ل‍

‍ی‍

‍د

ا

ن‍

‍ر

ژ

ی

م‍

‍ی

ش‍

‍و

ن‍

‍د

.



ح‍

‍ر

ک‍

‍ت

ع‍

‍ض‍

‍لا

ت

:

ل‍

‍ر

ز

با

ع‍

‍ث

ت‍

‍و

ل‍

‍ی‍

‍د

گ‍

‍ر

م‍

‍ا

م‍

‍ی

ش‍

‍و

د

.



و

ر

ز

ش

عوال موثر بر درجه حرارت



س‍

‍ن



ج‍

‍ن‍

‍س



مح‍

‍ی‍

‍ط



ت‍

‍ن‍

‍ی‍

‍د

گ‍

‍ی



ر

ی‍

‍ت‍

‍م

2

4

س‍

‍ا

ع‍

‍ت‍

‍ه

Temperature

Temperature



Old people

Old people

, people

, people

with disabilities,

with disabilities,

babies

babies

 and young

 and young

children typically

children typically

feel more

feel more

comfortable

comfortable

 at

 at

higher

higher

temperatures.

temperatures.

Temperature

Temperature



Women notice that

Women notice that

they are 

they are 

feeling

feeling

cool quicker than

cool quicker than

men

men

, which may be

, which may be

related to their

related to their

different body size.

different body size.

Temperature

Temperature



The normal body

The normal body

temperature of a

temperature of a

person varies

person varies

depending on 

depending on 

gender,

gender,

recent activity, food

recent activity, food

and fluid

and fluid

consumption

consumption

, 

, 

time

time

 of

 of

day, and, in women,

day, and, in women,

the stage of the

the stage of the

menstrual cycle.

menstrual cycle.

منابع اتلاف گرما در بدن



ت‍

‍ب‍

‍خ‍

‍یر



ع‍

‍ر

ق



گ‍

‍ر

م

و

م‍

‍ر

ط‍

‍و

ب

ش‍

‍د

ن

ه‍

‍و

ا

ی

ا

س‍

‍ت‍

‍ن‍

‍ش‍

‍ا

ق‍

‍ی



د

ف‍

‍ع

ا

د

ر

ا

ر

و

م‍

‍د

ف‍

‍و

ع

Temperature

Temperature



Temperature is

Temperature is

measured in either

measured in either

Celcius or

Celcius or

Farenheit

Farenheit

Temperature

Temperature



R

R

e

e

c

c

t

t

a

a

l

l

l

l

y

y

t

t

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

s

s

t

t

a

a

k

k

e

e

n

n

r

r

e

e

c

c

t

t

a

a

l

l

l

l

y

y

(

(

u

u

s

s

i

i

n

n

g

g

a

a

m

m

e

e

r

r

c

c

u

u

r

r

y

y

o

o

r

r

d

d

i

i

g

g

i

i

t

t

a

a

l

l

t

t

h

h

e

e

r

r

m

m

o

o

m

m

e

e

t

t

e

e

r

r

)

)

t

t

e

e

n

n

d

d

t

t

o

o

b

b

e

e

0

0

.

.

5

5

t

t

o

o

0

0

.

.

7

7

°

°

(

(

F

F

a

a

h

h

r

r

e

e

n

n

h

h

e

e

i

i

t

t

)

)

h

h

i

i

g

g

h

h

e

e

r

r

t

t

h

h

a

a

n

n

w

w

h

h

e

e

n

n

t

t

a

a

k

k

e

e

n

n

b

b

y

y

m

m

o

o

u

u

t

t

h

h

.

.

Temperature

Temperature



O

O

r

r

a

a

l

l

t

t

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

c

c

a

a

n

n

b

b

e

e

t

t

a

a

k

k

e

e

n

n

b

b

y

y

m

m

o

o

u

u

t

t

h

h

u

u

s

s

i

i

n

n

g

g

c

c

l

l

a

a

s

s

s

s

i

i

c

c

g

g

l

l

a

a

s

s

s

s

m

m

e

e

r

r

c

c

u

u

r

r

y

y

-

-

f

f

i

i

l

l

l

l

e

e

d

d

o

o

r

r

d

d

i

i

g

g

i

i

t

t

a

a

l

l

t

t

h

h

e

e

r

r

m

m

o

o

m

m

e

e

t

t

e

e

r

r

s

s

.

