vital signs demonstration

1. College of Nursing, KGMU.
Subject- Community Health Nursing
Lesson Plan on VITAL SIGNS
SUBMITTED TO: SUBMITTED BY:
Ms. Supriya Singh Rupali Singh
Clinical Instructor MSC Nursing 1st Year
College of Nursing College of Nursing
KGMU KGMU
SUBMITTED ON:
04.N0v.2019

2. LessonPlan on Vital signs
Subject Community health nursing
Topic Vital signs
Group BSc Nursing II year
Place Classroom
Date & time 04.Nov.2019
Teaching method Lecture cum demonstration.
AV aids / instructional aids Slides, community bag, chart & black board.
Student Pre requisite Students may have some knowledge about the vital signs.
General Objective After the completion of the class, students will be able to demonstrate the procedure of taking vital signs.
Specific objective At the end of the demonstration students will be able to;
 Introduce the topic
 Define vital signs
 Illustrate the purpose of taking vitals.
 List down the articles required for assessment of vital signs.
 Define temperature.
 Explain various methods of assessment.
 Enlist types of thermometer.
 Demonstrate the procedure of assessment of temperature from various sites.
 Define pulse.
 Demonstrate the procedure of assessment of pulse from various sites.
 Define respiration

3.  Explain normal values of respiration at different levels of life.
 Demonstrate the procedure of assessment from various sites.
 Define blood pressure.
 Demonstrate the procedure.
 Explain pain assessment.
 List down methods of assessment of pain.
Review of previous class Reviewed the vital organs and their importance to sustain life.
Introduction  Vital signs are Also referred as cardinal signs.
 They are important indicators of the body’s response to physical, environmental, and psychological
stressors
 Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a
medical setting, at home, at the site of a medical emergency, or elsewhere.

4. S. No Time Specific
objective
Content Teaching learning
activity
Evaluation
1 3min To define
vital signs.
VITAL SIGNS
Definition
 It is defined as “measurement of the body's most
basic functions. They are governed by vital organs
and often reveal even the slightest deviation from
the normal body function”. Because of the
importance of these measurements they are referred
to as Vital Signs.
The vital signs routinely monitored by medical
professionals and health care providers include the
following:
 Body temperature
 Pulse rate
 Respiration rate
 Blood pressure
 Recently Pain assessment has also added as 5th
vital signs as other 4 vital signs can be affected by
pain in several ways.
WHEN TO TAKE VITAL SIGNS?
 On a client’s admission
 According to the physician’s order or the
institution’s policy or standard of practice
 When assessing the client during home health visit
T: Lecture cum
discussion method with
the use of white board
S: Listening
What is vital signs?

5. 2.
3
2 min
2min
To illustrate
the purpose
of taking
vital signs.
To list down
the articles
required for
assessment.
 Before & after a surgical or invasive diagnostic
procedure
 Before & after the administration of medications or
therapy that affect cardiovascular, respiratory &
temperature control functions.
 When the client’s general physical condition
changes e.g. decrease in LOC , increase in pain.
 When client reports symptoms of physical distress.
PURPOSE;
Assessment of vital signs allows the nurse to;
 Identify specific life threatening conditions and plan
the needed nursing interventions.
 Detect changes in the client’s health status.
ARTICLES REQUIRED
A Community bag containing ;
 A bottle with disinfectant solution (Dettol 1:40/
savlon 1:20)- to disinfect the thermometer.
 Thermometer- to measure the temperature.
 A small bowl with cotton swabs- to clean the
thermometer.
 Paper bag/kidney tray. To collect the soiled
swabs/cotton balls.
 Pens- to note down the reading
 Watch- for measuring time.
T: Lecture cum
discussion method with
the use of slides.
S: Listening
T: Lecture cum
discussion method with
the use of slides.
S: Listening
What are the purposes
for measuring vitals?
Why is savlon used ?

