Are you a caregiver working with senior patients? These individuals rely on you for a better lifestyle and feedback on their health status. Understanding critical health factors are important to ensure patients live a healthy lifestyle, free from disease.
Their vitals give insight into how they feel at any specific moment. This post unpacks the meaning of vitals, the normal vital signs for seniors, and how to take correct readings in a brief health assessment.
Typically, vital signs are the basic platform indicating the essential foundation for any treatment or healthcare diagnosis. They assist medical practitioners in formulating a snapshot of the patient’s health. Vital signs include six key measurements, which we’ll discuss in this post.
Caregivers assist doctors and nurses by taking regular vital sign assessments to provide a track record of the patient’s health. These assessments allow doctors to look back on the patient’s history and spot inconsistencies that might help them diagnose the patient’s health problems.
Vital signs provide key information about organ function and other internal functions in the body. So, caregivers must understand the types of vital signs and how to measure these factors with the correct tools and methodology.
What Does it Mean to Take Vital Signs?
Caregivers must have training in assessing vital signs and vitals, meaning and importance to the patient’s health. “Vital signs” refer to the patient’s pulse, temperature, respiration, blood pressure, oxygen saturation, and pain level.
Their vital signs give caregivers a window into their patients’ health by assessing their essential bodily functions. If a patient says they aren’t feeling well, the caregiver considers these vital signs, looking for abnormalities.
If the caregiver discovers changes in the patient’s vital signs, deviating from the normal range of readings, they have the information they need to call for medical care from a doctor or nurse. Finding changes in vital signs away from the normal range may indicate underlying health problems or disease in the patient.
Why Do Caregivers Take Vital Signs?
Caregivers must learn to take vital sign assessments in their patients and how to record vital signs on a chart. Measuring vital signs is a standardized procedure performed to help assess a patient’s general physical health.
It provides clues to what’s going on in their body and if seniors face a health problem. Assessing vital signs is also key to understanding a patient’s recovery after experiencing ill health or a procedure.
Resource Link – PDF printable vital signs chart
Are Caregivers Qualified to take Vital Signs?
Caregivers can receive training to take routine vital signs in their patients. These assessments aren’t limited to healthcare professionals like paramedics, EMTs, nurses, medical assistants, and doctors. Anyone with the right training to carry out and interpret vital signs assessments can conduct the procedure.
By understanding how to take vital signs assessments, caregivers can give their patients a higher quality of care, performing spot checks on seniors instead of taking them to the doctor or hospital for a similar assessment.
How Long Does It Take to Measure Vital Signs?
With the right training and vital sign equipment on hand, a caregiver can perform these vital sign assessments in less than 15 minutes. It’s a short procedure consisting of testing, reviewing, and concluding results.
The caregiver will assess the following six areas, record the results, and assess them to formulate a conclusion on the patient’s overall health at that time.
What are the Vital Signs for Caregivers when Assessing Patients?
Here are the six areas and methods to document vital signs in senior patients. Caregivers must ensure they have a thorough understanding of each of these vital signs, how to record the results from the testing, and interpret the results.
#1 Body Temperature
The patient’s body temperature is a critical vital sign to monitor and the starting point for the vital sign assessment. If a patient’s core body temperature is lower or higher than 97.8 to 99 degrees Fahrenheit, it leads to extreme damage to the internal organs.
For instance, a higher body temperature over the normal range may indicate fever and viral infection. While many doctors usually let a fever run its course, they’ll need to treat it if it’s over 101F to prevent damage to the brain and internal organs.
If their temperature is below the normal range, it may be a sign of bacterial infection or a hypothermic state which could also affect organ function. The aging process makes it harder to regulate body temperature since seniors have lower “brown” adipose tissue levels in their bodies that regulate the thermal state.
As a result, seniors may feel drafts more intensely than younger individuals. These chills may cause illnesses like colds, flu, or even pneumonia if left unmanaged. It’s a good idea for caregivers to take a senior’s temperature every few hours throughout the day if they are not feeling well.
The senior’s vital signs are susceptible to temperature changes in their environment, and their body does its best to manage these changes. So, it’s important to ensure the patient has an even temperature in the summer and winter seasons.
We use a digital thermometer and the following process to take a patient’s body temperature.
- Start with washing your hands to remove any lingering pathogens.
- Press the power button to activate and set the thermometer.
- Remove the plastic tip covering the probe.
- Place the thermometer under the patient’s tongue.
- Instruct the patient to close their lips around the probe.
- Wait until the thermometer beep to remove it from the patient’s mouth.
- Record the temperature reading of the patients’ health journal.
- Record the time, date, and method using “O” for oral, “E” for ear, “R” for rectal, or “A” for axillary.
- Clean and sterilize the digital thermometer using an alcohol swab and replace the plastic probe cover.
Please note: if the patient cannot hold the thermometer in their mouth, caregivers can use an axillary method of placing it under the armpit. Or they can use a temperature gun to take a reading from the patient’s neck.
