Are you ready to get you learning on about the Vital Signs that all Respiratory Therapists must know? I sure hope so because that is what this study guide is all about. 

As an RT, checking the vital signs of your patient is something that you will do hundreds of thousands — maybe even millions — of times throughout your career.

But which ones are you supposed to check? How often? What are the normal values?

Have no fear, my friend.

In this study guide, we are going to break it all down for you to make learning this information easy. So if you’re ready to get started, let’s go ahead and dive right in. 

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What are Vital Signs?

Vital Signs are the body’s most commonly used measurements. That is because they provide useful information about the patient’s clinical condition and are easy (and fast) to obtain. 

The 5 primary vital signs are:

  • Pulse Rate (Heart Rate)
  • Respiratory Rate (Breathing Rate)
  • Oxygen Saturation
  • Blood Pressure
  • Body Temperature

As you already know, vital signs are crucially important to know and understand.

For example, let’s say you have a patient that is showing a decrease in respiratory rate and heart rate. As a Respiratory Therapist, one of your first thoughts is to provide oxygen for this patient. Let’s say you do, and almost immediately the patient’s status improves. You can recognize this thanks to their vital signs.

As a Respiratory Therapist, you will mostly be concerned with the patient’s pulse, respiratory rate, and oxygen saturation.

That’s not to say the others aren’t equally as important. In fact, they definitely are — which is why we have included them in this study guide as well. But in the clinical setting, they are most often taken by the nurse or other professional. Still, you are required to know about ALL of the major vital signs. And we are going to cover them below. Let’s get started!

What is Heart Rate (Pulse Rate)?

The heart rate or also known as pulse rate refers to the number of times your heart beats in one minute.

For you to better understand how a pulse is created, it is important for you to know how the heart works.

The heart is a muscular organ that is about the size of your fist.

Its main job is to pump blood to different body parts so that oxygen and other vital nutrients will be transported to cells, tissues, organs, and other body systems. 

Normally, a heartbeat has two sounds: “lub” and “dub”. A lub sound is created when the upper chambers of your heart contract to squeeze the blood down to your ventricles.

This, in turn, causes the lower chambers of your heart to contract pushing blood upward into the aorta (largest artery), resulting in a dub sound.

The blood from each contraction of your heart creates a bulge in the artery. This bulge is the pulse you feel.

The pulse can be felt anywhere an artery close to your skin such as:

  • Your wrist (radial)
  • Inner part of your elbow (brachial)
  • Side of your throat (carotid)
  • Temple (temporal)
  • Groin (femoral)
  • Back of your knee (popliteal)
  • Inner part of your ankle joint (posterior tibial)
  • Foot (dorsalis pedis)

Your pulse rate is exactly equal to your heartbeat because the contractions that your heart creates increase the pressure within your arteries that lead to a palpable pulse. Therefore, checking for your pulse rate is a direct measure of your heart rate.

What is a Normal Resting Heart Rate?

A normal resting heart rate depends on your age. In adults, the normal resting heart rate is 60-100 beats per minute while 140-160 beats per minute in infants and younger children.

However, there are several factors that can significantly affect your heart rate such as the following:

  • Air temperature
  • Being a smoker
  • Body anatomy
  • Body position
  • Emotions
  • Fitness and activity levels
  • History of heart disease, blood vessel disease, or hypertension.
  • Medications

For trained athletes and people who are physically active, a heart rate lower than 60 beats per minute is normal. If you have low activity levels and your heart rate is abnormally low, this may indicate an underlying problem.

The same goes for a resting heart rate above normal.

How to Check for a Pulse?

Checking for your pulse helps determine if you have an underlying medical condition. Your wrist is the most common and convenient area to palpate or check for a pulse.

However, if the use of radial pulse is contraindicated (e.g. presence of wound or injury), other alternative sites should be used.

In order to palpate for a radial pulse, follow these steps:

1. Turn your one hand over so that your palm is facing upwards. Use your non-dominant hand.

2. Use your free hand to place your point and middle finger gently below your wrist about an inch along from the base of the thumb. Never use your thumb to check for a pulse because it has its own pulse that you may feel, resulting in an inaccurate result.

3. Adjust your point and middle finger until you feel a strong pulse. Do not put too much pressure on your radial artery as it can impede blood flow.

