Vital Signs and Patient Monitoring
Ranges to memorize
Adult resting heart rate 60 to 100 beats per minute, respirations 12 to 20 per minute, SpO2 95 to 100 percent, oral temperature near 37 C (98.6 F), and blood pressure normally below 120/80 mmHg. An abnormal value should be rechecked before you report it, because equipment or technique is often the cause, but you still document and report what you found.
Technique traps
Temperature: rectal is contraindicated with diarrhea, rectal surgery, or neutropenia; oral is unsafe for an unresponsive patient or one who just drank hot or cold liquids. Pulse: count 30 seconds and double for regular rhythms, a full minute if irregular, and report rate, rhythm, and volume. A pulse deficit requires two people, one at the apical and one at the radial site, counting simultaneously. Respirations: count without announcing it, or the patient will change the pattern. Blood pressure: cuff width about 40 percent of arm circumference, arm supported at heart level, and avoid an arm with an IV, dialysis fistula, mastectomy, or lymphedema. Orthostatic vitals: lying after 5 minutes, then sitting, then standing within 1 to 3 minutes.
Why monitoring matters
Trends beat single readings. A rising pulse with a falling blood pressure suggests bleeding or shock; a dropping respiratory rate after opioids is an early warning. Pain is often called the fifth vital sign. A change in level of consciousness or breathing pattern is reported immediately, not at the end of the shift.
Worked example
You obtain 88/52 with a pulse of 118 in a patient who was 126/78 an hour ago and is now drowsy. Rule of thumb: abnormal plus a change from baseline means escalate now. Recheck on the other arm, stay with the patient, and notify the nurse.