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103.2 Vital Signs and Changes in Health Status
Measuring blood pressure, pulse, breathing and temperature, and what to report
Your materials
Slides (PowerPoint) Handout (Word)
For instructors
Facilitator guide Printable pre and post tests Quiz (LMS import)
What you will learn
- Measure blood pressure accurately with an automated upper-arm cuff
- Name normal adult ranges for pulse, breathing and temperature
- Sort blood pressure readings into the current AHA/ACC categories
- Recognize signs of change that must be reported or need 911
Start here
Have you ever had your blood pressure taken while you were rushed, talking or nervous? Do you think the number was right?
Lesson
Normal resting ranges for healthy adults
- 60-100 Heartbeats per minute (pulse)
- 12-18 Breaths per minute (respiratory rate)
- 98.6 F Average body temperature; normal is about 97.7 to 99.1 F
Source: MedlinePlus
Getting an accurate blood pressure
Before and during the reading:
- Prepare: No caffeine for 30 minutes. Empty the bladder if needed.
- Rest five minutes: Sit quietly in a chair with back support. No talking, no phone.
- Position the body: Feet flat on the floor, legs uncrossed, arm resting at heart level.
- Use the right cuff: Correct size, on the bare upper arm, just above the elbow.
- Take two readings: Wait about one minute between readings and write both down.
Why cuff size matters
- +19.5 Points higher on top number when cuff was much too small
- -3.6 Points lower when a regular cuff was too large
Source: AMA, JAMA Internal Medicine study
Blood pressure categories for adults
| Category | Top number (systolic) | Bottom number (diastolic) |
|---|---|---|
| Normal | Under 120 | and under 80 |
| Elevated | 120 to 129 | and under 80 |
| Stage 1 high blood pressure | 130 to 139 | or 80 to 89 |
| Stage 2 high blood pressure | 140 or higher | or 90 or higher |
| Severe: needs attention now | Higher than 180 | or higher than 120 |
A reading above 180/120
No symptoms
- Wait five minutes, then check again
- Still high: call the provider today
- Tell your RN supervisor right away
- Write both readings in your notes
With any of these symptoms: call 911
- Sudden, severe headache
- Chest, back or belly pain; trouble breathing
- Numbness, weakness or trouble talking
- Sudden change in vision
BE FAST: signs of a stroke
Sudden signs mean call 911 now. Note the time they started.
- B and E: Balance, Eyes: Sudden dizziness or loss of balance. Sudden blurry vision or vision loss in one or both eyes.
- F: Face: One side of the face droops or looks uneven. Ask the person to smile.
- A: Arms: Weakness or numbness in one arm. Ask them to raise both arms.
- S and T: Speech, Time: Slurred words or sudden confusion. Time to call 911 right away.
Why the numbers differ by neighborhood
- What we see: Mr. Washington in East Cleveland has readings in stage 2 at every visit, and he says his pills run out.
- Why it happens (upstream): Pharmacy closures, cost of medicine, long work shifts, stress, few safe places to walk, and stores heavy on salty food.
- What we can build on (assets): Blood pressure checks at barbershops, churches and health fairs, neighbors who walk together, rec centers, and pharmacists who explain medicine costs and options.
Situation: the high reading at the health fair
Situation: At a health fair in Hough, you check Ms. Carter's blood pressure. It reads 184/118. She feels fine and wants to go home. You check again after five minutes: 182/116.
What do you do next?
- Ask about headache, chest pain, vision change, weakness or trouble talking
- If any symptom: call 911 and stay with her
- If none: help her call her provider before she leaves
- Tell your RN supervisor and document both readings
Study sheet
The big idea: Accurate vital signs and fast reporting of changes help keep our neighbors safe and connected to care.
Key points
- Rest five minutes, feet flat, back supported, arm at heart level, bare upper arm, no talking.
- A cuff that is too small can make blood pressure read much too high.
- Normal adult blood pressure is under 120/80; stage 2 is 140/90 or higher.
- A reading above 180/120: recheck in five minutes, then call the provider, or 911 with symptoms.
