How to Measure a Person's Vitals

Imagine yourself as a medical intern. You receive a message on your pager from your attending physician: “Report to room 4-227.” Navigating your way down the long, winding halls of the hospital, you reach your destination. Your attending physician, Dr. Jones, is waiting at the room occupant’s bedside. As you step through the door, you greet the physician and introduce yourself to the patient, a healthy-looking young man. Dr. Jones updates you on the patient, Joshua’s, condition. He is two days post-operative an appendectomy, and his surgical team has deemed him fit for discharge. All that is left to do is measure his vital signs one last time to assure his health is in good standing.

Now, imagine yourself as Joshua's partner. It has been a couple of days since he left the hospital. You get a call from Dr. Jones; he wants to know how Joshua is doing. You explain that he's doing well, just feeling a little nauseous. Dr. Jones asks if he's experiencing anything other than nausea, and now that you think of it, you've noticed that he's felt a little warmer than usual. While both of these are normal symptoms after a surgery, Dr. Jones assures you, they could also be signs of infection or sepsis. Airing on the side of caution, he asks you to take Joshua's vitals at home to assure that nothing is out of the ordinary.

Whether you're working in the medical field or taking care of someone at home, knowing how to measure a person’s vital signs is a useful and important skill for anyone to learn. Especially in light of the COVID-19 pandemic, it may be prudent for you to monitor someone else's or your own vitals at home to determine whether further medical attention is needed.

Vital signs are assessments that indicate the status of the body’s life-sustaining functions. Though there are several different vitals that can be evaluated, physicians generally agree only four are essential: temperature, heart rate, respiratory rate, and blood pressure. Here, you're going to learn how to measure those four vitals using the most common methods.

If you or someone else is having a medical emergency, this is not where you need to be. Please stay calm, get off this site, and call your local emergency number (such as 911).

Supplies

Before you begin assessing a person’s vitals, be sure that you have the necessary materials:

• a thermometer, for measuring temperature
• a clock or watch, for measuring heart and respiratory rates
• a sphygmomanometer, for measuring blood pressure
• a notebook, for recording data
• a writing utensil, for recording data
• optional: a stethoscope, for measuring heart rate and blood pressure

It is a good idea for you to clean all your supplies before use. Using rubbing alcohol or disinfectant wipes are good ways to sterilize the medical instruments. Make sure to rinse the parts that may come in contact with the body with cold water in order to remove any alcoholic or chemical residue.

Step 1: Prepare the Patient

Before you begin your evaluation, have your patient assume one of the following positions:

• sitting in a chair, body relaxed and feet dangling
• lying supine (on one's back)

Request that the patient roll up their sleeves and remove any watches or jewelry around the wrists.

Always make sure to wash your hands thoroughly before touching a patient.

Step 2: Temperature

Temperature (BT) refers to the degree of internal heat of a person's body.

The normal body temperature for an average adult is about 98.6 degrees Fahrenheit (°F) (37 degrees Celsius [°C]), but can range anywhere from 97 - 99 °F (36.1 - 37.2 °C).

Temperature can be measured in multiple ways, such as orally, rectally, axillary (underarm), by ear, or by skin. There are three primary types of thermometers: oral, tympanic, and infrared. Oral thermometers are best suited for oral usage, but can also be used to measure temperature rectally and axillary. Just be sure to clean it extra well afterwards. Tympanic thermometers are made for measuring temperature in the ear. Infrared thermometers measure the heat emitting from one's forehead, sometimes without even touching the skin.

Measuring the Temperature Using an Oral Thermometer

Take the thermometer out of its holder. Use the designated button/switch to turn the thermometer on, and wait for it to be ready (this can be indicated in different ways, such as with the word “Lo”, the number "0.0", a green screen).

Ask the patient to open their mouth. Gently place the tip of the thermometer under the tongue.

Ask the patient to close their mouth, as you hold the thermometer steady in its place. Readings on the thermometer will begin to increase.