.

Temperature

Temperature



A

A

x

x

i

i

l

l

l

l

a

a

r

r

y

y

t

t

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

s

s

c

c

a

a

n

n

b

b

e

e

t

t

a

a

k

k

e

e

n

n

u

u

n

n

d

d

e

e

r

r

t

t

h

h

e

e

a

a

r

r

m

m

.

.

T

T

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

s

s

t

t

a

a

k

k

e

e

n

n

b

b

y

y

t

t

h

h

i

i

s

s

r

r

o

o

u

u

t

t

e

e

t

t

e

e

n

n

d

d

t

t

o

o

b

b

e

e

0

0

.

.

3

3

t

t

o

o

0

0

.

.

4

4

°

°

(

(

F

F

a

a

h

h

r

r

e

e

n

n

h

h

e

e

i

i

t

t

)

)

l

l

o

o

w

w

e

e

r

r

t

t

h

h

a

a

n

n

t

t

h

h

o

o

s

s

e

e

t

t

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

s

s

t

t

a

a

k

k

e

e

n

n

b

b

y

y

m

m

o

o

u

u

t

t

h

h

.

.

Temperature

Temperature



B

B

y

y

e

e

a

a

r

r

a

a

s

s

p

p

e

e

c

c

i

i

a

a

l

l

t

t

h

h

e

e

r

r

m

m

o

o

m

m

e

e

t

t

e

e

r

r

c

c

a

a

n

n

q

q

u

u

i

i

c

c

k

k

l

l

y

y

m

m

e

e

a

a

s

s

u

u

r

r

e

e

t

t

h

h

e

e

t

t

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

o

o

f

f

t

t

h

h

e

e

e

e

a

a

r

r

d

d

r

r

u

u

m

m

,

,

w

w

h

h

i

i

c

c

h

h

r

r

e

e

f

f

l

l

e

e

c

c

t

t

s

s

t

t

h

h

e

e

b

b

o

o

d

d

y

y

'

'

s

s

c

c

o

o

r

r

e

e

t

t

e

e

m

m

p

p

e

e

r

r

a

a

t

t

u

u

r

r

e

e

.

.

Fever

Fever

or pyrexia or hyperpyrexia

or pyrexia or hyperpyrexia

ا

ا

ف‍

ف‍

‍ز

‍ز

ا

ا

ی‍

ی‍

‍ش

‍ش

د

د

ر

ر

ج‍

ج‍

‍ه

‍ه

ح‍

ح‍

‍ر

‍ر

ا

ا

ر

ر

ت

ت

ب‍

ب‍

‍د

‍د

ن

ن

ب‍

ب‍

‍ی‍

‍ی‍

‍ش

‍ش

ا

ا

ز

ز

4

4

1

1

د

د

ر

ر

ج‍

ج‍

‍ه

‍ه

س‍

س‍

‍ل‍

‍ل‍

‍س‍

‍س‍

‍ی‍

‍ی‍

‍و

‍و

س

س

ی‍

ی‍

‍ا

‍ا

1

1

0

0

5

5

د

د

ر

ر

ج‍

ج‍

‍ه

‍ه

ف‍

ف‍

‍ا

‍ا

ر

ر

ن‍

ن‍

‍ه‍

‍ه‍

‍ا

‍ا

ی‍

ی‍

‍ت

‍ت

ر

ر

ا

ا

ه‍

ه‍

‍ا

‍ا

ی‍

ی‍

‍پ‍

‍پ‍

‍ر

‍ر

پ‍

پ‍

‍ا

‍ا

ی‍

ی‍

‍ر

‍ر

ک‍

ک‍

‍س‍

‍س‍

‍ی‍

‍ی‍

‍ا

‍ا

م‍

م‍

‍ی

‍ی

گ‍

گ‍

‍و

‍و

ی‍

ی‍

‍ن‍

‍ن‍

‍د

‍د

.

.

Hypothermia

Hypothermia



Hypothermia

Hypothermia

 is

 is

defined as a drop in

defined as a drop in

body temperature

body temperature

below  35/9 .

below  35/9 .



