The In Home Care Paradise Valley Pros Share Tips for Taking Vital Signs

If you are a caregiver for a loved one who has a medical condition that requires monitoring, chances are his or her physician has asked you to keep an eye on a measurement or two in order to detect a change in condition. Learning to monitor vital signs is a necessity for caregivers of people with chronic conditions.

Checking vital signs is an important skill to learn, because it tells us how the person’s body is functioning, helping us to monitor current conditions and alerting us to changes in health status. It can also give us clues to possible medical conditions that have yet to be diagnosed. The four main vital signs that are measured to give us an overview of your loved one’s health status are:

• Body temperature
• Heart rate (pulse)
• Respiration rate
• Blood pressure

Our team of experts in home care Paradise Valley, AZ at Nightingale Homecare shares the following instructions on how to correctly monitor vital signs:

Body Temperature

No individual has the exact same temperature reading throughout the day, as body temperature naturally fluctuates. Normal body temperature measured orally ranges from 97.6 to 99.6 degrees Fahrenheit (36.4 to 37.5 degrees Celsius) for a healthy adult. Of course, normal temperature variation depends on recent activity, food and fluid intake, time of day, etc.

Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). According to the American Academy of Family Physicians, a fever is indicated when body temperature rises one degree or more over the normal temperature of 98.6 degrees Fahrenheit. Hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.

There are four different ways to measure body temperature:

Orally: At Nightingale, we ask that our caregivers and clinicians use a digital thermometer to measure oral temperature over glass thermometers due to safety reasons. If you do not have this piece of equipment to monitor your loved one’s temperature, you should make the investment; they are inexpensive and reliable.

Rectally: If your loved one’s doctor asks you to take a rectal temperature, you should use a digital thermometer over a glass thermometer for safety reasons. Rectal temperatures tend to be 0.5 to 0.7 degrees F higher than when taken by mouth.

Axillary: Temperatures can be taken under the arm using a digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth.

By ear: A special thermometer can quickly measure the temperature of the ear drum, which reflects the body’s core temperature (the temperature of the internal organs). An ear temperature is between 0.5 -1.0 degrees F higher than an oral temperature.

By skin: A special thermometer can quickly measure the temperature of the skin on the forehead. A skin temperature is between 0.5 -1.0 degrees F lower than an oral temperature.

Taking Body Temperature Using a Digital Thermometer:

• Wash your hands.
• Cover thermometer mouth tip with a clean plastic shield.
• Press button to set the thermometer.
• Place the thermometer under the tongue and instruct your loved one to close his or her lips around the probe.
• Wait several minutes and remove thermometer when beeping indicates the reading is complete.
• If you are taking a record for your loved one’s physician, write down the temperature, including the date, time and method used as follows: “O” for oral, “R” for rectal, “E” for ear, “A” for axillary.
• Remove the plastic shield.
• Clean and sterilize the thermometer following manufacturer’s instructions, or with an alcohol prep pad wiping from the top to the tip.

Note: Oral thermometers are not indicated for some individuals, such as those with a history of seizures, or people unable to close their mouth fully. Digital thermometers can be used to take an axillary temperature by being placed under the armpit, against dry skin, and following the instructions noted above.

Pulse Rate 

Pulse rate, also called heart rate, indicates the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can give us information on the strength and rhythm of the heart.

Normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may fluctuate and increase with exercise, illness, room temperature, injury, and emotions. It is not uncommon for athletes, who do a lot of cardiovascular conditioning, to have a heart rate of nearly 40 beats per minute and experience no problems.

Taking a Pulse Rate:

• Wash your hands.
• Make sure that your loved one is at rest before you begin.
• The easiest place to find a pulse to measure is at the radial artery found on the inside of the wrist at the base of the thumb. Alternatively, you can find the pulse on the inside of the elbow (brachial artery), or neck (carotid artery).
• Note: If you use the neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain.
• Use your first and second fingertips (never the thumb, because it has a pulse and will interfere with an accurate assessment of your loved one’s heart rate) to press firmly but gently on the wrist (or otherwise) until you feel a pulse
• With an analog clock or watch, wait until the second hand is on the 12 to begin counting.
• Begin counting the beats of the pulse
• Count pulse for 60 seconds until the second hand returns to the 12. Or, you may also count for 15 seconds and multiply by 4 to calculate beats per minute. Note: The physician may request for you to take the loved one’s heart rate for a full minute, if he/she has an irregular heart rate.
• When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
• If your loved one’s physician asks for a record, write down the heart rate, including the date, time, and if you notice any irregularities.