- BE FAST: balance, eyes, face, arms, speech, time. Sudden signs mean call 911.
- Report changes to your RN supervisor and follow program protocol; CHWs do not diagnose.
Remember
- Pulse 60 to 100; breaths 12 to 18; temperature about 97.7 to 99.1 F
- Normal under 120/80; elevated 120 to 129 and under 80
- Stage 1: 130 to 139 or 80 to 89; stage 2: 140 or more or 90 or more
- Above 180/120 with symptoms: call 911
Ask yourself
- Which step of a blood pressure reading am I most likely to rush?
- What would I say to a client who wants to leave after a very high reading?
Vocabulary
| Word | What it means |
|---|---|
| Vital signs | Basic body measurements: blood pressure, pulse, breathing rate and temperature. |
| Blood pressure | The force of blood pushing on the walls of the arteries. |
| Systolic | The top blood pressure number: pressure when the heart beats. |
| Diastolic | The bottom blood pressure number: pressure when the heart rests between beats. |
| Pulse | The number of times the heart beats in one minute, felt at the wrist or neck. |
| Respiratory rate | The number of breaths a person takes in one minute. |
| mm Hg | Millimeters of mercury, the unit used for blood pressure readings. |
| Hypertension | High blood pressure, diagnosed by a provider after more than one reading. |
| Stroke | When blood flow to part of the brain is blocked or a blood vessel bursts. |
| Change in health status | A new sign or symptom, or a vital sign outside a person's normal, that must be reported. |
Real-life situations
The cuff that does not fit
During a home visit in Glenville, you try to check Mr. Edwards' blood pressure. The regular cuff barely closes around his arm.
What to do
- Stop and do not take the reading with that cuff
- Measure his arm and use a large or extra-large cuff that matches
- If you do not have the right cuff, note it and tell your supervisor
- Help him ask his clinic about the right cuff size for home use
Why: A cuff that is too small can make readings far too high and lead to wrong decisions about care.
The neighbor who suddenly cannot talk clearly
At a senior center in Slavic Village, Mrs. Novak suddenly slurs her words and her face droops on one side.
What to do
- Call 911 right away and say you think it is a stroke
- Note the time the signs started
- Stay with her, keep her safe, and do not give food, drink or pills
- Tell your supervisor and document after she is in EMS care
Why: Stroke treatment works best when it starts fast. The start time helps the medical team decide on treatment.
The client who feels fine
Mr. Brooks in Fairfax has a reading of 150/95 during a routine visit. He has no symptoms and says he always runs high.
What to do
- Recheck after rest, using correct technique
- Tell him which category the reading falls in, as education
- Encourage him to share his readings with his provider and help schedule a visit
- Document the readings and report to your RN supervisor per protocol
Why: High blood pressure often has no symptoms. Regular follow-up with a provider prevents heart attacks, strokes and kidney damage.
Activity: Blood pressure practice log
About 30 minutes.
- Before lab, watch your RN instructor's demonstration and read the steps slide again.
- In lab, take blood pressure on at least five classmates using an automated upper-arm cuff.
- For each reading, record cuff size, arm used, both readings and the category.
- Have a partner use a checklist to watch your technique and mark any missed steps.
- Your RN instructor watches you complete the skill correctly and signs your competency checklist.
Post-test
Ten questions. You need 75% to pass, with one retake. Your result is saved in this browser.
Sources
- MedlinePlus, Vital signs (body temperature, pulse rate, respiration rate, blood pressure)
- MedlinePlus, Vital Signs
- American Medical Association, How to measure blood pressure at home
- American Medical Association, For accurate BP measurement, one cuff size does not fit all
- National Heart, Lung, and Blood Institute, High Blood Pressure: Symptoms
- University of Iowa Health Care, BE FAST when you see a stroke
- Ohio Administrative Code 4723-26-13, Standard curriculum
- American Heart Association, Understanding Blood Pressure Readings
- American Medical Association, New BP guideline: 5 things physicians should know (2025 AHA/ACC guideline)
- Penn Medicine, If someone is having a stroke: 3 things to do and 3 things not to do