Checklist On Vital Signs

CHECKLIST ON PULSE TAKING
NAME: DATE & TIME:

COURSE & SECTION: SEMESTER:
PROCEDURE ABLE TO ABLE TO UNABLE TO

PERFORM PERFORM WITH PERFORM
ASSISTANCE
Assessment
1. Assessment client’s condition
2. Check nature of pulse.
Planning
3. Wash hands.
4. Assemble the equipment
Implementation
5. Identify client and explain procedure.
6. Have the patient rest his arm along
side of his body with the wrist
extended and the palm of the hands
downward.
7. Place the tips of your middle three
fingers on the palm side of the
patient’s wrist. Rest thumb on the back
of the patient wrist.
8. Apply enough pressure so that you
can feel the pulse(not too hard not too
light.)
9. Using a watch with second hand count
the number of pulsations felt on the
patient’s pulse for one full minute.
10. If the pulse rate is abnormal repeat the
counting in order to determine
accurately its rate, quality and rhythm.
11. Wash hands.
Evaluation
12. Evaluate nature of pulse.
Documentation
13. Record result rhythm and force in
graphing sheet.
REMARKS:___________________________________________________________________________________
_____________________________________________________________________________________________
________________________________________________________
GRADE:_____________
CLINICAL INSTRUCTOR:_____________________________
STUDENT’S SIGNATURE:________________
CHECKLIST ON RESPIRATION TAKING
NAME:_______________________________________ DATE & TIME:___________

COURSE& SECTION:________________________ SEMESTER:_____________

ASSISTANCE
Assessment
1. Assess client’s condition
2. Check nature of respiration.
Planning
3. Wash hands.
4. Identify client and explain procedure.
Implementation
5. Hold the client’s wrist just as if you were
taking his/her pulse.
6. Note the rise and fall of the client’s
chest.
7. Using a watch with second hand, count
the number of respiration for one full
minute.
8. Wash hands.
Evaluation
9. Evaluate the character of respiration.
Documentation:
10. Record the character and the depth the
respiration.
REMARKS:___________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________
GRADE:___________
CLINICAL INSTRUCTOR: ________________________
STUDENT’S SIGNATURE____________
CHECKLIST ON BLOOD PRESSURE TAKING

NAME: DATE & TIME:
COURSE & SECTION: SEMESTER & YEAR:
ASSISTANCE
Assessment
1. Assess the client’s physical condition.
2. Assess for factors that affect blood pressure
3. Determine the client’s baseline blood pressure.
Planning
4. Wash hands
5. Gather the equipment needed.
Implementation
6. Identify the client and explain the procedure.
7. Place the client in a comfortable position(lying
or sitting) and position the arm at the level of
the heart.
8. Place the cuff at the center observing at least 1
to 2 inches above the inner aspect of the
brachial artery.
9. Wrap cuff around the arm smoothly and snugly.
10. Feel the pulse beat over the inner aspect of the
elbow with the use of the fingertips.
11. Place the stethoscope earpiece and close
screw valve on the air pump.
12. Palpate brachial artery, close valve and
compress bulb to inflate cuff to 30 mmHg
13. Release the valve (deflating) on the cuff slowly
so that pressure goes down at the rate of 2-
3mmHg/sec. Listen to the sound(first distinct
loud muffling sound is systolic.)
14. Continue to release the air evenly and
slowly(last soft muffling sound is diastolic
pressure.
15. Deflate cuff rapidly and completely after the
final sound has disappeared.
16. Clean and store the equipment.
17. Wash hands.
Evaluation
18. Evaluate the nature of the blood pressure.
19. Evaluate the client condition.
Documentation
20. Record the result taken.
REMARKS:___________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________
GRADE:___________
CLINICAL INSTRUCTOR: ________________________
STUDENT’S SIGNATURE____________

Checklist On Vital Signs

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CHECKLIST ON PULSE TAKING

NAME: DATE & TIME:

PROCEDURE ABLE TO ABLE TO UNABLE TO

CHECKLIST ON RESPIRATION TAKING

NAME:_____________________________ DATE & TIME:_

PROCEDURE ABLE TO ABLE TO UNABLE TO

CHECKLIST ON BLOOD PRESSURE TAKING

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