Respiratory Rate

Respiration rate, also referred to as breathing rate, is the number of breaths taken over a minute. This measurement is always taken when the person is at rest and involves how many times the chest rises per minute.  One respiration count is equal to the chest rising (inhaling) and falling (exhaling) once. The normal range for an adult is 12 to 20 respirations per minute.  Factors like age, fever, agitation, activity, illness and sleeping can alter breathing and therefore the respiratory rate.  When a person is acutely ill, respiratory rate fluctuations and patterns are monitored as a warning sign for further decline.  

Taking Respiratory Rate:

• You can keep your fingers on the radial pulse after you have stopped counting pulse rate, and use the next minute to count the person’s respiratory rate.
• With an analog clock or watch, wait until the second hand is on the 12 to begin counting.
• Count breaths (inhale + exhale = 1 respiration) for one minute. You may also count for 15 seconds and multiply by 4 to calculate breaths per minute.
• If your loved one’s doctor wants a record, write down respiration rate, noting any observations (such as irregularity, increased effort or wheezing). 

Blood Pressure

Blood pressure is the force of the blood pushing against the artery walls during contraction and relaxation of the heart. Each time the heart beats, it pushes blood into the arteries, resulting in the highest (top) number of pressure reading. This is called “systolic.” The bottom number, lowest reading or “diastolic” is when the heart is totally relaxed before the next beat. The blood pressure measurement is recorded in millimeters of mercury or mm Hg and written as systolic/diastolic.

A blood pressure reading identifies how effectively the oxygenating blood is moving through the blood vessels of the circulatory system. In healthy adults, the systolic pressure should be less than 130 and the diastolic pressure should be less than 85. High pressure is called hypertension and low pressure is called hypotension.   Many health conditions can affect blood pressure. Cardiac patients, and those afflicted with hypertension, are instructed to monitor their blood pressure, as it can directly lead to life-altering conditions like heart attack, heart failure and stroke.

At Nightingale, all of our staff use manual or android cuffs, as electronic blood pressure machines can be unreliable and false readings could lead to devastating consequences for your loved one. You will need to have a stethoscope, blood pressure cuff with inflatable balloon (sphygmomanometer) with a numbered pressure gauge called a digital monitor or aneroid monitor.

Before you measure your loved one’s blood pressure:

The American Heart Association recommends the following guidelines for home blood pressure monitoring:

• Have your loved one refrain from smoking or drinking coffee for 30 minutes before taking blood pressure.
• Have your loved one go to the bathroom before the test.
• Your loved one should relax for 5 minutes before taking the measurement.

Taking Blood Pressure 

• Have your loved one sit with the back supported (he or she shouldn’t sit on a couch or soft chair). Your loved one’s feet should be on the floor and uncrossed.
• Wash your hands.
• Place your loved one’s arm on a solid flat surface (like a table) with the upper part of the arm at heart level.
• Place fingers on the underside of the elbow to locate the pulse (called the brachial pulse).
• Wrap and fasten the deflated cuff snugly around the upper arm at least one inch above where you felt the strong and steady brachial pulse.
• Position the stethoscope diaphragm directly over the brachial pulse and insert the earpieces.
• Turn the knob on the air pump clockwise to close the valve.
• Pump air, inflating the arm cuff until the dial pointer reaches 170.
• Gently turn the knob on the air pump counter-clockwise to open the valve and deflate the cuff.
• As the dial pointer falls, watch the number and listen for a thumping sound.
• Note the number shown where the first thump is heard (systolic pressure).
• Note the number shown where the last thump is heard (diastolic pressure).
• Deflate and remove cuff.

• If your loved one’s doctor asked you to take multiple readings during one sitting, take the readings one minute apart and record all the results.
• It is best to take blood pressure at the same time every day.
• If your loved one’s doctor asks for a record, write down the date, time, and blood pressure reading.
• When blood pressure reaches a systolic (top number) of 180 or higher OR diastolic (bottom number) of 110 or higher, this could require emergency medical treatment, so call your loved one’s doctor for further instruction. 

Properly monitoring vital signs can be a challenge, which is why we recommend letting Nightingale Homecare’s professional home health care staff take care of it for you! Our team of experts in home care Paradise Valley, AZ is highly skilled in a wide range of both medical and non-medical home care services, ensuring that older adults live their safest and healthiest lives possible, in the comfort and familiarity of home. Contact us at (602) 504-1555 to learn more and to find out if our services are available in your area.