If  drop below 34

If  drop below 34

death

death

R

R

e

e

s

s

p

p

i

i

r

r

a

a

t

t

i

i

o

o

n

n

r

r

a

a

t

t

e

e

Vital signs

رویداد فیزیکی

•

ت‍

‍ه‍

‍و

ی‍

‍ه

ر

ی‍

‍و

ی

•

ت‍

‍ن‍

‍ف‍

‍س

خ‍

‍ا

ر

ج‍

‍ی

•

ت‍

‍ن‍

‍ف‍

‍س

د

ا

خ‍

‍ل‍

‍ی

مرکز تنفس



بصل النخاع و پل مغزی



ش‍

‍ی‍

‍م‍

‍ی‍

‍ا

ی‍

‍ی

و

ا

ق‍

‍ع

د

ر

ق‍

‍و

س

آ

ئ‍

‍و

ر

ت

ش‍

‍ر

یا

ن

ه‍

‍ا

ی

ک‍

‍ا

ر

و

ت‍

‍ی‍

‍د

و

ن‍

‍ی‍

‍ز

م‍

‍ح‍

‍ر

ک

ه‍

‍ا

ی

و

ا

ق‍

‍ع

د

ر

ر

ی‍

‍ه

و

گ‍

‍ی‍

‍ر

ن‍

‍د

ه

ه‍

‍ا

ی

ع‍

‍ض‍

‍لا

ت

و

م‍

‍ف‍

‍ا

ص‍

‍ل

W

W

h

h

a

a

t

t

i

i

s

s

t

t

h

h

e

e

r

r

e

e

s

s

p

p

i

i

r

r

a

a

t

t

i

i

o

o

n

n

r

r

a

a

t

t

e

e

?

?



The respiration rate is

The respiration rate is

the 

the 

number of breaths

number of breaths

a person takes per

a person takes per

minute.

minute.

R

R

e

e

s

s

p

p

i

i

r

r

a

a

t

t

o

o

r

r

y

y

R

R

a

a

t

t

e

e



Try to do this as

Try to do this as

surreptitiously as

surreptitiously as

possible

possible

.

.

Observing the rise

Observing the rise

and fall of the

and fall of the

patient's hospital

patient's hospital

gown while you

gown while you

appear to be 

appear to be 

taking

taking

their pulse

their pulse

.

.

R

R

e

e

s

s

p

p

i

i

r

r

a

a

t

t

o

o

r

r

y

y

R

R

a

a

t

t

e

e



They should be

They should be

counted for 

counted for 

at least

at least

30 

30 

seconds 

seconds 

15

15

second period is

second period is

rather small and

rather small and

any miscounting

any miscounting

can result in rather

can result in rather

large errors when

large errors when

multiplied by 4

multiplied by 4

.

.

R

R

e

e

s

s

p

p

i

i

r

r

a

a

t

t

o

o

r

r

y

y

R

R

a

a

t

t

e

e



Respiration rates

Respiration rates

may increase with

may increase with

fever, illness,…

fever, illness,…

.

.

When checking

When checking

respiration, also

respiration, also

note whether a

note whether a

person has 

person has 

any

any

difficulty breathing

difficulty breathing

.

.

A

A

b

b

n

n

o

o

r

r

m

m

a

a

l

l

R

R

e

e

s

s

p

p

i

i

r

r

a

a

t

t

o

o

r

r

y

y

R

R

a

a

t

t

e

e



Respiration rates

Respiration rates

over 25

over 25

 or under

 or under

12 breaths

12 breaths

 per

 per

minute (when at

minute (when at

rest) may be

rest) may be

considered

considered

abnormal

abnormal

under 12 breaths

under 12 breaths

over 25 breaths

over 25 breaths

R

R

e

e

s

s

p

p

i

i

r

r

a

a

t

t

o

o

r

r

y

y

R

R

a

a

t

t

e

e



Normal respiration

Normal respiration

rates at rest range

rates at rest range

from 

from 

15 to 20

15 to 20

breaths

breaths

 per minute.

 per minute.

In the 

In the 

cardio-

cardio-

pulmonary

pulmonary

 illness,

 illness,

it can be a very

it can be a very

reliable

reliable

 marker of

 marker of

disease activity.

disease activity.

