"Introduction to Vital Signs Examination and

Evaluation Study Guide"

Using the Vital Signs Examination and Evaluation Study Guide
This module will walk the student or clinician through the fundamentals of assessing vital signs. This
module is broken down into sections for ease of use and will follow a sequence that reflects how vital
signs are assessed in a health care environment. The guide was not designed to replace a
comprehensive physical examination course or textbook. Additionally, because this module was
designed to be completed in tandem with “hands-on” or experiential learning laboratory (i.e., clinical
practice), the learner should complete the linked laboratory performance tool as he/she completes
the module (i.e., click the "PDF” icon to access the attached tool). The individual sections of the
module are described below.
Section Description
Introduction Introduces the topic to be covered
Review Provides the learner with a review of foundational concepts (foundational knowledge
will not be tested and is not required to successfully complete this module)
Tests to be performed Describes, in simple terms, which test(s) or measure(s) will be performed
Expected findings Describes the expected/normal findings for a given test or measure
Equipment Describes the required equipment for a given test or measure
Testing procedures Specifically describes testing procedures
Special instructions Provides additional instructions and information if needed
Clinical notes and Provides clinical considerations and interpretations beyond normal or abnormal
interpretation interpretation of findings

Vital Signs Examination and Evaluation Key Features

The following section will briefly describe the key features of the guide. The learner is encouraged to
review the “Read Me First” page if he/she has not already done so.

Performance Tools

Performance tools reflect a variety of resources that can be used to augment the learning
experience, such as a laboratory study guide, worksheets, and study tools. Most performance tools
will offer the option to open the tool in Acrobat Reader, save the tools for future use, and/or print the
tool for use in the classroom, laboratory, or clinic.

Learning Checkpoint Testing Interactions

This module contains a variety of testing interactions that will allow the learner to test his/her
understanding of module content. Testing interactions are spread throughout the module and include
multiple choice, fill-in-the-blank, true/false, and drag and drop testing items. All testing interactions
provide feedback to enhance learning.

Introduction
Health care professionals are expected to conduct a variety of tests and measures to effectively
evaluate a patient's health condition. Assessing a patient’s vital signs is often the first assessment
that a clinician will perform. Vital signs are measurements of the body’s most basic functions.
Traditionally, vital signs have been described as body temperature, pulse, respiratory rate, and blood
pressure because through these basic functions a clinician can determine signs of human life or
death. Pain is often considered “the fifth vital sign," and is covered in the Somatosensory
Examination and Evaluation Study Guide. These values alone, or in combination, will also help a
clinician understand the relative risk to a patient’s health and wellness by determining if the values
deviate from known normative data and by what degree. The values can be useful in establishing
the presence of disease, monitoring chronic disease states, and determining a differential diagnosis.
These values are dynamic and can change in an instant. It is essential that clinicians demonstrate
proper techniques and understand other variables that can affect these values to ensure accuracy
(i.e., validity) of the vital signs that have been measured.

Vital signs have been monitored since the earliest days of medicine. Recently, clinicians have
widened the scope of vital signs to include temperature, pulse, respirations, blood pressure, height,
and weight. Some settings will also include blood oxygen saturation rate. The following tutorial will
cover each component of the vital signs in detail.

Indications for Vital Signs Examination

The degree and frequency of vital sign assessment will vary depending on the setting. A good rule to
follow is that all patients on initial evaluation should have a complete set of vital signs assessed, and
any change in a patient’s status should precipitate a reassessment of the vital signs. 

The health care professional should always remember:

"You only find what you look for, and you only look for what you know"

Getting Started and General Considerations

The following considerations should be addressed before assessing vital signs:

 The room should be quiet, well lit, warm, and comfortable.

 The patient should not have consumed alcohol, tobacco, or caffeine or exercised for 30
minutes prior to the examination.
 It is best to complete a thorough history to allow the patient to relax and the effect of any of
the above to resolve.
 The patient should be sitting with his or her back supported and feet on the floor.

