TEMPERATURE PULSE AND RESPIRATION RATE CHART

Patient Name: __________________________________________ Attending Physician: ________________________________________

Age: _______ Sex: _______ Room No. /Bed No. ___________ Hospital Unit No. ____________________________________________

Day of
Hospitalization
Post-Operative
Day No.

Date
RR PR Temp 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12 4 8 12

150 41

140 40

130 39

120 38

110
37

36
100
35

90

80
70
70
60
60

50
50

40
40
30
30
20

10

BLOOD PRESSEURE
6-2
2-10
STOOL
10-6
TOTAL

6-2
URINE 2-10
10-6
TOTAL
DOH-SWUMeD-NSD-F-007 Rev.
 Print one copy of the TPR sheet and plot the data shown below.
 Use a RED ballpen for the PULSE RATE and a BLACK ballpen for the RESPIRATORY RATE, TEMPERATURE,
and BLOOD PRESSURE.
 Make use of a fine-tipped pen ( make sure the pen wont blot)
 Keep in mind that each square equals 5.

RESPIRATORY BLOOD
DAY DATE TIME TEMPERATURE PULSE RATE RATE PRESSURE
4:00 AM 36.5 85 30 120/80
8:00 AM 36.4 82 25 130/90
12:00 NN 37.5 90 15 130/90
1 April 10
4:00 PM 38 87 16 120/70
8:00 PM 37 76 17 120/70
12:00 MN 36.8 75 25 120/80
4:00 AM 38.5 70 20 140/100
8:00 AM 38.3 74 18 140/101
12:00 NN 37.6 78 19 130/90
2 April 11
4:00 PM 37 79 23 140/100
8:00 PM 39 74 25 120/90
12:00 MN 38.4 73 25 120/80
4:00 AM 36.5 80 30 130/90
8:00 AM 36.4 86 24 120/80
12:00 NN 37.5 87 21 120/81
3 April 12
4:00 PM 38.2 92 26 120/82
8:00 PM 37 81 16 120/70
12:00 MN 36.5 85 18 120/80
4:00 AM 38.5 95 19 140/100
8:00 AM 38.9 87 17 120/80
12:00 NN 37.6 87 20 120/70
4 April 13
4:00 PM 37 87.6 22 130/80
8:00 PM 39 89 23 140/100
12:00 MN 38.4 80 23 130/80