4. Using a watch or a digital timer, count your pulse for one minute. Another way to do this is to count the number of beats for 15 seconds and then multiply it by 4 to get your total beats in a minute. However, this method is not recommended for people with underlying heart disease because the pattern of their pulses might be different (there might be an additional pulse in the first 15 seconds and it can fade in the next 15 seconds). Therefore, counting the pulse for a full minute is recommended in people with heart disease.

5. Record the result for future reference. If you have abnormalities in your pulse, consult immediately with a medical professional for further management.

So now that you have a handle on Heart Rate, let’s move onto Respiratory Rate.

What is Respiratory Rate?

The Respiratory Rate is the number of breaths you take in per minute. The unit of measure is expressed in cycles per minute (cpm) or breaths per minute (bpm). Respiratory rate is usually measured when you are at rest and simply involves counting the number of breaths in one full minute by observing for the rise and fall of the chest.

One inhalation and one exhalation is counted as one breath in the respiratory rate.

The aim of measuring the respiratory rate is to check for the presence of normal, fast (tachypnea), slow (bradypnea), or nonexistent (apnea) respirations.

Several factors such as activity levels, emotions, stress, smoking and drinking habits, medications, and illness can affect the respiratory rate.

In adults, the normal respiratory rate range from 10 to 20 breaths per minute while it can go as high as 30 to 60 breaths per minute in younger children.

What is Respiration?

Respiration is the process by which your body takes in oxygen through inhalation and eliminates carbon dioxide through exhalation. The exchange of these gases takes place across cell membranes.

When oxygen is transferred in your body, it enters the cells and breaks down food particles into smaller pieces in order to produce energy in the form of adenosine triphosphate (ATP). This energy is then used by the cells to perform various metabolic activities at optimal levels.

Now let’s talk about Oxygen Saturation.

What is Oxygen Saturation?

Oxygen saturation, also known as O2 sats or SpO2, is the extent to which hemoglobin is saturated with oxygen.

The major role of hemoglobin is to carry oxygen to the different parts of the body. For instance, one hundred hemoglobin molecules can carry a maximum of 400 oxygen molecules (1 hemoglobin can carry 4 oxygen molecules) so that it can provide 100% saturated oxygen.

If one hundred hemoglobin molecules are only carrying 200 oxygen molecules, then the oxygen saturation is only 50%.

In healthy adults and children, normal oxygen saturation ranges from 95% to 100%. For people with abnormally low oxygen saturation levels, additional oxygen may be administered via nasal cannula or facemask.

Oxygen saturation levels are dependent upon several factors such as the following:

  • Ability of hemoglobin to carry oxygen molecules.
  • Gas exchange in the lungs.
  • Oxygen availability.
  • The concentration of hemoglobin in red blood cells.

How to Measure Oxygen Saturation?

A qualified medical professional usually recommends the use of the following methods to check for oxygen saturation levels:

1. Arterial blood gas (ABG): This procedure is an invasive method of measuring oxygen saturation. An ABG involves drawing blood from an artery such as the radial artery in the wrist to be analyzed in the laboratory.

2. Pulse oximetry: Pulse oximetry, on the other hand, is a non-invasive method of assessing oxygen saturation as it only requires the use of a sensor attached to a finger or earlobe. Compared to an ABG test, this method is quicker and painless.

Now let’s move right along to Blood Pressure.

What is Blood Pressure?

Blood pressure is a unit of measure of the force that your heart uses to pump blood to all parts of the body.

Blood pressure is measured in a unit called millimeters of mercury (mmHg).

The readings are given as 2 numbers. The first reading or the number above is known as the systolic blood pressure, which is the level of pressure when the heart pumps blood through the arteries and around the body. The second reading or the number below is the diastolic blood pressure, which is the level of pressure when the heart is resting before it pumps blood again.

For instance, the blood pressure reading is 120/80 mmHg. 120 is the systolic reading while 80 is the diastolic reading. The ideal blood pressure for healthy adults is 120/80 mmHg. Like all other vital signs, the blood pressure reading can be affected by activity levels, stress, diet, medications, and underlying medical conditions.

How to Measure Blood Pressure?

The following are the steps in measuring blood pressure:

1. Remove air out of the bulb of the sphygmomanometer by turning it counter-clockwise while pressing the cuff.

2. Place the cuff about 1 inch above the elbow of the person. Make sure to wrap about two-thirds of the cuff to fit the entire arm. Never place the cuff in a weak arm, wound, or an arteriovenous fistula.

