NAME: __________________________________________ LEVEL/ SECTION: _______________

NAME OF INSTRUCTOR:_____________________________ DATE: _______________________

ASSESSING VITAL SIGNS CHECKLIST

Performed
Remarks
Preparation Not Incorrectly Correctly
1. Assess:

A.) Temperature
- Clinical signs of fever
- Clinical signs of hypothermia
- Site most appropriate for measurement
- Factors that may alter body temperature
B.) Pulse
- Clinical signs of cardiovascular alteration, other
than pulse rate, rhythm, or volume
- Factor that may alter pulse rate
C.) Respiration
- Skin and mucus membrane color
- Position assumed for breathing
- Chest movement
- Chest pain
- Dyspnea
-Factors affecting respiratory rate.
D.) Blood Pressure
- Signs and symptoms of hypertension
- Signs and symptoms of hypotension
- Factors affecting blood pressure.

2.Assemble equipment and Supply:

- Thermometer
- Cotton balls with alcohol or alcohol wipes
- Watch with a second hand or indicator.
- Stethoscope
- Blood pressure cuff of the appropriate size
- Sphygmomanometer

Procedure

1. Identify the client properly and explain the

procedure
2.Wash hand and observe other appropriate
infection control procedure
3. Provide for client privacy.
4.Place the client in the appropriate position

ASSESSING BODY TEMPERATURE (AXILLARY

TEMPERATURE)

1.Wipe the armpit with tissue paper or ask the

client to do it if able
2.Wipe the thermometer from bulb to stem with
alcoholized cotton ball.
3.Place the thermometer on the client’s
appropriate site.
4.Wait for appropriate amount of time.
5. Read the temperature.
6.Wipe the thermometer with alcoholised
cottonball from stem to bulb. Return to container.

ASSESSING A PERIPHERAL PULSE (RADIAL PULSE)

1.Assist patient to appropriate position
2. Palpate and count the pulse. (Used watch to
count rate).Place two or three middle fingers
lightly and squarely over the pulse site.
3. Count rate for 30 seconds if pulse was
regular,multiplied total by 2
- if irregular,count for 60 sec.
4. Determine the strength and rhythm of pulse

ASSESSING RESPIRATIONS
1. Placed patient’s arm in appropriate position
2. Observed complete respiratory cycle.
3. Count rate properly
- Count 30 seconds if rhythm is regular
- count 60 sec.if irregular
4. Assess depth after counting rate,Note Rhythm
of ventilatory cycle

ASSESSING THE BLOOD PRESSURE

1. Position the patient (sitting or lying)

Forarm at heart level,palm up.Instruct feet flat
on floor without crossing the legs.
2. Expose extremity fully by roving constricting
clothing
3. Palpate brachial artery.Wrap cuff evenly around
extremity.(1 inch,2 fingerbreath above the
antecubital fossa.
4. Position manometer gauge vertically at eye
level.
5. Measure BP
6. REMOVE Cuff from extremity.
7. Help patient to comfortable position and cover
upper arm if previously clothed.
8. Perform hand hygiene
Evaluation
1. Compare reading with previous baseline
and/or acceptable value of BP for patients
age
2. Documentation