Once the thermometer is done measuring the temperature (this can be indicated in different ways, such as by a beeping noise, the numbers stopping or flashing, the screen changing color), you may slide the thermometer out from under the patient’s tongue.

Observe the final temperature reading given on the thermometer screen, and use your writing utensil to record this number in your notebook as the patient’s temperature (BT).

Finally, use the designated button/switch to turn the thermometer off, rinse/disinfect its tip, and place the device back in its holder.

Measuring the Temperature Using a Tympanic Thermometer

Remove the cover on the pointed tip of the thermometer. Use the designated button/switch to turn the thermometer on, and wait for it to be ready (this can be indicated in different ways, such as with the word “Lo”, the number "0.0", a green screen).

Ask the patient to turn one of their ears towards you.

Place the tip of the thermometer snugly in the ear, pointed directly at the opposite ear, and hold it steady in its place. Readings on the thermometer will begin to increase.

Once the thermometer is done measuring the temperature (this can be indicated in different ways, such as by a beeping noise, the numbers stopping or flashing, the screen changing color), you may slide the thermometer out from the patient’s ear.

Observe the final temperature reading given on the thermometer screen, and use your writing utensil to record this number in your notebook as the patient’s temperature (BT).

Finally, use the designated button/switch to turn the thermometer off, rinse/disinfect its tip, and replace the tip's cover.

Measuring the Temperature Using an Infrared Thermometer

Use the designated button/switch to turn the thermometer on, and wait for it to be ready (this can be indicated in different ways, such as with the word “Lo”, the number "0.0", a green screen).

Ask the patient to face forward towards you.

Place the thermometer's end on one side of the forehead and slowly drag it across to the other side.

Once the thermometer is done measuring the temperature (this can be indicated in different ways, such as by a beeping noise, the numbers stopping or flashing, the screen changing color), you may remove the thermometer from the patient's forehead.

Observe the final temperature reading given on the thermometer screen, and use your writing utensil to record this number in your notebook as the patient’s temperature (BT).

Finally, use the designated button/switch to turn the thermometer off and disinfect the thermometer's end.

Measuring the Temperature Using a Touchless Infrared Thermometer

Use the designated button/switch to turn the thermometer on, and wait for it to be ready (this can be indicated in different ways, such as with the word “Lo”, the number "0.0", a green screen).

Ask the patient to face forward towards you.

Extend your arm and point the thermometer towards the center of the forehead, leaving about 0.5 - 2 inches of space between the thermometer's end and the patient's forehead.

Once the thermometer is done measuring the temperature (this can be indicated in different ways, such as by a beeping noise, the numbers stopping or flashing, the screen changing color), you may retract your arm and the thermometer.

Observe the final temperature reading given on the thermometer screen, and use your writing utensil to record this number in your notebook as the patient’s temperature (BT).

Finally, use the designated button/switch to turn the thermometer off.

Step 3: Heart Rate

Heart rate (HR) is the number of heartbeats per unit of time, usually per minute. It is based on the number of contractions of the ventricles, or lower chambers, of the heart.

The average adult’s normal resting heart rate is between 60 and 100 beats per minute (BPM).

Heart rate is measured primarily in two ways: using a stethoscope on the chest or using one’s fingers to identify a pulse point. Stethoscopes identify the apical pulse, which roughly corresponds to the lower (pointed) end of your heart. Two other common pulse points are the radial (on the wrist) and the carotid (on the neck) points. There are several others, but these are the easier and most reliable.

Measuring the Heart Rate Using a Stethoscope

Position the stethoscope in front of you so that the binaurals (earpieces) are bent forward away from you. Gently place them into your ears, adjusting them to make sure they are not too tight or too loose.

Hold the tunable (the chest piece) between the index and middle fingers of your dominant hand, and place your thumb under the tubing.

Ask the patient to lift their shirt if they are comfortable doing so.

Place the flat side of the tunable on the chest, directly on the skin.

Palpate, or lightly press, the area directly under the left nipple, towards the center of the chest. Move the stethoscope in a circular motion as you scan for the pulsation of the heart. If no pulse is felt on this area, repeat these steps on the area above the patient’s left nipple. Once a pulse is felt, press firmly and look to a nearby clock or watch.