6.  Flow sheet/graphic chart/paper- to record the
findings.
 Lubricant (in case if rectal method)- for easy
insertion of thermometer & to prevent any damage
to soft tissues of rectum.
 Sphygnomanometer- to measure B.P.
 Stethoscope – to hear the pulse sound
4.
5.
5min
8min
To define
temperature .
To explain
various
methods of
assessment.
Temperature.
It is defined as;
 ‘Balance between heat produced and heat lost
by the body.
 Heat Regulating center – hypothalamus.
Normal body temperature -
 Normal body temperature can range from
97.8 degrees F (or Fahrenheit, equivalent to 36.5
degrees C, or Celsius) to 99 degrees F (37.2
degrees C) for a healthy adult.
Methods
A person's body temperature can be taken in any of the
following ways:
 Orally- Temperature can be taken by mouth using
either the classic glass thermometer, or the more
modern digital thermometers that use an electronic
probe to measure body temperature.
 Rectally- Temperatures taken rectally (using
a glass or digital thermometer) tend to be 0.5 to 0.7
degrees F higher than when taken by mouth.
 Axillary- Temperatures can be taken under the
T: Lecture cum
discussion method with
the use of slides.
S: Listening S:
listening, watching &
interacting
T: Lecture cum
discussion method with
the use of slides.
S: Listening S:
listening, watching &
interacting
Which is called heat
regulating center?
What are the different
methods used for
taking temperature?

7. 6
7.
5min
9min
To enlist
types of
thermometer.
To
demonstrate
the procedure
of assessment
of
temperature
from various
sites.
arm using a glass or 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.
TYPES OF THERMOMETER
 Glass thermometer/clinical thermometer –
mercury expands or contracts in response to heat.
 Electronic – heat sensitive probe, (reads in seconds)
there is a probe for oral/axillary use (red) & a probe
for rectal use (blue). There are disposable plastic
cover for each use. Relies on battery power .
 Infrared Tympanic (Ear) – sensor probe shaped
like an otoscope in external opening of ear canal.
Ear canal must be sealed & probe sensor aimed at
tympanic membrane.
PROCEDURE
1. Upon arrival at the patient’s home, place the bag on
the table lined with a clean paper. The clean side
must be out and the folder part, touching the table
2. Ask for water or a glass of drinking water if tap
water is not available. Open the bag and take out the
towel and soap.
3. Wash hands using soap and water, wipe to dry.
4. Take out the apron from the bag and put it on with
the right side. Put out all the necessary articles
needed for the specific care.
T: Lecture cum
discussion method with
the use of slides.
S: Listening listening &
interacting.
T: Lecture cum
demonstration method
with the use of slides.
S: Listening &
interacting.
How many types of
thermometer are used?
How to clean
thermometer?

8. 5. Close the bag and put it in one corner of the
working area.
6. Ascertain method of taking temperature. Explain the
procedure to the patient. This will help the patient to
understand and will make it easier for them to
cooperate.
7. Wash and dry hands – this will help to prevent
cross-infection.
8. Prepare equipment. Disinfect the thermometer by
wiping with an alcohol wipe from bulb to stem.
9. Check temperature;
 For oral method -
*Place bulb of thermometer at base of tongue on the
side of frenulum in the posterior sublingual pocket
*Instruct patient to close the lips and not teeth
around thermometer. leave it for 2-3 mins.
 For rectal method;
*Wear clean gloves. (Assure privacy).
*Apply lubricant on the bulb of thermometer using
cotton ball.
*With nondominant hand expose the anus raising
upper buttocks.
*Instruct pt. to take deep breath while inserting
thermometer. Hold it for 1-2 mins.
 For axillary method-
*Place bulb in centre of axilla.
*Place arm tightly across the chest to hold it in
place. Keep it in place for 3-5 mins.

9. 8. 5 min To define
pulse.
10. Remove thermometer wiping it from stem to bulb in
rotatory manner.
11. Read the temperature holding it at eye level & rotate
it till reading is visible and read it accurately.
12. Shake down the mercury level
13. Clean it with soap and water. Dry it and store it in
disinfectant solution.
14. Document temperature
15. Wash hands
16. Replace articles
ASSESSMENT OF PULSE
Definition- The pulse rate is a measurement of the heart
rate. This is 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 indicate the following:
 Heart rhythm
 Strength of the pulse
 There are some common sites which are used to
measure pulse rates.
T: Lecture cum
discussion method with
the use of slides.
S: Listening, watching
slides & interacting
What is pulse rate?