15

15

20

20

Pulse

Pulse

Vital signs

Vital signs

Pulse rate

Pulse rate



The normal

The normal

pulse for healthy

pulse for healthy

adults ranges

adults ranges

from 

from 

60 to 100

60 to 100

beats per

beats per

minute.

minute.

Pulse rate

Pulse rate



The pulse rate may

The pulse rate may

fluctuate and increase

fluctuate and increase

with 

with 

exercise, illness

exercise, illness

,

,

injury

injury

, and 

, and 

emotions

emotions

.

.

Girls ages 

Girls ages 

12 

12 

and

and

older and

older and

 women

 women

, in

, in

general, tend to have

general, tend to have

faster

faster

 heart rates than

 heart rates than

do boys and men.

do boys and men.

Pulse rate

Pulse rate



Athletes, such as

Athletes, such as

runners

runners

, may

, may

have heart rates

have heart rates

in the 

in the 

40's 

40's 

and

and

experience no

experience no

problems.

problems.

H

H

o

o

w

w

t

t

o

o

c

c

h

h

e

e

c

c

k

k

y

y

o

o

u

u

r

r

p

p

u

u

l

l

s

s

e

e



You feel the 

You feel the 

beats

beats

 by

 by

firmly pressing

firmly pressing

 on the

 on the

arteries, which are

arteries, which are

located 

located 

close to the

close to the

surface

surface

 of the skin at

 of the skin at

certain points of the

certain points of the

body.

body.

H

H

o

o

w

w

t

t

o

o

c

c

h

h

e

e

c

c

k

k

y

y

o

o

u

u

r

r

p

p

u

u

l

l

s

s

e

e



The pulse can be

The pulse can be

found on the 

found on the 

side

side

of the lower neck

of the lower neck

,

,

on the 

on the 

inside of the

inside of the

elbow

elbow

, or at the

, or at the

wrist

wrist

.

.

P

P

u

u

l

l

s

s

e

e



Place the

Place the

 tips 

 tips 

of your

of your

index 

index 

and

and

 middle

 middle

fingers

fingers

 just proximal

 just proximal

to the patients wrist

to the patients wrist

on the 

on the 

thumb side

thumb side

,

,

orienting them so that

orienting them so that

they are both over the

they are both over the

length of the vessel.

length of the vessel.

P

u

l

s

e



Push lightly at first,

Push lightly at first,

adding pressure if

adding pressure if

there is a lot of

there is a lot of

subcutaneous fat or

subcutaneous fat or

you are 

you are 

unable to

unable to

detect a pulse

detect a pulse

. If you

. If you

push too hard

push too hard

, you

, you

might 

might 

occlude the

occlude the

vessel

vessel

 and mistake

 and mistake

your own pulse

your own pulse

 for

 for

that of the patient.

that of the patient.

P

u

l

s

e

:

Q

u

a

n

t

i

t

y



Measure the rate of

Measure the rate of

the pulse (recorded in

the pulse (recorded in

beats per minute).

beats per minute).

Count for 

Count for 

30 seconds

30 seconds

and multiply by 2 (or

and multiply by 2 (or

15 seconds x 4

15 seconds x 4

).

).

P

u

l

s

e

:

Q

u

a

n

t

i

t

y



If the rate is

If the rate is

particularly 

particularly 

slow or

slow or

fast

fast

, it is probably

, it is probably

best to measure for

best to measure for

a 

a 

full 60 seconds

full 60 seconds

 in

 in

order to minimize

order to minimize

the error.

the error.

P

u

l

s

e

:

R

e

g

u

l

a

r

i

t

y



Is the time

Is the time

between beats

between beats

constant

constant

?.

?.

Irregular

Irregular

rhythms

rhythms

, are

, are

quite 

quite 

common

common

.

.

P

u

l

s

e

:

V

o

l

u

m

e



Does the pulse 

Does the pulse 

volume

volume

 feel normal? This

 feel normal? This

reflects changes in 

reflects changes in 

stroke volume

stroke volume

. In

. In

hypovolemia

hypovolemia

, the pulse volume is relatively

, the pulse volume is relatively

low

low

Blood pressure

Blood pressure

Vital signs

P

P

r

r

e

e

p

p

a

a

r

r

a

a

t

t

i

i

o

o

n

n

f

f

o

o

r

r

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t

P

P

r

r

e

e

p

p

a

a

r

r

a

a

t

t

i

i

o

o

n

n

f

f

o

o

r

r

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



Patient  should

abstain from eating,

drinking, smoking and

taking drugs that

affect the blood

pressure one hour

before measurement.

