DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE

College of Nursing
Dasmariñas, Cavite

NAME:________________________ Yr. & Sec.__________ Date:_________ Score:______

VITAL SIGNS TAKING

Write / if performed correctly and X if not performed or incorrectly performed.

ITEMS

WEIGHT
Followed proper technique / approach in:
a. assembling equipment 1
b. washing / disinfecting hands 1
c. introducing self 1
d. identifying patient 1
A. Temperature
Followed proper technique / approach in:
1. explaining the:
a. purpose 1
b. procedure 1
2. positioning the client 1
3. cleaning thermometer w/ alcoholized cotton about 2”
from the bulb of the thermometer to the stem 1
4. cleaning thermometer w/ dry cotton about 2” from the
bulb of the thermometer to the stem 1
5. pressing the “on” button of the thermometer, 1
checking if it is ready for use
6. placing the thermometer at the prescribed site 1
7. assuring that the thermometer is safely placed 1
8. listening for the “beep” completion 1
9. wiping thermometer w/ dry cotton ball about 2” from
the stem to the bulb of the thermometer 1
10. reading temperature on display 1
11. informing the client of the temperature reading. 1
12. cleaning the thermometer w/ alcoholized cotton &
dry cotton, from the stem to the bulb, pressing the “off” 3
button after use
B. Pulse
Followed proper technique / approach in:
1. explaining the:
a. purpose 1
b. procedure 1
2. placing fingertips at prescribed pulse site 2
3. counting the pulse correctly for 1 full minute 5
4. informing the client of the pulse rate (after taking the
respiration) 2
C. Respiration
Followed proper technique / approach in:
1. assuring that the client is not conscious by not
removing fingertips at pulse site 1
2. counting the respiratory rate correctly for 1 full 5
minute

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 3. informing the client of the respiratory rate 2
ITEMS

WEIGHT
D. Blood Pressure
Followed proper technique / approach in:
1. explaining the
a. purpose 1
b. procedure 1
2. positioning the client 1
3. asking previous blood pressure as baseline data or
obtaining the palpatory systolic pressure 2
4. placing the cuff around the arm (smoothly, snugly, 1
inch above the antecubital fossa w/ the center of the BP
cuff’s bladder over the brachial artery, making sure that 2
ends of the cuff are tucked)
5. placing the earpieces of the stethoscope in place 1
6. palpating the pulsation of the brachial artery w/ index
& middle fingertips 1
7. placing the bell of the stethoscope over the brachial
artery @ point of pulsation 1
8. Inflating the cuff 30 mmHg above the previous BP or
systolic palpatory blood pressure 2
9. releasing pressure on the cuff 2 to 3 mmHg per 2
seconds
10. deflating the cuff completely 1
11. informing the client of the BP reading 1
12. getting the correct BP reading 5
E. proper sequence in taking vital signs 2
F. observe aseptic technique 1
G. after care of equipment 1
F. washing/disinfecting hands after the procedure 1

Computation:
Actual Score x 50 + 50 = ________%
64

ATTITUDE
3 2 1
1. very good rapport with good rapport with poor rapport with patient
patient patient
2. uses respectful words in not so respectful uses tactless words in
explaining explaining
3. sensitive, gentle not so sensitive, not so Insensitive, harsh, non-
approach gentle gentle
4. uses appropriate non- uses some never uses any
verbal form of inappropriate non- appropriate form of non-
communication verbal form of verbal communication
communication

Total Score = ____________

Computation:
Actual Score x 50 + 50 = _________%
12

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DOCUMENTATION:

100% = All (T, PR, RR, BP) are plotted correctly and data are complete.

95% = All (T,PR, RR, BP) are plotted correctly but data are incomplete.

90% = 3 are plotted correctly and data are complete

85% = 3 are plotted correctly but data are incomplete

80% = 2 are plotted correctly and data are complete

75% = 2 are plotted correctly but data are incomplete

70% = Only 1 is plotted correctly.

60% = All (Temp, PR, RR, BP) are incorrectly plotted.

50 % = Not able to plot the results

OVERALL RATING

TPR & BP = 90%

ATTITUDE 10%
DOCUMENTATION

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