Equipment Needed

 Stethoscope
 Blood pressure cuff
 Timing device with second hand
 Thermometer
 Scale with height measurement device, tape measure, or both

Components of Vital Signs

  Temperature
 Pulse
 Respiration
 Blood pressure
 Height
 Weight

Measuring Body Temperature

Body temperature is a measure of the body's ability to create and eliminate heat in order to maintain optimum
operating temperature and is referred to as thermoregulation. Internal body temperature is strictly regulated in
order to maintain normal chemical reactions and cellular function. An increase or decrease of internal body
temperature by more than 4° Celsius can produce devastating effects on the human body. Common factors
that influence body temperature are as follows:
 Age and gender
 Emotional status
 Time of day
 Site of measurement
 Air temperature (environment)
 Injury to hypothalamus
 Infection/ illness (increases temperature)
 Activity (increases temperature)
 Menstrual cycle (higher at time of ovulation)
 Eating and drinking (oral temp)
 Smoking (oral temp)

The American Medical Association (AMA) defines the range of normal body temperature from 97.80 ° F to 99.0
° F (36.5 °C to 37.2 °C). Fever, or pyrexia, is defined as a body temperature that is higher than the individual’s
normal steady state. A fever is defined by the AMA as an oral temperature above 98.6°F or 99.8°F rectally,
and hypothermia is defined as a drop of body temperature below 95.0°F. This section of the vital signs study
guide will describe oral, rectal, axillary, and tympanic measurements of body temperature.

Test to be performed - Measuring body temperature orally

Equipment - Temperature by mouth can be determined by utilizing a traditional

mercury-filled thermometer or digital thermometer that uses an electronic probe cover to
measure body temperature.

Testing procedures
 1. When taking an oral temperature, shake down the glass mercury thermometer to
96°F (35°C) or below. This procedure is not needed for digital thermometers.
2. Have the patient place the thermometer under one side of the back of the tongue
as pictured to the right.
3. Instruct the patient to close both lips around the thermometer and breath through
his/her nose.
4. Wait 3-5 minutes for a mercury thermometer or until the digital beep sounds if
using a digital device.
5. If using a mercury thermometer, reinsert the thermometer after the initial reading
for 1 minute and read again. If the temperature is still rising, repeat this
procedure until the reading remains stable.

Clinical notes - The clinician should note that hot and cold liquids consumed by
patients within the past 15 minutes can adversely affect thermometer readings.
Test to be performed - Measuring body temperature rectally

Equipment - Traditional mercury-filled or digital rectal thermometer

Testing procedures

1. Rectal temperature can be taken with the patient lying on one side and the hips flexed.
2. Wearing exam gloves, lubricate the thermometer and insert it into the rectum 3-4 cm (1 ½
in).
3. Remove the thermometer after 3 minutes and read. Alternatively, a digital thermometer can
be used with a lubricated probe cover.
4. Document your findings.

Clinical notes

 Most experts agree that this method of taking a patient’s temperature is the most accurate.
 Temperatures taken rectally tend to be 0.7 to 0.9 °F higher than those taken orally.

Test to be performed - Measuring axillary body temperature

Equipment - Traditional mercury-filled or digital thermometer

Testing procedures

1. Axillary temperature can be taken by placing a thermometer in the axillary region.

2. Keep the patient’s arm adducted for 3 minutes if using a traditional mercury-filled
thermometer or until the digital beep sounds if using a digital device.
3. Document your findings.

Clinical notes

 The axillary method is used most often with pediatric patients.

  Axillary temperature values tend to be 0.3 to 0.4 °F lower than those temperatures taken
orally.
 Most experts agree that this method of taking temperature is the least accurate.

Test to be performed - Measuring tympanic body temperature

Equipment - Tympanic digital thermometer

Testing procedures

1. Place the tympanic digital device in the external auditory canal with the probe aimed at the
tympanic membrane.
2. Wait 2-3 seconds until the digital reading occurs or the digital beep sounds. 
3. Document your findings.

Clinical notes

 A tympanic digital thermometer will quickly measure the temperature of the ear drum, which
reflects the body’s core temperature.
 The core temperature can be 1.4°F (0.8°C) higher than oral measurements. Cerumen (ear
wax) impaction can affect tympanic temperature values by as much as 0.3 °F lower than the
unobstructed ear.