Remember the following

Remember the following

for

for

accuracy of your readings

accuracy of your readings



Instruct your patients

Instruct your patients

to avoid 

to avoid 

coffee

coffee

,

,

smoking

smoking

 or any other

 or any other

unprescribed drug

unprescribed drug

with sympathomimetic

with sympathomimetic

activity on the day of

activity on the day of

the measurement

the measurement

P

P

r

r

e

e

p

p

a

a

r

r

a

a

t

t

i

i

o

o

n

n

f

f

o

o

r

r

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



Because a 

Because a 

full

full

bladder

bladder

 affects the

 affects the

blood pressure it

blood pressure it

should have been

should have been

emptied.

emptied.

P

P

r

r

e

e

p

p

a

a

r

r

a

a

t

t

i

i

o

o

n

n

f

f

o

o

r

r

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



Painful procedures

Painful procedures

and exercise should

and exercise should

not have occurred

not have occurred

within one hour.

within one hour.



Patient should have

Patient should have

been sitting quietly for

been sitting quietly for

about 5 minutes.

about 5 minutes.

P

P

r

r

e

e

p

p

a

a

r

r

a

a

t

t

i

i

o

o

n

n

f

f

o

o

r

r

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



BP take in quiet room

and comfortable

temperature, must

record room

temperature and time

of day.

P

P

o

o

s

s

i

i

t

t

i

i

o

o

n

n

o

o

f

f

t

t

h

h

e

e

P

P

a

a

t

t

i

i

e

e

n

n

t

t

P

P

o

o

s

s

i

i

t

t

i

i

o

o

n

n

o

o

f

f

t

t

h

h

e

e

P

P

a

a

t

t

i

i

e

e

n

n

t

t



Sitting position



Arm and back are

supported.



Feet should be

resting firmly on the

floor



Feet not dangling.

P

P

o

o

s

s

i

i

t

t

i

i

o

o

n

n

o

o

f

f

t

t

h

h

e

e

a

a

r

r

m

m



The measurements should be made on the 

The measurements should be made on the 

right arm

right arm

whenever possible.

whenever possible.



Patient 

Patient 

arm should be resting on the desk

arm should be resting on the desk

 and raised (by

 and raised (by

using a pillow)

using a pillow)

P

P

o

o

s

s

i

i

t

t

i

i

o

o

n

n

o

o

f

f

t

t

h

h

e

e

a

a

r

r

m

m



Raise patient  arm so that the 

Raise patient  arm so that the 

brachial artery is roughly

brachial artery is roughly

at the same height as the heart

at the same height as the heart

. If the arm is held too

. If the arm is held too

high,

high,

 the reading will be artifactually 

 the reading will be artifactually 

lowered,

lowered,

 and vice

 and vice

versa.

versa.

P

P

o

o

s

s

i

i

t

t

i

i

o

o

n

n

o

o

f

f

t

t

h

h

e

e

a

a

r

r

m

m



Palm is 

Palm is 

facing up

facing up

.

.



The arm should remain 

The arm should remain 

somewhat bent

somewhat bent

 and

 and

completely relaxed

completely relaxed

Equipment

Equipment

In order to measure the Blood

In order to measure the Blood

Pressure (equipment)

Pressure (equipment)



Pediatric Cuff size

Pediatric Cuff size

–

Minimum Cuff Width:

Minimum Cuff Width:

2/3 length of upper

2/3 length of upper

arm

arm

–

Minimum Cuff length:

Minimum Cuff length:

Bladder nearly

Bladder nearly

encircles arm

encircles arm

In order to measure the Blood

In order to measure the Blood

Pressure (equipment)

Pressure (equipment)



Adult Cuff size

Adult Cuff size

–

Cuff Width: 

Cuff Width: 