#2 Pulse Rate
Heart rate indicates how many times the patient’s heart beats per minute when at rest. It measures how many times the heart expands and contracts in 60 seconds. Normal heart rates for seniors are between 60 to 100 beats per minute, depending on their age, health, and fitness level.
Heart rate will vary depending on the patient’s current emotional state and physical activity. Therefore, it’s important to do this when the senior is at rest and feeling calm. While a heart rate in the normal range indicates the normal cardiovascular function, it is not the final crux of a cardiovascular assessment.
Heart rhythm is also a critical component of the assessment. The patient’s heart rhythm and the interval between beats should be stable and consistent, with no murmurs or arrhythmia. Irregularities in the heart’s electrical system may indicate anxiety, heart disease, or emotional distress.
If caregivers notice any irregularities in these factors, they should contact a doctor immediately. You can use the following methodology when taking a heart rate assessment.
- Ensure the senior is at rest and comfortable before taking their reading.
- Locate the radial artery inside the wrist by the base of the thumb.
- If this pulse is weak, you can use the brachial artery inside the elbow or the carotid artery in the neck for the assessment. (Do not press too hard if you’re using the carotid artery).
- Place your first and second fingertips over the pulse source, don’t use your thumb.
- Set a timer and count the pulses over a 60-second duration. Or calculate the pulses over 15 seconds and multiply the result by four. If they have an irregular heart rate, use the full minute for counting.
- Concentrate on the pulse, not the time, when counting.
- Record the heart rate reading in the patient’s journal using the time, date, and any notes on irregularities.
Please note: Several devices are available that give an accurate heart rate record, removing human error from the assessment. Be sure to take two to three recordings when using an electronic device for the procedure.
#3 Respiration Rate
The patient’s respiration rate (RR) refers to the speed at which they inhale and exhale. The RR gives the caregiver an idea of the oxygen entering the bloodstream and the patient’s emotional state. Shallow breathing can indicate stress or anxiety in the patient’s mental condition, showing signs of emotional distress like anxiety or panic attacks. It also reveals the presence of an infection, such as pneumonia or asthma.
The caregiver should take note of how many times the patient’s chest rises and falls over the course of a minute. They should also pay attention to the depth of the patient’s breath and its cadence. The senior should be in a relaxed position when conducting this assessment. Activity will affect the respiration rate, as will their emotional state.
If the senior was walking or climbing stairs, have them rest for five minutes before conducting the RR assessment. Activities like smoking will also affect the RR rate and its outcome. The caregiver should notify the doctor immediately if the patient has abnormal breathing or wheezing in their RR. These abnormalities can be signs of infection or other health complications.
Breathing difficulties are one of the most common problems facing seniors. Environmental factors like air pollution and lifestyle factors like smoking can dramatically affect RR. The normal RR range is between 12 to 18 breaths per minute.
Caregivers can conduct a respiration rate assessment using the following methodology.
- Keep your fingers on the patient’s radial pulse after counting their pulse rate.
- Use the following minute to count their respiratory rate.
- Count the breath rate using a timer.
- An inhale and exhale count as one respiration. Count total respirations over one minute or over 15 seconds and multiply the result by four.
- Record the results in the journal and note the assessment’s time, date, and results.
#4 Blood Pressure
Blood pressure is a critical component of the patient’s cardiovascular assessment. High or low blood pressure in the patient may lead to health complications. The normal range is 120/80 mm Hg. A reading over 130/90 mm Hg is borderline hypertensive, and a reading below 90/60 mm Hg indicates low blood pressure.
High blood pressure, also known as “hypertension,” can affect organs like the brain, heart, kidneys, and liver. It’s a dangerous phenomenon in seniors and requires medication to keep it under control. Leaving it untreated may result in cardiovascular and organ complications in the patient, resulting in ill health and death.
Low blood pressure is just as dangerous to the senior. It may leave the patient feeling dizzy or woozy, especially when rising from a sitting or lying position. If the senior experiences a dizzy spell when getting to their feet, they may collapse or slip and hit their head on a table or the floor, resulting in severe injury.
An electronic blood pressure machine is common for checking the patient’s reading. Before you take the assessment, ensure the individual refrains from drinking coffee or tea or smoking for at least 30 minutes. The senior should go to the bathroom before taking the test and relax for five minutes.
Follow this methodology for taking the patient’s blood pressure.
- Have them sit in a high-backed chair with good support. Don’t take the test with them lying in bed or sitting on a plush couch.
- The individual must not cross their feet during the test.
- Place their arm on a flat surface like a table with their upper arm at heart level.
- Place your fingers on the underside of the elbow and locate the brachial pulse.
- Wrap and secure the deflated BP cuff around the upper arm, one inch above where you feel the brachial pulse.
- The blood pressure cuff on the device should provide a marking indicating where to line it up to the artery.
- Activate the machine and wait for it to take the reading.
- Perform two more readings to get an average for the test.
- Take the readings one minute apart.
- In the patient’s health journal, note the three readings for systolic and diastolic pressure.
- Remove the deflated cuff.
- It’s a good strategy to take the patient’s BP readings at the same time each day, usually in the morning.
