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Vital Sign Chart

This document contains instructions and a table for recording a patient's vital signs over time, including pulse, blood pressure, temperature, pain level, respiration rate, oxygen saturation, and staff information. The table has columns for date, time, pulse, blood pressure, temperature, pain score, respiration, oxygen saturation, and space for a staff signature. It instructs the user to use different colored pens to record the different vital signs and rates pain from 0 to 10.

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Flower Anne
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1K views1 page

Vital Sign Chart

This document contains instructions and a table for recording a patient's vital signs over time, including pulse, blood pressure, temperature, pain level, respiration rate, oxygen saturation, and staff information. The table has columns for date, time, pulse, blood pressure, temperature, pain score, respiration, oxygen saturation, and space for a staff signature. It instructs the user to use different colored pens to record the different vital signs and rates pain from 0 to 10.

Uploaded by

Flower Anne
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Name :

MRN : D.O.B :
GENDER: MALE FEMALE

VITAL SIGNS BED NO : AGE :


INSTRUSTIONS :
1. Use ' Key ' accordingly - BP - TEMP - PULSE - RESP X - PAIN
2. Use Red Pen for Pulse (Black Pen) (Red Pen) (Blue Pen) (Black Pen)
3. Use Blue Pen for Respiration

DATE
TIME
PULSE BP TEMP PAIN
RESP °C SCORE
250 10

240 9

180 230 8

170 220 7

160 210 6

150 200 5

140 190 4

130 180 3

120 170 2

110 160 42 1

100 150 41

90 140 40

80 130 39

70 120 38

60 110 37

50 100 36

40 90 35

30 80 34

20 70

10 60

SPO ₂
SIGN
STAFF NO
Rate the Severity of Pain
0 1 2 3 4 5 6 7 8 9 10
No Pain Mild Pain Moderate Pain Severe Pain Worst Pain

KPJAPSH/NSG - 02/ISSUE.04/MARCH 12

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