Performance Evaluation Checklist for

Vital Signs Taking

Name: ___ Level Section: Date: ___

Define the following:

Vital Signs: ______________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Temperature: ______________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Pulse Rate: ______________________________________________________________

___________________________________________________________________________

Respiratory ______________________________________________________________
Rate ____________________________________________________________________

Blood ____________________________________________________________________
Pressure __________________________________________________________________

Pain _______________________________________________________________________
___________________________________________________________________________

Rating
Procedure Rationale 5 4 3 2 1
Taking the Axillary Temperature
1. Wash hands
2. Gather the equipment needed. A tray with
lining containing the following:
 Digital thermometer
 BP apparatus
 Container of CB soaked with disinfectant
 Container with dry CB
 Container with cool water
 Jotdown notebook
 TPR / BP Sheet
 Receptacle
 Tissue paper or client’s face towel
3. Identify the patient and explain the
procedure.
4. Provide privacy
5. Position client. Roll client’s sleeves.
6. Pat dry the axilla using the patient’s face
towel using mitten’s folding.
7. Place used face towel on a container using
correct folding of contaminated area or side.
8. Take the thermometer then remove probe
cover. Set aside cover on tray.
9. Hold the thermometer firmly and clean
thermometer from probe tip to stem/ body
using CB soaked with disinfectant and rinse
it with cool water.

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 Rating
Procedure Rationale 5 4 3 2 1
10. Insert the thermometer in the axilla and
instruct client to hold thermometer in place
until the beep is heard or when numbers
show up in the thermometer window.
11. Remove the thermometer and wipe it using
dry CB from stem/body down to the probe
tip.
12. Read the client’s temperature and record on
the jotdown notebook.
13. Fix client’s sleeves.
14. Rinse the digital thermometer on the
disinfectant solution making sure not to
place disinfectant directly onto the sensor.
15. Dry and place the cover cap on the probe
tip and set aside for next use.
Taking the Pulse Rate
16. Proceed with the taking the pulse rate of
the client. Wear watch with second hand.
17. Have the client rest his arm alongside of his
body with the wrist extended and the palm
of the hand downward.
18. Place the tips of the three fingers on the
palm side of the patient’s wrist. Rest thumb
on the back of the patient wrist
19. Apply enough pressure so that you can feel
the pulse (not too hard not to light).
20. Using a watch with second hand count the
number of pulsations felt on the patient for
one full minute.
21. Record the result in the jotdown notebook.
Taking the Respiratory Rate
22. Hold the client’s wrists just as if you were
taking his/her pulse.
23. Note the rise and fall of the client’s chest
with each respiration.
24. Using a watch with a second hand, count
the number of respiration for one full
minute.
25. Record the respiratory rate.
Taking the Blood Pressure
26. Position and expose the arm of the client.
27. Locate the brachial artery pulse.
28. Apply and wrap the deflated cuff evenly
around the arm at least 1 inch above the
antecubital space.
29. Close the valve on the pump by turning the
knob clockwise.
30. Obtain the stethoscope and place earpieces
after disinfection.
31. Place the bell of the stethoscope over the
brachial pulse.
32. Pump up the cuff until sphygmomanometer
reads 30 mm Hg above the point where the
brachial pulse disappeared.
33. Release the valve of the cuff slowly. Note
the first beat heard and the last beat heard.
34. Remove the cuff. Fix or roll down sleeves.
35. Record reading on jotdown notebook.
36. Dispose wipes and used contaminated
items.
37. Inform that you are leaving after fixing
clothes and linens of client. Wash hands

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 Rating
Procedure Rationale 5 4 3 2 1
Recording of Vital Signs
38. Using the Vital Signs Sheet/Record, show
documentation of vital signs to your
respective clinical instructor for correctness.

Supervised by:

____________________________
Signature Over Printed Name