Measuring body temperature review, clinical notes and interpretation

Medical conditions or symptoms related to body temperature that require emergency medical

treatment include:

 Heatstroke
 Trauma
 Severe Hypothermia

Medical conditions or symptoms related to body temperature that require medical referral include:

 Disease
 Infection
 Sunburn
 Vertigo
 Confusion
 Extended exposure to cold temperature

Measuring Pulse Rate
An individual’s pulse rate is a measure of the rate at which his/her heart beats. Pulse rate is normally
referred to as heart rate and is recorded as the number of times a heart beats per minute (bpm).
Common factors that influence pulse rate are as follows:

 Age (decreases with age)  Heart function/conditioning

 Gender  Illness (decreases or increases)
 Emotional status  Cardiopulmonary disease (i.e., decreases with
  Environment hypertension and increases with hypotension)
 Medication  Pain (typically increases)
 Exercise (increases with exercise)  Resting or sleeping (decreases)

Common heart rate measures are as follows:

Population or disorder Beats per

minute
(bpm)
Infants 120-160
-Newborn 100-130
-Child 1 year old 110
-Child 5 years old 95
Children 70-120
Healthy adults 60-100
Well-conditioned athlete 40–60
Bradycardic below 55-
60
Tachycardic above 100
The arterial pulse
The arterial pulse is a measurement of the heart’s
contraction rate because a pulse wave is created when
the left ventricle contracts. The arteries expand in
response to this contraction and increase in volume.
Once expanded, the arteries will contract forcing blood
to circulate to the capillaries and then to the veins. The
arterial pulse is evaluated for the contour of the pulse
wave and its volume, rate, and rhythm. The carotid
pulse is the most accurate reflection of central aortic
pulse.
The arterial pulse rate can be palpated in any of the
body’s accessible sites as pictured to the right, and as
specifically described on page 3 of this module section.

Accessible arterial pulse sites
Carotid artery pulse - The common carotid artery is palpated on the neck below the jaw and lateral
to the larynx/trachea (i.e., mid-point between your earlobe and chin) using the middle and index
fingers.
Brachial artery pulse - The brachial artery is palpated on the anterior aspect of the elbow by gently
pressing the artery against the underlying bone with the middle and index fingers. The brachial
artery pulse is commonly used to measure blood pressure with a stethoscope and
sphygmomanometer.
Radial artery pulse - The radial pulse is palpated immediately above the wrist joint near the base of
the thumb (i.e., common site), or in the anatomical snuff box (i.e., alternative site), by gently pressing
the radial artery against the underlying bone with the middle and index fingers.
Femoral pulse - The femoral pulse is palpated over the ventral thigh between the pubic symphysis
and anterior superior iliac spine with the middle and index fingers.
Popliteal pulse - The popliteal pulse is palpated on the posterior knee with the middle and index
fingers; this pulse is more difficult to palpate as compared to other pulse sites.
Posterior tibial pulse - The posterior tibial pulse is palpated posterior and inferior to the medial
malleolus by gently pressing the tibial artery against the underlying bone with the middle and index
fingers.
Dorsalis pedis pulse - The dorsalis pedis pulse is palpated in the groove between the first and
second toes slightly medial on the dorsum of the foot (i.e., dorsal-lateral to the extensor hallucis
longus tendon and distal to the dorsal prominence of the navicular bone) with the middle and/or
index fingers.
Temporal pulse - The temporal pulse (i.e., superficial temporal artery) is palpated on the temple
directly in front of the ear with the index finger.
Apical pulse - The unilateral apical pulse (i.e., apex of the heart) can be located in the fifth
intercostal space immediately to the left of the sternum using a stethoscope.  In contrast to other
pulses, the apical pulse is measured over the heart and not an artery and is commonly heard with a
stethoscope as opposed to palpated.

When palpating arterial pulse, the clinician should note:

Quantity
Count the pulse waves for 30 seconds and multiply by two or alternatively, count for 15 seconds and
multiply by four. If the rate is very slow, fast, or irregular then it is suggested that you count for a full
minute.

Regularity
Is the rhythm or time between the beats consistent?

Volume
Does the volume or amplitude of the pulse wave feel normal? If this value is decreased (i.e.,
demonstrating a decreased stroke volume), it may be a reflection of dehydration or hypovolemia. An
increased volume of the pulse wave may be due to abnormal metabolic states such as anemia,
fever, and/or structural valvular heart disease. 

