2.  Pulse.  Respiratory rate.  Blood pressure.  Temperature.  Pulse oximetry

3.  Rate:  beats/min  Rhythm:  Regular  Irregular

4.  Radial pulse commonly used to assess heart rate  Palpate with index & middle fingers  Rhythm regular & rate normal: count for 30 seconds & multiply by 2  Rate unusually fast or slow: count for 60 seconds  Rhythm irregular: evaluate heart rate by cardiac auscultation

5. Normal pulse rate:  New born 120- 160 Beats/min  Up to 2 years 80- 140 Beats/min  A2- 6 years 75-120 Beats/min  7- 12years75- 110 Beats/min  Adults 18 and above 60- 100 Beats/min  Athletes 40- 60 Beats/min

6.  Count respirations with your hand on pulse  Count for at least 30 sec: multiply by 2  Normal Adult R/R: 14-18

7.  Patient seated in quiet, calm environment  Bared arm supported: midpoint of upper arm heart level  Proper cuff size: bladder inside the cuff should encircle 80% of arm  Place midline of bladder over arterial pulsation  Lower edge of cuff should be 2.5 cm above the antecubital fossa adapted from Perloff et al

9. Method  Inflate cuff while palpating the radial pulse  Note reading at which pulse disappears & then reappears during deflation  This is Systolic Pressure  To determine systolic blood pressure  To avoid auscultatory gap

10. Inflate bladder to pressure 20-30 mm above level determined by palpation Deflate bladder at 2 mm/sec: listen for appearance of Korotkoff sounds Note manometer readings at: –Appearance of repetitive sounds (phase I): Systolic –Disappearance of these sounds (phase V): Diastolic After last Korotkoff sound, deflate cuff slowly for another 10 mm, then rapidly & completely deflate Blood Pressure: Auscultatory method

11. Record systolic (phase I) & diastolic (phase V) pressures, to the nearest 2 mm Hg Measure blood pressure in both arms at first visit Measure in different positions (lying, sitting, standing) if indicated

12. Normal blood pressure:  120/80 mmHg.  Pre-hypertension ( 139- 120/89-80)  Stage I (159-140/ 99-90)  Stage II (> 160/>100)

13.  Wash the thermometer before use  Shake mercury down  Wash after use  For oral: ask patient to breath through nose & keep lips firmly closed  Keep thermometer for at least one minute

14.  Conscious Adults: Oral / Axillary  Young Children: Groin/ Rectal  Tympanic Membrane Temperature  Oral/ Rectal Temperature 0.5°C > Axillary/ Groin  Normal:36.6-37.2°C  Febrile:>37.2°C

17. Thank you