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Vital Signs

Tuesday, November 9, 2021

If you are a caregiver for an elderly or disabled person in the U.S., you may be a part of the Consumer Directed Personal Assistance Program (CDPAP). This program is offered by Medicaid and it allows the elderly or disabled to hire a friend or family member as their caregiver. You may assist them in everything from getting dressed, to bathing, to moving around the house, to remembering to take their medication. Caregivers may also cook, clean, and provide companionship.

 

While caregivers do not need to have medical training, it can be important for you to know how to check a patient’s vital signs in order to help their medical team assess their treatment plan.

 

Below, we’ll explain the basics of understanding and measuring vital signs for CDPAP caregivers.


What are vital signs?

Vital signs are measurements of our body’s basic, life-sustaining functions. They can tell us how a person is feeling and/or responding to treatment and give caregivers insight into whether a client needs to see a doctor.

 

With the right tools, vital signs can be easily measured at home.


The four main vital signs

There are 4 classic vital signs that help caregivers and medical staff tell if a person needs medical attention:

-          Body temperature

-          Pulse rate

-          Respiration rate (rate of breathing)

-          Blood pressure

 

Doctors, nurses, and EMT also take measurements of other bodily functions. While they aren’t considered “classic” vital signs, these include:

-          Blood glucose level

-          Oxygen saturation

-          Pain (on a scale of 1-10)

-          Skin condition

-          Pupil size

 

However, if you’re a caregiver without medical training, you’ll probably want to stick with the 4 classic vital signs unless the client’s treatment plan requires more and their doctors equips you with the tools to record this information.

 

Here’s what you should know about the 4 easiest vital signs to take:

 

What is body temperature?

Since fever is a sign that the body is fighting off illness, it’s important that it stays in a stable range. Normal body temperature ranges from 97.8 to 99 degrees Fahrenheit (or 36.5-37.2 Celsius). While an abnormally high temperature indicates a fever, an irregular low temperature can be cause for concern as well, as it may indicate hypothermia.

 

It’s important to know an individual’s average body temperature. For example, if they tend to have a body temperature on the lower side (below 98 degrees) and their temperature suddenly spikes to 99 degrees, then that may already indicate a fever. It will all depend on the individual.

 

Sometimes doctors recommend that caregivers take a patient’s body temperature regularly and keep a record.


How to take a person’s body temperature

There are 4 ways to take a person’s body temperature, and depending on the client’s condition and how well they cooperate, one method may be easier than another. Choose the one that works best for you and your client.

 

Taking temperature orally  

If you have a cooperative client who can breathe through their nose easily, it’s most common to take their body temperature with an oral thermometer.

 

Place the silver tip of the thermometer under the tongue and ask the person to close their mouth and wrap their lips around the device to keep it in place.

 

Leave the thermometer in place for 3 minutes before taking the reading. If you have an electronic thermometer, remove it when the device beeps.

 

Taking temperature rectally

This method is typically used on infants or those who cannot hold a thermometer in their mouths. Modern thermometers that can measure temperature via the skin or ear make rectal thermometers less ideal for everyone involved. However, they tend to take the most accurate readings when inserted correctly.

 

If you need to take a client’s temperature rectally, you will need to place petroleum jelly on the bulb of the instrument, spread the patient’s buttocks, and gently insert the thermometer about 1 inch into the anal canal. Remove the thermometer after 3 minutes or when the device beeps.

 

Taking axillary temperature

To take a client’s axillary temperature, the thermometer is inserted into their armpit. But it’s important to remember that this will give a less accurate reading since the device is not inside the body. Axillary temperature is typically 1 degree lower than oral or rectal temperature. A normal axillary temperature is between 96.6° (35.9° C) and 98° F (36.7° C).

 

If you take a client’s axillary temperature, it’s important to wait at least 15 minutes after bathing or exercising to take their temperature. When you’re ready, place the glass or digital thermometer under their armpit when they are at rest and keep it in place for 5 minutes or until the device beeps.

 

Taking temperature in the ear

You will need a special thermometer to take a client’s temperature via their ear. Do not insert a regular thermometer into the ear canal.

 

Ear temperature can be taken with a digital ear thermometer or a tympanic thermometer. These use infrared sensors to measure body temperature, and they require far less waiting than other thermometers do. The reading is typically ready in a few seconds.

 

However, body temperature taken in the ear may not be as accurate, so you will want to have a good sense of the patient’s normal ear temperature in order to spot anomalies.

 

Taking temperature via the skin

Forehead thermometers have become more popular in the last few years. These can measure body temperature using infrared scanners pointed at the forehead’s temporal artery. These can be very useful if a client doesn’t like to be touched or if infectious disease is a concern.

 

However, these devices have received criticism for being less accurate, so they may not be the best method to start with.

 

Plastic strip thermometers also measure temperature via the skin using a plastic strip applied to the forehead. But these can really only measure skin temperature and caregivers will get more useful readings using instruments that measure body temperature.


What is a pulse rate?

Your pulse rate is the number of times your heart beats each minute. When taking a patient’s pulse, most medical professionals also take note of heart rhythm and the strength of the pulse as well, but that requires training.