10. 9. 5min To
demonstrate
the procedure
of assessment
of pulse from
various sites.
Procedure
 Explain procedure.
 Ask whether the patient has walked, climbed stairs,
or otherwise exerted himself in the last 20 minutes.
If not,proceed with the procedure. If the answer is
yes, wait 20 minutes before taking the reading. This
will help to prevent false readings.
 Select the pulse site.
 Make sure the patient is relaxed and comfortable.
 Place the tips of your first and second finger on the
inside of the patient's wrist.
 Press gently against the pulse. Take your time to
note any irregularities in strength or rhythm.
 If the pulse is regular and strong, measure the pulse
T: Lecture cum
demonstration method
with the community
bag.
S: Listening, watching
the procedure &
interacting.
What is the first step
for pulse assessment?

11. 10. 2min To define
respiration.
for 30 seconds. Double the number to give the beats
per minute (e.g.: 32 beats in 30 seconds means the
pulse is 64 beats per minute). If you noticed changes
in rhythm or strength, you must measure the pulse
for a full minute.
 Record the pulse rate (the number of beats per
minute) in the patient's notes.
 Wash and dry your hands.
Special points;
 Never press both the carotids at same time as
this can cause reflex drop in B.P./pulse rate.
 Brachial and femoral sites are used with
cardiac arrest in infants.
Age Group Normal Values of pulse
• Infant 120 – 160 bpm
• Child 80 – 100 bpm
• Adult 60 – 100 bpm
Definition-
 The gaseous interchange between the tissue cells
and the atmosphere.
 It is a process in living organisms involving the
production of energy, typically with the intake of
oxygen and the release of carbon dioxide from the
oxidation of complex organic substances.
T- lecture cum
discussion method with
the use slides.
S- Listening &
interacting.
What is respiration?

12. 11.
12.
2min
4min
To explain
normal
values of
respiration at
different
levels of life.
To
demonstrate
the procedure
of assessment
from various
sites.
ASSESSING RESPIRATION
 Monitoring inspiration and expiration in a patient.
 The respiration rate is the number of breaths taken
per minute.
 The rate is usually measured when the body is at
rest. It simply involves counting the number of
breaths for one minute by counting how many times
the chest rises.
 Normal respiration rates
For an adult person at rest range from 16 to 22 breaths
per minute.
 At birth- 36 to 40 breaths per minutes
 1-12 month- 28-32 breaths per minutes
 2-4 years- 22-26 breaths per minutes
 5-10 years-18-24 breaths per minutes
 Old age- 10 to 20 breaths per minutes
Procedure
 Wash hands.
 Allow the patient to rest, if possible, for 10 minutes
before taking the measurement (RR may increase
after activity, giving an abnormal baseline).
 Position the patient in sitting or supine position with
head elevated at 45-60 degree.
 Keep fingers over the wrist as if checking pulse, and
position patient’s hand over his lower chest or
abdomen Observe one complete respiratory cycle,
assess rate, rhythm, and character of respiration.
T- lecture cum
demonstration with the
use of articles & slides.
S- Listening &
interacting.
T- lecture cum
demonstration with the
use of articles & slides.
S- Listening &
interacting.
What are the normal
respiration rates?
For how long
respiration has to be
measured?

13.  Count respiration for one whole minute.
 Wash hands
 Record the findings.
13. 2min To define
blood
pressure.
Monitoring Blood Pressure
Blood pressure- force of the blood pushing against the
artery walls during contraction and relaxation of the heart.
Each time the heart beats, it pumps blood into the arteries.
It results in the highest blood pressure as the heart
contracts. When the heart relaxes, the blood pressure falls.
It is measured as
 Systolic- force exerted against the arterial wall as lt.
ventricle contracts & pumps blood into the aorta –
max. pressure exerted on vessel wall.
 Diastolic – arterial pressure during ventricular
relaxation, when the heart is filling, minimum
pressure in arteries.
 Measured in mmHg – millimeters of mercury
 Normal range is 120/80 mmHg.
 Non invasive method of B/P measurement that is
measure by using Sphygmomanometer and
stethoscope.
T- lecture cum
demonstration with the
use of articles & slides.
S- Listening &
interacting
What is the systolic
B.P.?