3. Place the gauge of the sphygmomanometer near you so that it is at your eye level.

4. Get the stethoscope and put on the earpieces.

5. Place the flat part of the stethoscope (called diaphragm) at the brachial artery and listen for the pulse.

6. Turn the valve on the bulb of the sphygmomanometer clockwise until it will turn no further. If you hear a hissing sound, this indicates air leak or the valve is loose.

7. Inflate the cuff rapidly by squeezing the bulb repeatedly.

8. Deflate the cuff slowly by turning the valve on the bulb counter-clockwise. Let the needle on the gauge move at about a rate of 2 mm or one marking per second.

9. Listen to the 2 sounds during cuff deflation. The first sound is a clear and loud tapping sound – this is the systolic blood pressure. The second sound is the last tapping sound and is usually weak – this is the diastolic blood pressure. Check the number markings on the gauge of the sphygmomanometer as you hear these sounds and remember them.

10. Turn the valve on the bulb of the sphygmomanometer counter-clockwise all the way to expel all the air from the cuff.

11. Remove the cuff and record the blood pressure.

Next, we must discuss Body Temperature.

What is Body Temperature?

Your body temperature is the by-product of the chemical processes in the body. It is measured using a thermometer that can be inserted into the anus, mouth or under the armpit.

In some cases, the ear canal and the forehead can be measured using a special thermometer. 

The average body temperature is 36.5 to 37.5 degrees Celsius or 98.6 degrees Fahrenheit. Certain factors such as environment, physical activity, and disease can affect normal body temperature.

How to Take Vital Signs?

Taking vital signs can be performed in less than 5 minutes if done in the correct order.

The following are the appropriate steps:

1. Wash hands thoroughly with an antibacterial soap and clean water.

2. Prepare the necessary materials: Digital thermometer, a watch, stethoscope, sphygmomanometer, cotton balls soaked in alcohol, pen, and small notebook.

3. Explain the procedure to establish trust and cooperation.

4. Instruct the person to sit or lie still. Abrupt position changes can affect blood pressure results.

5. Insert the thermometer in the armpit and instruct the person to hold it still.

6. While waiting for the thermometer to beep, instruct the person to rest the other arm on a chair or bed.

7. Palpate the brachial pulse using the middle and point finger of your dominant hand.

8. Start counting both the pulse and the respiration rate for one full minute.

9. Place the cuff of the sphygmomanometer on the arm and check the blood pressure. Make sure to wrap about two-thirds of the cuff to fit the entire arm.

10. At this time, the thermometer should be beeping already. Check the temperature and clean the thermometer from the base down to the tip.

11. Record the vital signs.

12. Wash your hands with an antibacterial soap and clean water.

What are Pediatric Vital Signs?

Just as with our adult patients, we must know how to obtain vital signs on pediatric and neonatal patients as well. Keep in mind — the normal vital signs are totally different in kids as compared to adults.

In children, their heart rate and respiration rate are significantly faster than adults because their body is performing various functions necessary for growth and development.

The blood pressure and body temperature also varies as well. There can be variations in pediatric vital signs due to the following factors:

  • A congenital heart problem
  • Climate
  • Inadequate oxygen supply
  • Low body temperature
  • Side effects of medication
  • Stress

So now you know pretty much everything there is to know about Vital Signs. In order to truly reinforce this information into your memory, let’s now go through some practice questions on this topic.

Going through practice questions is one of the most effective ways to retain new information. As you can see below, we’ve listed out quite a few of them for you on the topic of Vital Signs.

Practice Questions about Vital Signs:

1. What are the most common Vital Signs?
Pulse Rate, Respiratory Rate, Blood Pressure, Body Temperature, and Oxygen Saturation.

2. What is the normal pulse rate?
60–100 beats/minute.

3. Where can you find the pulse?
The radial, brachial, femoral, and carotid arteries.

4. What is the normal respiratory rate?
12–20 breaths/minute.

5. What is the normal Blood Pressure?

6. What is the normal body temperature?
Oral: 97.7–99.5 F (36.5–37.5 C); Axillary: 96.7–98.5 F (35.9–36.9 C); Rectal or ear: 98.7–100.5 F (37.1–38.1 C).

7. What is the normal Oxygen Saturation?
95–99% or greater than 93%.

8. What is the normal Heart Rate?

9. A low oxygen saturation is a good indicator of what?

10. What are complications with pulse oximeters?
Low perfusion, incorrectly fitted probe, the vascular bed is not pulsating dark fingernails, or the light is unable to pass through.