40% of

40% of

limb's

limb's

 circumference

 circumference

–

Cuff Length: Bladder

Cuff Length: Bladder

at 80% of limb's

at 80% of limb's

circumference

circumference

In order to measure the Blood

In order to measure the Blood

Pressure (equipment)

Pressure (equipment)



Adult Cuff size

Adult Cuff size

–

Indications for large

Indications for large

cuff or thigh cuff

cuff or thigh cuff



Upper arm

Upper arm

circumference >34 cm

circumference >34 cm

–

Indications for 

Indications for 

forearm

forearm

cuff

cuff

 (with radial

 (with radial

palpation)

palpation)



Upper arm

Upper arm

circumference >50 cm

circumference >50 cm

Blood Pressure



If it is too

If it is too

 small

 small

, the

, the

readings will be

readings will be

artificially 

artificially 

elevated

elevated

.

.

The opposite occurs if

The opposite occurs if

the cuff is too

the cuff is too

 large

 large

.

.

Clinics should have at

Clinics should have at

least 

least 

2 cuff sizes

2 cuff sizes

available, normal and

available, normal and

large.

large.

Cuff Position

Cuff Position

In order to measure the Blood

In order to measure the Blood

Pressure (Cuff Position)

Pressure (Cuff Position)



Patient's arm

Patient's arm

slightly 

slightly 

flexed at

flexed at

elbow

elbow



Push the 

Push the 

sleeve up

sleeve up

,

,

wrap the cuff

wrap the cuff

around the bare arm

around the bare arm

In order to measure the Blood

In order to measure the Blood

Pressure (Cuff Position)

Pressure (Cuff Position)



Cuff applied directly

Cuff applied directly

over skin

over skin

 (Clothes

 (Clothes

artificially raises

artificially raises

blood pressure )

blood pressure )



Position lower cuff

Position lower cuff

border 

border 

2.5 cm

2.5 cm

above antecubital

above antecubital



Center inflatable

Center inflatable

bladder over

bladder over

brachial artery

brachial artery

Measurement of the pulse rate

Measurement of the pulse rate



The 

The 

manometer scale

manometer scale

should be at eye

should be at eye

level

level

, and the column

, and the column

vertical. 

vertical. 

The patient

The patient

should not be able to

should not be able to

see the column

see the column

 of the

 of the

manometer

manometer

T

T

e

e

c

c

h

h

n

n

i

i

q

q

u

u

e

e

o

o

f

f

B

B

P

P

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t

In order to measure the BP

In order to measure the BP



Feel for a pulse

Feel for a pulse

from the artery

from the artery

coursing through

coursing through

the 

the 

inside of the

inside of the

elbow

elbow

(antecubital

(antecubital

fossa).

fossa).

In order to measure the BP

In order to measure the BP



Wrap the cuff

Wrap the cuff

 around

 around

the patient's upper

the patient's upper

arm

arm



Close the thumb-

Close the thumb-

screw.

screw.

In order to measure the BP

In order to measure the BP



With your left hand

With your left hand

place the

place the

 stethoscope

 stethoscope

head directly over the

head directly over the

artery you found

artery you found

.

.

Press in firmly but not

Press in firmly but not

so hard that you block

so hard that you block

the artery.

the artery.

T

T

e

e

c

c

h

h

n

n

i

i

q

q

u

u

e

e

o

o

f

f

B

B

P

P

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



Use your right hand to

Use your right hand to

pump the squeeze

pump the squeeze

bulb

bulb

 several times

 several times

and Inflate the cuff

and Inflate the cuff

until you can no

until you can no

longer feel the pulse

longer feel the pulse

to level above

to level above

suspected SBP

suspected SBP

T

T

e

e

c

c

h

h

n

n

i

i

q

q

u

u

e

e

o

o

f

f

B

B

P

P

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



If you immediately

If you immediately

hear sound, pump up

hear sound, pump up

an additional

an additional

 20

 20

mmHg and repeat

mmHg and repeat

T

T

e

e

c

c

h

h

n

n

i

i

q

q

u

u

e

e

o

o

f

f

B

B

P

P

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



Deflate cuff slowly

Deflate cuff slowly

 at

 at

a rate of 2-3 mmHg

a rate of 2-3 mmHg

per second until you

per second until you

can again detect a

can again detect a

radial pulse

radial pulse

T

T

e

e

c

c

h

h

n

n

i

i

q

q

u

u

e

e

o

o

f

f

B

B

P

P

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



Listen for auditory

Listen for auditory

vibrations from artery

vibrations from artery

"bump, bump, bump"

"bump, bump, bump"

(Korotkoff)

(Korotkoff)

In order to measure the BP

In order to measure the BP



Systolic blood

Systolic blood

pressure

pressure

 is the

 is the

pressure at which you

pressure at which you

can first hear the

can first hear the

pulse.

pulse.