Tests to be performed - Radial pulse rate measurement

Equipment - Appropriate analog or digital clock positioned in clear view

Expected findings - Normal pulse rate for age and fitness level

Testing procedures
1. Sit or stand facing your patient.
 2. Position the patient in a comfortable position and support the extremity with your arm, the exam
table, or bed.
3. Locate the radial artery with your index and middle fingers.
4. Using the first and second fingers, press firmly on the arterial site.
5. Once you feel the arterial pulse wave, begin counting for 15, 30, or 60 seconds as described above,
and multiply as needed.
6. Concentrate on the regularity and volume of the pulse wave once the quantity has been determined.
7. Repeat on the contralateral arterial site, and repeat if necessary.
8. Document your findings.

Clinical notes
 Good clinical habits include evaluating pulses bilaterally. However, it is not advised to check both
carotid arteries at the same time due to possible induction of a syncopal (i.e., fainting) episode.
 Be careful when checking the carotid pulse on older adults as pressing too hard can result in
dizziness and risk of injury from falling.
 If applicable, grasp the patient's wrist with your non-watch wearing hand.

Measuring pulse rate review, clinical notes and interpretation

A fast resting heat rate may be caused by: A weak pulse may be caused by:

 Exercise  Heart disease

 Meal  Reduced heart pumping capacity
 Smoking  Dehydration
 Anxiety  Hemorrhagic shock
 Dehydration
 Medications/drugs Conditions or symptoms that require emergency
 Young age (children) medical treatment include:
 Disease
o Sepsis  Disease - sepsis, myocardial infarction
o Myocardial infarction  Hemorrhagic shock

A slow resting heart may be caused by: Conditions or symptoms that require medical
referral include:
 Physically fit
 Heart disease  Heart disease
 Cardiac medications  Dehydration
 Enhanced body relaxation  Reduced heart pumping capacity

Measuring respirations
The respiratory rate is the number of breaths that a patient takes each minute. The rate should be
taken when the patient is at rest, and it is assessed by counting the number of times the chest rises
in one minute. Common factors that influence respiration rate are as follows:

 Age
 Emotional status
  Air quality and altitude
 Exercise
 Internal temperature
 Disease (i.e., cardiopulmonary)
 O2 and CO2 level (i.e., pulmonary status)
 Effectiveness of breathing pattern

Common respiratory values are listed below.

Age Breaths per minute

Infant 30 or more
Child 22-28
Adolescent 16 -20
Adult - normal 14-18*
Adult - abnormal <10 and >20

*It has been shown that women typically have higher respiratory rates than men.

Tests to be performed - Respiratory rate measurements

Equipment - Appropriate analog or digital clock positioned in clear view

Expected findings - Normal respiratory rate for age and fitness level

Testing procedures
1. Position the patient in a comfortable position.
2. After taking the patient's radial pulse, continue to hold the extremity as a distraction for the patient and count
respirations for one minute, or subtly listen with the stethoscope over the patient’s chest and count the
respirations for one minute.
3. Document your findings.

Clinical notes
 When counting breaths, it is best to be as unobtrusive as possible because many patients tend to breathe fas
when they know that attention is being directed to their breathing.

Special instructions
 Respiratory rates above 25 breaths per minute (i.e., tachypnea) or under 12 breaths per minute (i.e., bradypn
when at rest may be abnormal.

Video demonstration
Measuring pulse rate and respiratory rate demonstration.

 Clinician positioned to prevent obstructed view.