- If you note a systolic (top number) of 150 or higher, or a diastolic (bottom number) of 100 or higher, contact the doctor as it may be a sign of cardiovascular complications.
Please note: The electronic blood pressure device may provide different readings across all three tests. The analog device doctors use offers a more accurate reading than the electronic device. Therefore, it’s a good idea to take at least three readings in the blood pressure test to ensure the accuracy of the results.
#5 O2 Saturation
The patient’s oxygen saturation range indicates how the body absorbs oxygen into the bloodstream. If the patient has low oxygen saturation levels, it may lead to impaired brain and organ function. Low oxygen presence in the blood is a sign of anemia and will require specialized treatment from the doctor to mitigate the risks of the condition.
The acceptable oxygen saturation range is between 97% to 100%. Seniors will have a lower SpO2 reading than young people, but it should not be below 95%. Lifestyle factors like smoking can dramatically influence the SpO2 reading during an assessment, especially if the patient smoked recently before the test.
Oxygen saturation levels vary considerably depending on the senior’s state of health. So, caregivers need to understand the baseline reading and any underlying physiological problems associated with health conditions when interpreting oxygen saturation levels and the changes in these levels.
Obese individuals or those with cardiovascular or lung diseases, such as COPD, emphysema, congenital heart disease, or sleep apnea, will have lower SpO2 readings than healthy individuals. Smoking influences the accuracy of pulse oximetry readings where SpO2 is falsely high or low, depending on the presence of hypercapnia.
With hypercapnia, it’s challenging for pulse oximeters to differentiate oxygen from carbon monoxide in the blood. Oxygen saturation levels may also decrease slightly if the senior talks during the test. It’s also important to note that patients with anemia or hemochromatosis may also present a normal SpO2 range.
However, this reading will not indicate adequate oxygenation in the blood due to lower levels of hemoglobin carrying a proper supply of oxygen. An inadequate oxygen supply in anemic individuals becomes apparent during periods of activity.
Falsely low SpO2 levels are often associated with the onset of hypothermia, coldness in the extremities, or decreased peripheral perfusion. If that’s the case, an ear lobe pulse oximeter device is better for accurately measuring oxygen saturation levels.
Caregivers will use an electronic oximeter to conduct a SpO2 test in seniors using the following protocol.
- Remove nail polish or false nails from the finger and warm up the hand if it feels cold.
- Rest for a minimum of five minutes before carrying out the SpO2 test.
- Rest their hand on the chest at heart level and ensure the patient remains still.
- Turn on the oximeter and place it on the index or middle finger.
- The SpO2 reading will require some time to stabilize.
- Keep the oximeter in place for a minute or longer to stabilize the SpO2 reading.
- Record the highest SpO2 result after it stabilizes for a minimum of five seconds.
- Record the baseline measurement in the health journal three times a day, testing at the same time of the day.
- Take additional readings if the results vary.
#6 Pain Level
Seniors over the age of 65 often deal with chronic pain. Studies show that more than half of all seniors over 65 have had to deal with chronic pain in the last 30 days, and many must deal with it daily. According to a 2006 National Center for Health Statistics study, up to 80% of patients in nursing homes claim they deal with daily symptoms of chronic pain.
While seniors commonly deal with chronic pain, there is undertreatment of the condition by nursing home staff and caregivers. Opioid dependence is a common reason for failing to treat seniors with medication to alleviate their pain symptoms.
However, it’s important to note that persistent pain symptoms are associated with impaired functional performance, anxiety, depression, slow rehabilitation, decreased socialization, and sleep disturbance. These factors often result in increased healthcare costs and utilization.
The Joint Commission removed the requirement of pain assessments in vital sign checkups in 2009. Experts attribute this decision to the instances of opioid addiction sweeping through nursing home communities and in seniors using home-care strategies.
However, The Joint Commission started a project to revise pain assessment and management in 2016. It reviewed the standards of care, identifying the evaluation and management of acute and chronic pain, making it a priority.
The identification and measurement of pain in seniors begins with a self-report from the patient. However, this assessment is challenging in communities with disparities in literacy, cognition, and language skills.
Simple questions and tools are the most effective strategies for pain assessment in seniors. The best options for pain assessment include the Numeric Rating Scale (NRS), the Iowa Pain Thermometer (IPT), and the Faces Pain Scale-Revised (FPS-R).
The NRS is the most widely used option, asking the senior to rate their pain on a scale of 1 to 10, with ten being intense. The IPT is a modified Verbal Descriptor Scale (VDS) with seven pain descriptors describing pain intensity. The FPS-R asks the seniors to express their pain with facial expressions corresponding to their pain intensity.
Vital Signs for Caregivers – Key Takeaways
Understanding the vital signs to monitor in seniors and how to conduct these vital sign assessments is a critical part of any caregiver’s responsibilities. By reading and understanding the six methodologies and parameters of vital sign assessments in this post, caregivers can move closer to offering professional standards of care to their patients.
Vital signs are key indicators of a patient’s health, providing a snapshot of their condition relevant for further medical assessments by doctors.