 

As a caregiver, you may only need to count the pulse rate and ensure it is in the patient’s normal range. “Normal” pulse rates vary by person and can also depend on age, illness, activity (such as exercise) and emotional state. For healthy adults, pulse rates are generally between 60 and 100 beats per minute.

 

How to measure your pulse

You can measure a person’s pulse rate (or your own) on the wrist. Start by using your first and second (pointer and middle) fingers to press firmly on the artery. This is located on the thumb side of the wrist.

 

Once you feel the pulse, you should use a clock or a timer to be sure you’re counting all the beats in a 60-second time frame. Going over or under that time will result in an inaccurate reading.

 

You can also count the number of pulse beats for 15 seconds and then multiply that number by 4 if a client is less cooperative.

 

If you have a hard time concentrating on counting the exact number of beats within a given time frame, it may be easier to use a timer. You can also ask someone to count the time for you while you count the beats.


What is a respiration rate?

A person’s respiration rate is the number of breaths they take in a minute. This is an important measurement because above or below average respiration rates can indicate serious illness or an incident that requires medical attention.

 

Our respiration rates tend to increase when we have a fever or other illness. But some conditions may make breathing more difficult.

 

While checking a client’s respiration rate, you should also ask if they feel any discomfort while breathing. Ask your client to breathe normally while having their respiration rate checked.

 

For an adult, a normal respiration rate can range from 12 to 16 breaths per minute.


How to measure respiration rate

In order to measure a client’s respiration rate, they should be at rest.

 

No contact is needed to make this measurement since a caregiver can simply count the number of times a person’s chest rises. If the client can sit up in a chair or in bed without straining, it’s usually better to take the measurement that way. 


What is blood pressure?

Blood pressure is a measurement of the force with which our circulating blood pushes against our artery walls as our hearts contract and relax.

 

When we take blood pressure, we get two numbers. One is the systolic blood pressure, which refers to the pressure inside of the artery as the heart contracts and pumps the blood. That’s the higher number. The second number is called the diastolic pressure number, and it refers to the pressure inside of the artery when the heart is at rest as it is refilling with blood.


You do not need to understand the technicalities of blood pressure in order to measure it. But it’s important to remember that high blood pressure is referred to as hypertension and it puts a patient at increased risk for a heart attack.

 

Stages of blood pressure

Ideal blood pressure is 120/80 (pronounced as one-twenty over eighty). A person’s blood pressure is considered “normal” when their systolic number is less than 120 and their diastolic number is less than 80.

 

If a person’s systolic number is between 120 and 129 and their diastolic is still less than 80, they are considered to have elevated blood pressure.

 

Numbers above this range indicate hypertension, which comes in 2 stages:

-          A systolic number between 130 and 139 and diastolic number between 80 and 89 is considered Stage 1 high blood pressure.

-          A systolic number over 140 and a diastolic number over 90 is considered Stage 2 high blood pressure.


High blood pressure should be treated by a doctor.


How to measure blood pressure 

There are 3 ways a caregiver can take a client’s blood pressure reading.

 

An aneroid monitor uses a Velcro cuff on the upper arm that you inflate by squeezing a rubber bulb. It also involves placing a stethoscope under the cuff. The device has a dial gauge and a pointer to give readings. This is the most accurate way to take blood pressure and the cheapest device, but it does require some training to learn how to use it properly.

 

To take a blood pressure measurement using this tool, rapidly squeeze the pump until the gauge reads at least 150. Turn the knob on the side of the gauge counterclockwise as you let the air out slowly. Listen for the sound of the heartbeat through the stethoscope as you let the pressure fall slowly. The number on the gauge when you first hear a heartbeat is the systolic pressure number. The number on the gauge when you stop hearing the client’s heartbeat is their diastolic pressure number.

 

You can also take a patient’s blood pressure using a digital monitor. They are more expensive but much easier to use since the device does all the work. You simply need to turn it on and record the numbers you see on the screen when it’s done.

 

The most precise digital monitors are used on the patient’s upper arm, just like a blood pressure cuff. You can find digital blood pressure monitors for the wrist and finger, but they are often more expensive and less accurate than other devices.

 

Before you measure your blood pressure

If you are regularly taking a client’s blood pressure, it will be most helpful to do it at roughly the same time each day, always recording the day and time along with the reading(s). And since blood pressure can be temporarily affected by many different things, it’s important that caregivers ensure their clients follow these guidelines before they have their blood pressure taken:

-          Sit in a chair with back support

-          Keep feet on the floor and do not cross legs or ankles

-          Relax for 5 minutes before having blood pressure measured

-          If a person needs to empty their bowels, they should do so before having their blood pressure taken

-          Do not smoke or drink coffee for 30 minutes before a blood pressure reading


If you are a caregiver taking a client’s blood pressure at home, it will be helpful to take the reading 2-3 times, if you’re able. This will ensure you end up with the most accurate number.

 

If you have any questions about how to take or record blood pressure, or measure any of a patient’s vital signs, a healthcare provider can assist you.