Vital Signs Chart for Clinical Monitoring
Core Vital Signs to Measure
All hospitalized patients should have the following traditional vital signs measured and documented at regular intervals: temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation. 1
Standard Vital Sign Parameters and Normal Ranges
| Vital Sign | Normal Range (Adults) | Measurement Method |
|---|---|---|
| Heart Rate | 50-100 beats/min [1,2] | Continuous monitoring or manual pulse [1] |
| Respiratory Rate | 12-20 breaths/min [1] | Direct observation, minimum 30-60 seconds [3] |
| Blood Pressure | Systolic: 100-140 mmHg Diastolic: 60-90 mmHg [1,2] |
Auscultation with appropriate cuff size on upper arm at heart level [3] |
| Temperature | 36.0-37.5°C (96.8-99.5°F) [1,2] | Oral (6-7 min sublingual) or tympanic with ear tug [3] |
| Oxygen Saturation (SpO₂) | 95-100% [1,2] | Pulse oximetry, continuous or intermittent [1] |
Supplemental Vital Signs
Beyond the traditional five vital signs, pain level and mental status (level of consciousness) should be routinely assessed and documented. 1
- Pain Scale: 0-10 numeric rating scale for patients able to self-report 1
- Level of Consciousness: Alert-Voice-Pain-Unresponsive (AVPU) or Glasgow Coma Scale 1, 2
Documentation Frequency
General Hospital Patients
Vital signs should be measured and documented at minimum every 4 hours for stable patients, with frequency increased based on clinical status. 1
- Stable patients: Every 4-8 hours 1
- Acute phase or deteriorating patients: Every 10-15 minutes to hourly 1
- Post-procedure recovery: Every 10-15 minutes until discharge criteria met 1
Critical Vital Sign Thresholds Requiring Escalation
The following critically abnormal values warrant immediate clinical escalation and potential rapid response team activation: 1, 4
- Systolic blood pressure <85 mmHg 4
- Heart rate >120 bpm 4
- Respiratory rate ≤12 or ≥24 breaths/min 1, 4
- Temperature <35°C or >38.9°C 4
- Oxygen saturation <91% 1, 4
- Any alteration in level of consciousness from baseline 1, 4
The simultaneous presence of three critically abnormal vital signs is associated with 23.6% mortality and requires immediate intervention. 4
Special Population Considerations
Elderly Patients (Long-Term Care)
Fever definition differs in elderly patients and requires modified thresholds: 1
- Single oral temperature ≥100°F (37.8°C), OR
- Repeated oral temperatures ≥99°F (37.2°C), OR
- Increase of ≥2°F (≥1.1°C) over baseline 1
Vital signs for elderly patients with suspected infection must include temperature, heart rate, blood pressure, and respiratory rate measured by nursing assistants and reported immediately to the on-site nurse. 1
Pregnant and Postpartum Women
Pregnant women require modified normal ranges due to physiological changes of pregnancy: 1
| Vital Sign | Modified Range in Pregnancy |
|---|---|
| Heart Rate | Increase of 10-20 bpm above baseline, particularly third trimester [1] |
| Blood Pressure | May decrease 10-15 mmHg by 20 weeks, returns to baseline by term [1] |
| Respiratory Rate | Unchanged (abnormal if >20 breaths/min) [1] |
| Temperature | Unchanged [1] |
| Oxygen Saturation | Unchanged [1] |
Mean arterial pressure should be maintained below 130 mmHg in pregnant patients with hypertension. 1
Pediatric Patients (Late Preterm Newborns)
Late preterm newborns (34-36 weeks gestation) have distinct vital sign ranges: 5
- Heart rate: 102-164 bpm 5
- Respiratory rate: 15-67 breaths/min 5
- Oxygen saturation: 94-100% 5
- Temperature: 36.4-37.6°C 5
- Systolic blood pressure: 51-86 mmHg 5
Procedural Sedation Monitoring
During procedural sedation, vital signs must be documented at minimum every 10 minutes in a time-based record, including heart rate, respiratory rate, blood pressure, oxygen saturation, and expired CO₂ values. 1
Continuous monitoring during sedation requires: 1
- Continuous pulse oximetry and heart rate 1
- Capnography (preferred) or audible pretracheal/precordial stethoscope when verbal communication not possible 1
- Blood pressure every 10-15 minutes for stable, well-oxygenated patients 1
Critical Pitfalls to Avoid
Vital signs alone (heart rate, blood pressure, respiratory rate, oxygen saturation, end-tidal CO₂) are not valid indicators for pain assessment and should only serve as cues to initiate further assessment using validated pain scales or behavioral tools. 1
Incomplete or incorrect vital sign measurement is common and leads to failure to detect deterioration; education, audits, and feedback are essential to ensure proper measurement techniques and timely reporting of abnormalities. 1
Blood pressure measurement accuracy requires: 3
- Appropriate cuff size (narrow cuff overestimates, wide cuff underestimates) 3
- Upper arm positioning at heart level 3
- Auscultation using Phase I Korotkoff sound for systolic and Phase V for diastolic pressure 3
Oral temperature measurement requires 6-7 minutes in the posterior sublingual pocket; hot or cold liquids will affect accuracy. 3