Vital Signs: How Important Are They?

When I was a CNA, I got really tired of taking vital signs. As soon as I got done with one set of vital signs, it was time to start taking another set of vital signs. Also, it seemed as if something always happened to make it take roughly four times longer than it should to do it: the patient would twitch and cause the blood pressure cuff to reinflate or the oximeter had to be put on four different fingers to get a reading or something else would go wrong. Or the patient would say, “While you’re in here, can you help me up to the commode?” So I developed the saying “vital signs are called vital because they’re important!” to avoid dreading the task. (I know that isn’t the origin of “vital signs,” but stay with me here.)

They are important, and therefore we need to take them and interpret them, which means they need to be accurately and appropriately measured. This is a loaded statement. Let’s take it apart.

Vital signs need to be accurate. Is your CNA taking them? Do you know that he or she is doing it correctly? You’d better, because you’re still responsible. Is the patient lying on her side? Is the cuff the right size? Is the oximeter on a finger with poor circulation? Did the patient just drink coffee or ice water? All of those things can throw off vital sign values to the point that they become completely useless for clinical decision-making.

Vital signs need to be appropriately measured. Does your patient have chest pain and a history of aortic dissection? If so, vital signs probably need to be taken and recorded more often than every 4 hours (much more often). Does your patient have a hangnail? If so, you probably have better things to do than take his vital signs hourly while he waits for more emergent cases to be seen. What is appropriate? I can’t find any standards. Guidelines, yes. But at baseline, nurses need to use our brains. For example, if a patient becomes unstable, increase the frequency of taking vital signs no matter what the order says. Appropriate measurement may mean wildly different things to different specialties. For example, if I have a patient who is finally getting some sleep and has been stable, is it appropriate to wake her up every hour just because I need to document something?

Finally, we need to interpret them. Having a list of values is useless unless we look at trends. What is the MAP? The pulse pressure? Is the blood pressure trending up or down? Did that fever get better after Tylenol? A 10 mm Hg difference in 4 hours may seem trivial, but a 20 mm Hg drop after 8 hours can mean your patient is headed for septic shock and you weren’t paying attention. A monkey could probably be trained to take vital signs, so our nursing knowledge and experience must come into play to interpret the data and act accordingly.

Vital signs are important: let’s not skip their relevance because they’re so common in our task lists. This is a nursing judgment issue; our job is not just to take vital signs by rote. It is to take them according to the patient’s condition and interpret them so that we can make decisions and inform the decisions of other healthcare providers.