14. 14. 3min To
demonstrate
the
procedure.
Procedure
 Check physicians order, NCP and progress notes.
 Explain the procedure and reassure the patient has
not recently exercised, the patient is cold or
otherwise uncomfortable, the patient has consumed
alcohol or caffeine less than 30 minutes before the
reading, the patient is anxious or stressed or the
patient is talking during the procedure.
 Wash and dry hands
 Assist the pt. to either sitting or lying down position
and ensure that legs are not crossed.
 Collect and check the equipment.
 Position the sphygmomanometer at approx.. heart
level of pt. and ensuring the mercury level at zero.
 Select a cuff of appropriate size. Expose the arm to
make sure that there is no constriction above the
placement of cuff.
 Apply the cuff approx. 2.5 cm above the point
where brachial artery can be palpated.
 Palpate the radial pulse and inflate the cuff until
pulse is obliterated.
 Inflate compression bag and then deflate cuff
slowly. Note the point at which reappears. Release
the valve.
 Palpate brachial artery and place diaphragm of
stethoscope.
 Release the valve of the inflation bulb. Note the first
sound heard i.e. diastolic.
 Continue to deflate the cuff. Note the point on
manometer at which sound muffled. This is diastolic
pressure.
 Remove and clean the equipment (ear peace)
T- Lecture cum
demonstration with the
use of articles & slides.
S- Listening &
interacting.
What is NCP ?

15. 15.
16.
2min
2min
To explain
pain
assessment.
To list down
the methods
of assessment
of pain.
 Wash hands.
 Record the findings.
PAIN ASSESSMEMENT
Pain assessment is a broad concept involving clinical
judgment based on observation of the type, significance and
context of the individual’s pain experience.
is a multidimensional observational assessment of a
patients’ experience of pain.
Acronyms- O,P,Q,R,S,T,
O- Onset- What the patient was doing when the signs and
symptoms first occurred.
P- Provocation or Palliation- Whether or not anything
makes it better
or worse.
Q -Quality -Description of what the patient is feeling. For
example, the pain can be
described as dull, sharp, crushing,
aching, tearing, throbbing,
R- Region and Radiation -Where the pain is located and if
it moves to another part of the body.
S -Severity -What the severity is based on a PAIN
SCALE of 1 to 10.
T- Timing -When the signs and symptoms first Occurred.
Pain assessment scale
 Explain to the person that each face is for a person
who feels happy because he has no pain (hurt) or
T- Lecture cum
discussion with the use
of slides.
S- Listening &
interacting.
T: lecture cum
demonstration method
with the use of articles.
S: listening &
practicing
Why pain assessment
is done?
What does ‘O’ stands
for?

16. sad because he has some or a lot of pain.
 Face 0 is very happy because he doesn't hurt at all.
 Face 2 hurts just a little bit.
 Face 4 hurts a little more. Face 6 hurts even more.
 Face 8 hurts a whole lot.
 Face 10 hurts as much as you can imagine, although
you don't have to be crying to feel this bad. Ask the
person to choose the face that best describes how he
is feeling.

17. SUMMARY: We discussed about definition and purpose of measuring vital signs. We also discussed about the definition of temperature, pulse,
respiration & blood pressure. Demonstrated various procedure for measuring vitals using community bag.
CONCLUSION: Vital signs are also referred as cardinal signs. Its assessment plays an important role in reporting any kind of deviation from
normal health. Temperature, pulse, respiration & blood pressure are assessed under vital signs.
EVALUATION:
 Assessing current ability to recall the topic by asking questions related to the learning objectives.
 hat is vital signs?
 What are the different sites used for temperature assessment & types of thermometer?
 What are different sites for measurement & the purposes of assessing pulse?
 What are the normal respiration rates?
 Define blood pressure & what is normal B.P. value?
 Why pain assessment is done?
ASSIGNMENT / APPLICATION: Give an assignment on vital signs. Date of assignment submission is 15.Nov.2019.

18. Bibliography:
1) Jacob Annamma, R. Rekha, Tarchand J.S.Clinical nursing Procedures:The Art of Nursing Practice.3rd ed. Jaypee publication ; Page no. 112-
125.
2) Perry & Potter.Fundamental of Nursin.8th ed.Elsevier publication ; Page no. 35-44.
3)Basavanthappa B.T.Textbook on Community Health Nursin.5th ed. Jaypee publication; Page no. 46-54.
4)Lawrence Jean , Dee May. Infection Control in Community. Elsevier publication: March 2003; Page no. 67-78.
Web reference –
5)John Hopkins Medicine Home. Health-Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)[document on the
internet].Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/vital-signs-body-temperature-pulse-rate-respiration-
rate-blood-pressure
6)University of Rochester medical centre.Health encyclopedia.Vital Signs(Body Temperature, Pulse Rate,Respiration Rate,Blood Pressure),
[document on the internet].URMC Infromation, 2019. Available from:
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00866 .