 This demonstration includes the measurement of pulse rate and respiration, which are
typically performed together in a clinical setting. This is the same video clip that was
presented in the last section.
Measuring respiratory rate review, clinical notes and interpretation

A fast respiratory rate may be caused by: Conditions or symptoms that require emergency medical
treatment include:
 Exercise
 Medications  Medications/drugs if person can’t “catch breath”
 Disease  Angina
o COPD
o Angina Conditions or symptoms that require medical
 URTI referral include:
 Anxiety
 Young age (children)  Upper respiratory tract infections
 Smoking  Disease (i.e., chronic obstructive pulmonary
disease)
A slow respiratory rate may be caused by;  Shortness of breath

 Physically fit
 Medications/drugs
 Enhanced body relaxation

Understanding blood pressure

Blood pressure is a measurement of the force of blood pushing against arterial walls. Blood pressure
is highest when the heart contracts or pumps blood and lowest when the heart relaxes or pauses
between beats. The measure of blood pressure during the point in the cardiac cycle when the heart
contracts is called systolic pressure, and the measure of blood pressure when the heart relaxes is
called diastolic pressure. Blood pressure is typically recorded using a sphygmomanometer, which
relies on the height of a column of mercury to represent arterial pressure in millimeters of mercury
(mmHg) or kilopascals (kPa). For example, adult blood pressure of 110/70 mmHg would be
considered within normal values, and blood pressure of 120/90 mmHg would be considered as high
blood pressure or hypertension.

Common factors that influence blood pressure are as follows:

 Age, gender, and body type

 Time of day
 Body position
 Activity and exercise
 Emotional status
 Medication
 Medical and family history
 Social habits (i.e., smoking and alcohol consumption)
 Disease (i.e., kidney, metabolic, or congestive heart failure)
 Pain
 Blood volume
 Blood thickness/viscosity
 Vessel resistance and size

Measuring blood pressure

The Korotkoff method typically includes the occlusion of the brachial artery by a cuff placed on the
upper arm and inflated to a pressure above systolic pressure. When the cuff is inflated above
systolic pressure, blood flow in the artery is completely occluded or stopped. The pressure is then
gradually lowered at 2-3 mmHg per second until pulsatile blood flow occurs. This will cause intra-
arterial sounds during auscultation over the brachial artery secondary to turbulent flow and
oscillations of the arterial wall. The sounds are described to have five phases, which are as follows:

 Phase I is the appearance of tapping sounds corresponding to the appearance of a palpable

pulse
 Phase II sounds become softer and longer
 Phase III sounds become crisper and louder
 Phase IV sounds become muffled and softer
 Phase V sounds disappear completely

The fifth phase is the recorded value of the last audible sound. There is agreement among
researchers that phase I corresponds to systolic pressure but tends to underestimate the systolic
pressure recorded by intra-arterial measurement.

There has been some debate in the past as to whether phase IV or V is the accepted value for
diastolic pressure, but both are felt to occur before diastolic pressure is determined by intra-arterial
recordings. Therefore, it is now accepted that phase V should be used, except when the
disappearance of the sounds cannot be reliably determined because the sounds are audible even
after complete deflation of the cuff. This situation can occur in pregnant women, patients with
arteriovenous fistulas, and patients with aortic insufficiency. 

Korotkoff sounds reviewed

 The following animation will

review the Korotkoff sounds
 The animation will repeat
when finished.
 Please disable your pop-up
blocker to view this
animation.

Classification of hypertension
According to the Seventh Report of the Joint National Committee on the Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of hypertension is
presented below:

JNC 7 Classification of blood pressure for adults

Blood pressure classification SBP mmHg DBP mmHg
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension >160 >100

Please click the icon if you would like to access the complete report: Evaluation, and Treatment of
High Blood Pressure: National Institutes of Health and National Heart, Lung, and Blood Institute;
2004. 

Stethoscope selection and use

 A single tube scope vs. a dual tube

scope has less chance of noise
interference from the tubes banging
together.
 Longer stethoscope tubes decrease or
soften the audible sounds.
 The diaphragm (disc) of the
stethoscope is best used for high-
pitched sounds, and the bell (hollow
cup) of the stethoscope is best used for
low-pitched sounds. The Korotkoff
sounds are accepted to be low-pitched
sounds, and many authors recommend
using the bell when assessing blood
pressure. A diagram of a typical
stethoscope is depicted to the right.