Count the number of pulsations you hear for 60 seconds, then remove the stethoscope.

Use your writing utensil to record this number in your notebook as the patient’s heart rate (HR).

Measuring the Heart Rate Using the Radial Pulse Point

If the patient is sitting upright, ask them to extend their arm forward. Have them place their arm on a stable surface (e.g. chair armrest, table). You may also hold the patient’s arm in one of your hands if there is no available surface to rest it upon. If the patient is lying down, have them rest their arm alongside their body.

Rotate the arm so that the inside of the elbow and palm of the hand are facing upward.

Using your free hand, hold out your index and middle finger, and keep them together.

Palpate, or lightly press, the distal (outer) area of the wrist directly under the thumb. Move your two fingers toward the wrist’s center as you scan for the pulsation of the radial artery. If no pulse is felt on this arm, repeat these steps on the patient’s opposite wrist.

Once a pulse is felt, press firmly and look to a nearby clock or watch.

Count the number of pulsations you feel for 60 seconds, then remove your hand.

Use your writing utensil to record this number in your notebook as the patient’s heart rate (HR).

Measuring the Heart Rate Using the Carotid Pulse Point

Ask the patient to slightly rotate their chin upwards and expose their neck.

Using your hand, hold out your index and middle finger, and keep them together.

Palpate, or lightly press, the distal (outer) area of the neck directly under the jaw. Move your two fingers toward the neck’s center as you scan for the pulsation of the carotid artery. If no pulse is felt on this side of the neck, repeat these steps on the patient’s opposite side.

Once a pulse is felt, press firmly and look to a nearby clock or watch.

Count the number of pulsations you feel for 60 seconds, then remove your hand.

Use your writing utensil to record this number in your notebook as the patient’s heart rate (HR).

Step 4: Respiratory Rate

Respiratory rate (RR) is the number of movements indicative of inspiration and expiration per unit of time, usually per minute.

An average adult’s normal respiratory rate is about 12 - 20 breaths per minute (BrPM).

It is best to count respirations after counting the heart rate and to let the patient know you counted their respirations afterwards. This assures that a patient’s rate of breathing does not change under the knowledge that their breathing is being observed.

Measuring the Respiratory Rate

Ask your patient to assume their former resting position, either relaxed in a chair or lying on their back.

Look to a nearby clock or watch, and count the number of times the chest rises for 60 seconds.

Use your writing utensil to record the number of respirations you observe in your notebook as the patient’s respiratory rate (RR).

Step 5: Blood Pressure

Blood pressure (BP) is the pressure that is exerted by the blood upon the walls of the blood vessels.

Two numbers are recorded when measuring blood pressure. The higher number is the systolic pressure. This refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number is diastolic pressure. This refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as millimeters of mercury (mm Hg).

A normal blood pressure for an average adult is between 120/80 and 90/60.

Blood pressure can be measured with various devices, such as an aneroid sphygmomanometer or a digital sphygmomanometer. There are two types of digital sphygmomanometers, or blood pressure gauges: arm monitors and wrist monitors.

Measuring the Blood Pressure with an Aneroid Sphygmomanometer (and Stethoscope)

Assist your patient in assuming a sitting position if they have not already. Once the patient is sitting upright, ask them to extend their arm forward. Have them place their arm on a stable surface (e.g. chair armrest, table). They may use their other hand to hold the extended arm steady by cupping the elbow if there is no available surface to rest it upon. If the patient is lying down, have them rest their arm alongside their body.

Rotate the arm so that the inside of the elbow and palm of the hand are facing upward.

Unwrap the cuff of the monitor and place it around the patient’s upper arm.

Position the stethoscope in front of you so that the binaurals (earpieces) are bent forward away from you. Gently place them into your ears, adjusting them to make sure they are not too tight or too loose.

Hold the tunable (the chest piece) between the index and middle fingers of your dominant hand, and place your thumb under the tubing.