In order to measure the BP

In order to measure the BP



Diastolic blood pressure

Diastolic blood pressure

 is the last pressure at

 is the last pressure at

which you can still hear the pulse

which you can still hear the pulse

In order to measure the BP

In order to measure the BP



Avoid moving 

Avoid moving 

your

your

hands

hands

 or the 

 or the 

head of

head of

the stethescope

the stethescope

 while

 while

you are taking

you are taking

readings as this may

readings as this may

produce noise that

produce noise that

can obscure the

can obscure the

Sounds of Koratkoff.

Sounds of Koratkoff.

T

T

e

e

c

c

h

h

n

n

i

i

q

q

u

u

e

e

o

o

f

f

B

B

P

P

m

m

e

e

a

a

s

s

u

u

r

r

e

e

m

m

e

e

n

n

t

t



BP must take

BP must take

in 

in 

both arms

both arms

and one lower

and one lower

extremity.

extremity.

In order to measure the BP

In order to measure the BP



The two arm readings

The two arm readings

should be within 

should be within 

10-

10-

15 mm Hg.

15 mm Hg.

Differences greater

Differences greater

then 

then 

10-15

10-15

 imply

 imply

differential blood flow.

differential blood flow.

In order to measure the BP

In order to measure the BP



If you wish to 

If you wish to 

repeat

repeat

the BP measurement

the BP measurement

you should 

you should 

allow the

allow the

cuff to completely

cuff to completely

deflate

deflate

, permit any

, permit any

venous congestion in

venous congestion in

the arm to resolve

the arm to resolve

and then 

and then 

repeat a

repeat a

minute or so later

minute or so later

.

.

Remember the following

Remember the following

for

for

accuracy of your readings

accuracy of your readings



If the BP is

If the BP is

surprisingly high or

surprisingly high or

low, 

low, 

repeat the

repeat the

measurement

measurement

towards the

towards the

 end

 end

 of

 of

your exam

your exam

(

(

Repeated

Repeated

 blood

 blood

pressure

pressure

measurement can

measurement can

be 

be 

uncomfortable)

uncomfortable)

.

.

In order to measure the BP

In order to measure the BP



You can verify the

You can verify the

SBP by palpation.

SBP by palpation.

Place the index

Place the index

and middle fingers

and middle fingers

of your right hand

of your right hand

over the 

over the 

radial

radial

artery.

artery.

W

W

h

h

a

a

t

t

A

A

b

b

n

n

o

o

r

r

m

m

a

a

l

l

R

R

e

e

s

s

u

u

l

l

t

t

s

s

M

M

e

e

a

a

n

n

In order to measure the BP

In order to measure the BP



Diastolic blood

Diastolic blood

pressure

pressure

 allow free

 allow free

flow of blood without

flow of blood without

turbulence

turbulence

 and thus

 and thus

no audible sound.

no audible sound.

These are known as

These are known as

the Sounds of

the Sounds of

Koratkoff

Koratkoff

.

.

Blood pressure

Blood pressure



The minimal SBP

The minimal SBP

required to maintain

required to maintain

perfusion

perfusion

varies

varies

 with

 with

the 

the 

individual.

individual.

Interpretation of low

Interpretation of low

values must take into

values must take into

account the 

account the 

clinical

clinical

situation.

situation.

Blood pressure for adult

Blood pressure for adult



Physician will want to

Physician will want to

see 

see 

multiple blood

multiple blood

pressure

pressure

measurements

measurements

 over

 over

several days or

several days or

weeks

weeks

 before making

 before making

a diagnosis of

a diagnosis of

hypertension

hypertension

 and

 and

initiating treatment.

initiating treatment.