Blood pressure cuff selection and sizing

Errors in measurement of blood pressure have been shown to be significant when the
blood pressure cuff is too large or too small. The error of “miscuffing” is the most
common error in an out-patient setting when it comes to blood pressure measurement
(Pickering et al. Circ 2005;111:697-716). The majority of these errors occur when
clinicians use blood pressure cuffs that are too small for the patients. The ideal cuff size
should have a bladder length that is 80% of the arm
circumference, a width that is at least 40% of the arm circumference, and a length-to-
width ratio of 2:1. AHA scientific statement recommendations (Hypertension 2005;
45:142-161), are presented below, and a diagram of a typical blood pressure cuff is
depicted to the right.
 For an arm circumference of 22 to 26 cm, the cuff should be a “small adult” size
or 12 x 22 cm.
 For an arm circumference of 27 to 34 cm, the cuff should be an “adult” size or 16
x 30 cm.
 For an arm circumference of 35 to 44 cm, the cuff should be a “large adult” size
or 16 x 36 cm.
 For an arm circumference of 45 to 52 cm, the cuff should be an “adult thigh” size
or 16 x 42 cm.
 Effects of body position on blood pressure
Blood pressure is commonly measured in the seated or supine position; however, the two
positions give different measurement values. With that in mind, any time a value is recorded,
body position should also be recorded. It is widely accepted that diastolic pressures while
sitting are higher than when a patient is supine by as much as 5 mmHg. When the arm is at
the level of the heart, systolic pressure can be 8 mmHg higher, such as when a patient is in
the supine position rather than sitting. A patient supporting their own arm (isometric exercise)
may increase the pressure readings. If the patient’s back is not supported (i.e., when a
patient is seated on an exam table instead of a chair) the diastolic pressure may be
increased by 6 mmHg. Crossing the legs also may raise systolic pressure by 2-8 mmHg. Arm
position plays a dramatic role in value errors as well. If the arm is below the level of the
heart, values will be too high; if the arm is above the level of the heart, values will be
underestimated. For every inch the arm is above or below the level of the heart, a 2 mmHg
difference will be found (Pickering et al. Circ 2005;111:697-716).
 Differences in bilateral measurements
Almost all of the studies evaluating blood pressure values bilaterally have demonstrated
differences between the two values in a fair percentage of patients. It is not clear why this
 occurs, and hand dominance (i.e., left vs. right handedness) does not seem to play a role.
Approximately 20% of patients will have differences of >10 mmHg between sides. When the
difference in values is greater than 10 mmHg, other secondary causes for this variation
should be investigated. These can include, but are certainly not limited to, coarctation of the
aorta (i.e., narrowing of the aorta), congenital obstruction of the aorta, and upper extremity
occlusion (Pickering et al. Circ 2005;111:697-716).
 Cuff inflation and deflation
In order to determine the estimated systolic pressure and how high the cuff will need to be
inflated, baseline palpable systolic pressure will need to be performed. As you feel the radial
artery of the extremity, you will be determining the patient’s blood pressure. Semi-rapidly
inflate the cuff until the radial pulse disappears. This will establish an estimate of systolic
pressure. When inflating the blood pressure cuff for actual measurement, you should inflate
the cuff to 30 mmHg greater than the estimated systolic value. This avoids over-inflation and
subsequent patient discomfort from increased pressure. It also avoids the error of an
auscultatory gap. This gap is a silent interval sometimes occurring between phase I and
phase V of the Korotkoff sounds. If this gap is unrecognized by a clinician, it can lead to a
drastic underestimation of systolic pressure.
 The cuff should be deflated at a rate of 2-3 mmHg per second. You should note when the
sounds first appear with two consecutive beats; this is the systolic pressure. Continue to
lower the pressure at a rate of 2-3 mmHg per second until the sounds are muffled and
disappear; this is the diastolic pressure. To confirm that this is the correct value, continue to
deflate the cuff for another 10-20 mmHg, and then deflate the cuff completely. Blood
pressure readings should be read to the nearest 2mmHg. It is then recommended to wait 2
or more minutes and repeat this procedure. If the first two readings differ by more than 5
mmHg, take additional readings.

Stethoscope bell and sphygmomanometer cuff placement

The brachial artery is palpated on the anterior aspect of the
elbow by gently pressing the artery against the underlying
bone with the middle and index fingers. The brachial artery
pulse will be used to measure blood pressure with a
stethoscope and sphygmomanometer in the next
demonstration.

The lower end of the blood pressure cuff is placed 2-3 cm

above the antecubital fossa, which should be at approximately
the same vertical height as the heart while allowing room for
the stethoscope. The cuff should be placed snugly around the
upper arm, and the bladder of the cuff should cover at least
80% of the arm's circumference.

