Vital Signs: Pulse, Blood Pressure, Oxygen Saturation & Temperature Routes

Vocabulary flashcards covering when to assess apical pulse, detailed steps for accurate blood pressure and oxygen saturation measurements, and advantages/limitations of various temperature routes.

Situations that require assessing an apical pulse

When the pulse is irregular or very fast, before administering cardiac medications, and in infants or critically ill clients.

Pre-measurement questions for blood pressure

Ask if the client has had caffeine or nicotine in the last 30 minutes; if so, wait before taking the BP.

Rest period before blood pressure reading

Allow the client to rest for 5 minutes prior to measurement.

Proper client position for BP

Client seated or lying with the arm at heart level and palm facing up.

Correct BP cuff size

Cuff bladder should cover 80 % of the arm’s circumference and be placed 1 inch above the elbow crease.

Cuff alignment for BP

Align the cuff arrow with the brachial artery.

Inflation guideline for BP cuff

Inflate the cuff to 30 mm Hg above the client’s expected systolic pressure.

Deflation rate for BP measurement

Deflate the cuff slowly at approximately 2 mm Hg per second.

Korotkoff sounds used to record BP

The 1st sound marks systolic pressure; the 5th (sound disappears) marks diastolic pressure.

Common sites for pulse oximetry probe

Finger, toe, or earlobe (use finger only if capillary refill is < 2 seconds).

Preparation for accurate pulse oximetry

Remove nail polish or artificial nails; avoid cold extremities, poor perfusion, dark polish, or low hemoglobin, which can reduce accuracy.

Oral temperature: pros & cons

✓ Easy and accurate for alert patients; ✗ Not appropriate for unconscious, confused, mouth-trauma patients, or after recent eating/drinking.

Rectal temperature: pros & cons

✓ Most accurate core reading; ✗ Contraindicated in infants, clients with rectal disorders, or clotting issues.

Axillary temperature: pros & cons

✓ Safe for children; ✗ Less accurate than other routes.

Tympanic temperature: pros & cons

✓ Fast and non-invasive; ✗ Ear infections or wax buildup may affect reading.

Temporal temperature: pros & cons

✓ Quick and well tolerated; ✗ Sweat or head coverings can interfere with accuracy.