▶What is the correct technique for manual blood pressure measurement?
Sit the patient upright with feet flat on the floor or bed, back supported, arm at heart level, and the cuff bladder centered over the brachial artery. No talking during measurement. Use the appropriate cuff size (bladder encircles 80% of arm). Inflate the cuff 20 mmHg above the palpated radial pulse, then slowly deflate at 2–3 mmHg per second while listening with a stethoscope over the brachial artery. Record the systolic pressure when you first hear Korotkoff sounds and the diastolic when the sound disappears. Take at least two readings one minute apart, average them, and document the arm used and patient position (sitting, lying, standing for orthostatic checks).
▶Why does blood pressure vary so much and when should I recheck?
Blood pressure fluctuates with activity, stress, pain, caffeine, full bladder, and time of day (higher in morning, lower in evening). Recheck if a reading seems inconsistent with the patient's baseline or if the patient is symptomatic. Take a repeat reading after two to three minutes of quiet rest. Use the other arm or leg if one arm is unavailable (note which one in the chart). If systolic is elevated 20+ mmHg on first reading, recheck. Orthostatic vital signs (lying, sitting, standing with one minute between) catch hypovolemia or medication side effects; a drop of ≥20 mmHg systolic or ≥10 mmHg diastolic on standing signals orthostatic hypotension.
▶How do you count respiratory rate accurately and what is normal by age?
Count breaths for 60 seconds (or 15 seconds × 4 if very busy) without the patient knowing you are watching — people breathe differently when they know. Normal adults = 12–20 breaths/min at rest. Tachypnea (>20) signals fever, pain, anxiety, pulmonary disease, or metabolic acidosis. Bradypnea (<12) occurs with opioid overdose, hypothermia, or intracranial pressure. Newborns: 30–60; infants 6–12 months: 25–35; toddlers 1–3 years: 20–30; children 4–6 years: 20–25. Assess depth (shallow vs. deep) and pattern (regular vs. irregular, labored vs. easy). Cheyne-Stokes breathing (crescendo-decrescendo with apnea) signals critical illness.
▶What does an abnormal pulse rate tell you and when is it critical?
Normal resting heart rate = 60–100 bpm in adults. Tachycardia (>100) occurs with fever, pain, anxiety, anemia, hyperthyroidism, or dehydration. Bradycardia (<60) occurs with athletic training, hypothyroidism, medication (beta-blockers), or critical illness (sepsis, cardiogenic shock). Check for regularity: an irregular pulse may signal atrial fibrillation (AF) and stroke risk. Weak or thready pulse = low perfusion from shock or dehydration. Bounding pulse = high cardiac output from fever or sepsis. Take the apical pulse (over the heart with a stethoscope) if peripheral pulses are weak or the rate is <60 or >100 and you are unsure of the rhythm.
▶How do you interpret oxygen saturation and when is it concerning?
SpO2 (oxygen saturation) is measured by pulse oximetry, with normal ≥95% on room air in healthy adults at sea level. SpO2 92–94% is borderline; <90% is hypoxemia requiring intervention. Pulse ox readings are unreliable if the patient has poor perfusion (hypothermia, shock), dark skin pigment (some devices underestimate), nail polish, or motion artifact, so always correlate with the patient's appearance and symptoms (shortness of breath, confusion, cyanosis). Check SpO2 on room air first, then repeat on supplemental oxygen if ordered. Trending is key: a slow drop from 97% to 93% over hours is more concerning than a one-time 94% if the patient looks well. An arterial blood gas (ABG) gives pH and CO2 and is the gold standard if you suspect respiratory failure.
▶What is a fever and how do you measure temperature accurately?
Fever is a core body temperature ≥38°C (100.4°F) in adults. Oral (under the tongue) is most common; tympanic (ear) is fast but less accurate if the probe is not placed correctly or the patient has ear wax. Axillary (armpit) is least accurate. Temporal (forehead with IR scanner) is increasingly common in healthcare. Digital thermometers are standard and most safe. An elevated temperature can signal infection, inflammation, heat stroke, or medication side effects. Monitor trend and context: a fever is less concerning in a patient with mild URI symptoms than in a postoperative patient with sepsis signs (tachycardia, hypotension, altered mental status).
▶How often should vital signs be taken and documented?
Frequency depends on acuity and clinical setting. Healthy outpatients = once per visit. Hospitalized stable patients = every 4–8 hours. ICU or unstable patients = continuous monitoring or every 1–2 hours. Post-operative patients = every 15 minutes for the first hour, then every 30 minutes to every hour as they recover. Home health patients = per the care plan, often weekly. Frequent trending (every hour or continuous) catches deterioration early. Always take vital signs if the patient has new symptoms or before and after a procedure. Document time, all five vital signs, the arm or site used, patient position, and any noteworthy findings (e.g., 'BP 180/110, patient anxious about procedure').