The bell of the stethoscope is placed over the brachial artery

with a good seal using light pressure. Applying too much
pressure with the bell of the stethoscope will cause it to act
like the diaphragm, and high-pitched sounds will be heard
better than low-pitched sounds. Blood pressure cuff and
stethoscope bell placement are pictured to the right.
 Tests to be performed - Blood pressure measurements (oscillometric method)

Equipment - Stethoscope and appropriately sized blood pressure cuff

Expected findings - Systolic blood pressure <120 mmHg and diastolic blood pressure <80 mmHg

Testing procedures
1. Place the patient in a quiet, well lit, warm, and comfortable room.
2. Have the patient remove all clothing that covers the location of the cuff placement. The sleeve
should not be rolled up because this can be restrictive or have a tourniquet effect on the artery.
3. Seat the patient with his or her legs uncrossed, feet on the floor, and back and upper arm
supported.
4. Place the arm being measured at the level of the heart or mid-point of the sternum.
5. Palpate the brachial artery in the antecubital fossa.
6. Place the middle of the bladder (commonly marked on the cuff) at this location.
7. Place the lower end of the cuff 2-3 cm above the antecubital fossa to allow room for the
stethoscope.
8. Place the bell of the stethoscope over the brachial artery with a good seal using light pressure.
9. Semi-rapidly inflate the cuff 30 mmHg greater than the estimated systolic value.
10. Deflate the cuff at 2-3 mmHg per second until pulsatile blood flow occurs.
11. Identify when the sounds first appear with two consecutive beats, and record this value as the
systolic pressure.
12. Continue to lower the pressure at a rate of 2-3 mmHg per second until the sounds are muffled and
disappear, and record this value as the diastolic pressure.
13. Confirm diastolic pressure by deflating the cuff for another 10-20 mmHg.
14. Deflate the cuff completely, wait 2 or more minutes, and repeat this procedure.
15. Take additional readings if the first two readings differ by more than 5mmHg, and document your
findings.

Special instructions

 The patient should not have consumed alcohol, tobacco, or caffeine or exercised for 30
minutes prior to the examination.
 It is best to complete a thorough history to allow the patient to relax and the effect of any of
the above to resolve.
 Avoid cuff over-inflation and subsequent patient discomfort.
 Do not allow the cuff to rub against the stethoscope because the extraneous noise can
complicate the auscultatory process.

Clinical notes

 Common mistakes include reading the manometer value without hearing the Korotkoff
sounds, taking BP through clothing, occluding the artery with restrictive clothing, improper
cuff sizing, holding the patient's arm in an incorrect position, and inappropriate environmental
conditions.
Measuring blood pressure review

High BP may be caused by:

 Anxiety
 Anger
 Stress
 Heart disease
 Kidney disease
 Increased body weight
 During exercise
 Aging
 Post menopause
 Medications/drugs

High BP and respiratory rate may be caused by:

 Exercise
 Medications/drugs
 Increased body weight
 Stress
 Anger
 Anxiety
 Heart disease

Conditions or symptoms that require emergency medical treatment include:

 Heart disease if symptomatic

o Shortness of breath
o Chest pain
 Kidney disease if symptomatic
 Dizziness leading to feeling of fainting
 Lightheadedness leading to feeling of fainting

Conditions or symptoms that require medical referral include:

 Medications/drugs
 Stress
 BP >180/110 mmHg
 Increased body weight
 Heart disease becoming more symptomatic
 Kidney disease becoming more symptomatic
 More frequent dizziness and lightheadedness
Module resources

 Accessible arterial pulse sites performance aid (PDF)

WSU Department of Health Care Sciences OpenCourseWare resources

 Wayne State University Department of Health Care Sciences OpenCourseWare  Home Page

Internet links

 Complete report: Evaluation, and Treatment of High Blood Pressure: National Institutes of
Health and National Heart, Lung, and Blood Institute; 2004.

Software resources

 Download Adobe Acrobat Reader  - select "Get ADOBE READER"

 Download Adobe Flash Player- select "Get ADOBE FLASH PLAYER"