Place the flat side of the tunable directly on the skin of the upper arm, just slightly under the cuff and to the proximal (inner) side of the arm.

Rest the gauge of the sphygmomanometer in the open palm of one free hand or on a nearby surface so that you can clearly see it.

Squeeze the pump rapidly with your opposite hand until the gauge is near its highest point. Stop squeezing and turn the knob on the pump counterclockwise to let the air out slowly.

Let the pressure fall 2 millimeters (lines on the dial) per second while listening for heart sounds with the stethoscope.

Note the number reading when you first hear a heartbeat. This is your systolic pressure.

Note the number reading when you no longer hear a heartbeat. This is your diastolic pressure.

Allow the cuff to deflate completely. You may now unlatch and remove the cuff from the patient’s wrist.

Observe the final blood pressure reading given on the sphygmomanometer screen, and use your writing utensil to record the systolic and diastolic numbers in your notebook as the patient’s blood pressure (BP).

Measuring the Blood Pressure with a Digital Arm Sphygmomanometer

Assist your patient in assuming a sitting position if they have not already. Once the patient is sitting upright, ask them to extend their arm forward. Have them place their arm on a stable surface (e.g. chair armrest, table). They may use their other hand to hold the extended arm steady by cupping the elbow if there is no available surface to rest it upon. If the patient is lying down, have them rest their arm alongside their body.

Rotate the arm so that the inside of the elbow and palm of the hand are facing upward.

Unwrap the cuff of the digital arm monitor, place it around the patient’s upper arm.

Use the designated button/switch to turn the sphygmomanometer on. Wait as the monitor inflates around the arm and measures the patient’s blood pressure. Readings on the monitor will continue to increase.

Once the monitor is done measuring the patient’s blood pressure, it will deflate and display its final readings. You may now unlatch and remove the cuff from the patient’s arm.

Observe the final blood pressure reading given on the sphygmomanometer screen, and use your writing utensil to record the systolic and diastolic numbers in your notebook as the patient’s blood pressure (BP).

Finally, use the designated button/switch to turn the sphygmomanometer off.

Measuring the Blood Pressure with a Digital Wrist Sphygmomanometer

Assist your patient in assuming a sitting position if they have not already. Once the patient is sitting upright, ask them to extend their arm forward. Have them place their arm on a stable surface (e.g. chair armrest, table). They may use their other hand to hold the extended arm steady by cupping the elbow if there is no available surface to rest it upon. If the patient is lying down, have them rest their arm alongside their body.

Rotate the arm so that the inside of the elbow and palm of the hand are facing upward.

Unwrap the cuff of the digital wrist monitor, place it around the patient’s extended wrist with the screen of the monitor facing upward, and fasten the strap around their wrist.

Lift the patient’s forearm about approximately a 45 degree angle and adjust the arm’s height so that their wrist is level with their heart.

Use the designated button/switch to turn the sphygmomanometer on. Wait as the monitor inflates around the wrist and measures the patient’s blood pressure. Readings on the monitor will continue to increase.

Once the monitor is done measuring the patient’s blood pressure, it will deflate and display its final readings. You may now unlatch and remove the cuff from the patient’s wrist.

Observe the final blood pressure reading given on the sphygmomanometer screen, and use your writing utensil to record the systolic and diastolic numbers in your notebook as the patient’s blood pressure (BP).

Finally, use the designated button/switch to turn the sphygmomanometer off.

Step 6: Review Vital Signs

Now, it's time to review the patient's vital measurements. The normal ranges for the average adult are as follows:

• Temperature: 97 - 99 °F (36.1 - 37.2 °C)
• Heart Rate: 60 - 100 BPM
• Respiratory Rate: 12 - 20 BrPM
• Blood Pressure: 120/80 - 90/60 mmHg

It is important to note that these are AVERAGES. Normal vitals will vary by person, age, activity, and time of day.

If any of the person's vitals are out of the ordinary for them, it may be a good idea to call a doctor.

Again, if someone is having a medical emergency, this is not where you need to be. Please stay calm, get off this site, and call your local emergency number (such as 911).

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