11. What is the accuracy range on a pulse oximeter?
+ or – 4%

12. What is the heart rate for someone who is bradycardic?
Less than 60 beats per minute.

13. What is the respiratory rate for someone who is tachypneic?
Greater than 20 breaths per minute.

14. What is the blood pressure for someone with hypotension?
Less than 90/60.

15. What is the breathing rate of someone who is apneustic?
Long gasping inspirations with insufficient expiration.

16. What are the primary causes of eupnea?
The normal physiology of being a human being.

17. Identify the following breathing pattern: Fast and deep breaths with periods of apnea and no set rhythm.
Biot’s breathing.

18. Which breathing pattern is normal in newborns and elderly, but abnormal for healthy adults?

19. What is a major tool in finding vital signs?
Stethoscope, especially for Respiratory Therapists.

20. What possible causes is Kussmaul’s breathing an indicator of?
DKA, severe hemorrhage, peritonitis, renal failure, and uremia.

21. What is normally the heart rate for a newborn?
90–180 beats per minute.

22. If a patient’s heart rate is greater than 100 beats/minute, you would say the patient is?

23. What is DKA?
It stands for Diabetic Ketoacidosis. A shortage of insulin which causes the body to burn fatty acids and produce acidic ketone bodies.

24. The pulse rate and rhythm can be measured by what?
It can be measured by auscultation or palpation of any artery.

25. What arteries can be used for the pulse to be checked?
Radial Artery, Brachial Artery, Femoral Artery, Carotid Artery, and Pedal.

26. Which artery is most commonly used to check for a pulse?
Radial Artery

27. How is pulse calculated?
The pulse is counted for 15 seconds and multiplied by 4 to get beats/minute.

28. How is respiratory rate measured?
By inspection of the movement of the chest for 1 minute.

29. What is the normal blood pressure for adults?

30. What is used to measure blood pressure?

31. What are the ways that the body temperature can be measured?
Orally, rectally, and axillary.

32. What is the normal body temperature?
37 degrees Celsius ( 97 degrees F).

33. What is fever?
A higher than normal body temperature (hyperthermia).

34. What is the normal pulse rate for an adult?
60–100 beats/minute.

35. What does pulse oximetry estimate?
It noninvasively estimates the hemoglobin oxygen saturation of arterial blood.

36. What factors affect the accuracy of pulse oximetry reading?
Movement, bright light, extreme cold, extreme darkness, and high methemoglobin.

37. What would you call a respiratory rate less than 12?

38. What would you call a respiratory rate greater than 20?

39. What would you call a heart rate less than 60?

40. What would you call a heart rate greater than 100?

41. What is hypotension?
A blood pressure less than 90/60.

42. What is hypertension?
A blood pressure greater than 140/90.

43. What is the normal newborn pulse?

44. What is the normal 1-year-old pulse?

45. What is the normal preschool-age kid pulse?

46. What is the normal 10-year-old pulse?

47. What is the normal adult pulse?

48. What is the systolic blood pressure?
The top number which measures the pressure in the artery when the heart beats.

49. What is the diastolic blood pressure?
The bottom number that measures the pressure in the arteries when the heart muscle is resting.

50. How is the strength (amplitude) of a pulse measured on a scale?
4–bounding, 3–full, 2–normal, 1–diminished, and 0–absent.

51. What is bradycardia?
A slower than normal heart rate of less than 60 beats per minute.

52. What is tachycardia?
A faster than normal heart rate greater than 100 beats per minute.

53. What is hypotension?
Low blood pressure, which can cause dizziness or fainting (Less than 90/60).

54. What is hypertension?
High blood pressure, which can cause heart disease (Greater than 140/90).

55. What is eupnea?
A normal respiratory rate (12-20 breaths per minute), normal rhythm. Causes: normal physiology.

56. What is apnea?
The absence of breathing. Causes: respiratory or cardiac arrest and an increased intracranial pressure.

57. What are the types of pulse oximetry probes?
Finger probe, foot probe, toe probe, forehead probe, and ear probe.

58. Can cool or heated aerosols affect a body temperature reading?
Yes, yes they absolutely can.

Final Thoughts

And that wraps up our study guide on the vital signs that you must know as a Respiratory Therapist. I hope this information was helpful for you. And, I hope you can use it to make your life easier when it comes to learning and memorizing all the vital signs.

Thanks again for reading and as always — breathe easy, my friend.

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