W

W

h

h

a

a

t

t

A

A

b

b

n

n

o

o

r

r

m

m

a

a

l

l

R

R

e

e

s

s

u

u

l

l

t

t

s

s

M

M

e

e

a

a

n

n



Pre-high blood

pressure: systolic

pressure consistently

120 to 139, or

diastolic 80 to 89



Stage 1 high blood

pressure: systolic

pressure consistently

140 to 159, or

diastolic 90 to 99

W

W

h

h

a

a

t

t

A

A

b

b

n

n

o

o

r

r

m

m

a

a

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l

R

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e

e

s

s

u

u

l

l

t

t

s

s

M

M

e

e

a

a

n

n



Stage 2 high blood

pressure: systolic

pressure consistently

160 or over, or

diastolic 100 or over

W

W

h

h

a

a

t

t

A

A

b

b

n

n

o

o

r

r

m

m

a

a

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R

e

e

s

s

u

u

l

l

t

t

s

s

M

M

e

e

a

a

n

n



Hypotension (blood

pressure below

normal): may be

indicated by a systolic

pressure lower than

90, or a pressure 25

mmHg lower than

usual

Hypertension

Hypertension



High blood pressure greater

High blood pressure greater

than 

than 

139-89..

139-89..

Blood pressure (

Blood pressure (

mm Hg)

mm Hg)



Normal blood

Normal blood

pressure 100/60 and

pressure 100/60 and

139/89.

139/89.



Prehypertension

Prehypertension

120,139-80,89…

120,139-80,89…

Blood pressure may be affected

Blood pressure may be affected

by many different conditions

by many different conditions

Blood pressure may be affected by

Blood pressure may be affected by

many different conditions

many different conditions



Cardiovascular

disorders



Neurological

conditions



Kidney and urological

disorders

Blood pressure may be affected by

Blood pressure may be affected by

many different conditions

many different conditions



Pre 

Pre 

eclampsia

eclampsia

 in

 in

pregnant women

pregnant women



Psychological factors

Psychological factors

such as stress, anger,

such as stress, anger,

or fear

or fear

Eclampsia

Eclampsia

Blood pressure may be affected by

Blood pressure may be affected by

many different conditions

many different conditions



Various 

Various 

medications

medications



"

"

White coat hypertension

White coat hypertension

" may occur if the

" may occur if the

medical visit itself produces extreme anxiety

medical visit itself produces extreme anxiety

Orthostatic Hypotention

Orthostatic Hypotention

Remember the following

Remember the following

for

for

accuracy of your readings

accuracy of your readings



Orthostatic (postural)

measurements of

pulse and blood

pressure are part of

the assessment for

hypovolemia.

Remember the following

Remember the following

for

for

accuracy of your readings

accuracy of your readings



First measuring BP

First measuring BP

when the patient is

when the patient is

supine

supine

 and then

 and then

repeating them

repeating them

after they have

after they have

stood for 2

stood for 2

minutes

minutes

, which

, which

allows for

allows for

equilibration.

equilibration.

Remember the following

Remember the following

for

for

accuracy of your readings

accuracy of your readings



Systolic blood

Systolic blood

pressure does

pressure does

not vary by more

not vary by more

then 

then 

20 points

20 points

when a patient

when a patient

moves from lying

moves from lying

to standing.

to standing.

Remember the following

Remember the following

for

for

accuracy of your readings

accuracy of your readings



Orthostatic

Orthostatic

measurements

measurements

 may

 may

also be used to

also be used to

determine if 

determine if 

postural

postural

dizziness

dizziness

 (diabethic

 (diabethic

autonomic nervous

autonomic nervous

system dysfunction) is

system dysfunction) is

the result of a fall in

the result of a fall in

blood pressure.

blood pressure.

O

O

x

x

y

y

g

g

e

e

n

n

S

S

a

a

t

t

u

u

r

r

a

a

t

t

i

i

o

o

n

n

Vital signs

Vital signs

O

O

x

x

y

y

g

g

e

e

n

n

S

S

a

a

t

t

u

u

r

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a

a

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i

o

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n

n



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O

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

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

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-

-

p

p

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y

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,

O

O

x

x

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g

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n

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c

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p

q

q

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.

.

THANK

THANK

TOU

TOU