Knock, enter the room, wash/sanitize hands and introduce yourself
Greet the patient, ask the patient’s name, explain the exam and ask for consent
Take a focused history before beginning vitals assessment:
Have you had any caffeine or cigarettes in the last 30 mins? Have you done any vigorous exercise in the last hour?
Have you taken any medications today? Have you had any surgeries in either arm? Any recent stress? History of white coat syndrome(change in blood pressure due to presence of healthcare professional)?
Ensure that patient has been seated at rest for at least 5 mins before beginning
Heart Rate & Respiratory Rate
Find patient’s radial pulse by palpation, have watch handy.
Measure HR first 15-30s (or full minute if irregular), pretend to continue, in last 15-30s, watch RR.
Report: HR is __ bpm; RR is __ breaths/minute. I would also measure HR while patient supine (laying on back)
Blood Pressure
Patient sitting quietly and relaxed, feet uncrossed and flat on ground, ideally after resting 5mins before measurement.
Elevate patient’s arm to level of heart – either use table/pillows, or support patient’s arm with one arm. Position cuff 2-3cm above the crease of the elbow, with the “artery” marker line aligned with brachial pulse.
Palpate the radial pulse and inflate cuff to 70 mmHg, then by 10 mmHg increments until pulse disappears – this is estimate of systolic blood pressure (SBP).
Place your stethoscope under cuff at brachial artery. Inflate the cuff above estimate (+30 mmHg), slowly let out (2 mmHg/second) until first sound comes back (SBP). Continue to deflate cuff until you hear last sounds in series (diastolic blood pressure – DBP). These are called Korotkoff sounds. Keep deflating slowly for another 10 mmHg to make sure these sounds don’t appear and disappear again, then rapidly drop the pressure all the way to zero.
Oxygen Saturation
Place the pulse oximeter on a digit free of nail polish on the opposite hand from your blood pressure cuff (can give erroneous readings if blood pressure cuff inflated).
Monitor waveform (synchronized with heart rate), wait for oxygen saturation readouts.
Stethopedia 