Vital Sign Parameters — When to Call

Vital signs and pulse oximetry are taken at every visit, by every skilled discipline. Not just nursing, and not only when something seems wrong.

Notify the PCP outside these parameters

Unless the PCP has previously specified different parameters for this patient and that is documented in the chart:

	Notify if
Temperature	greater than 100.4 °F or less than 96.4 °F
Pulse	greater than 100 bpm or less than 50 bpm
Respirations	greater than 30/min or less than 12/min
Blood pressure	greater than 160/90 mmHg or less than 90/50 mmHg
Pulse oximetry	less than 90%
Pain	greater than 6/10

Notify the PCP any time the vitals are not within normal limits — even if they return to a normal range by the end of the treatment. A blood pressure of 188/96 that settles to 148/88 after the patient rests is still a reportable event, and the fact that it resolved is part of what the physician needs to know.

Condition-specific monitoring

Vital signs are the floor, not the whole picture. Two groups need monitoring on top of them, on every visit and between visits.

Heart failure — daily weights with a written log

Every CHF patient is weighed daily, and a log is kept. Not weekly, not "when they remember", and not from memory.

Same scale, same time of day, after voiding, similar clothing
Written down on a log kept where the scale is
Patient states the threshold: more than 2–3 lb in 24 hours, or 5 lb in a week
Patient states who to call when it is crossed

Review the log at every visit and record the trend in your note — the log is the assessment, not a chore the patient does for you. A gap in the log is a finding worth asking about. See Heart Failure.

Diabetes — blood glucose monitoring, especially on insulin

Every diabetic patient has blood glucose monitoring in place, and for patients on insulin this is not optional.

Frequency and timing as ordered — before meals, at bedtime, or whatever the regimen requires
Readings written down, with date and time, not held in memory
Working meter, in-date strips, adequate lancets — check the supplies, not just the technique
Patient or caregiver can state their target range, what a low feels like, and exactly what to do about it
Review the readings at every visit and record the pattern, not just today's number

For insulin patients, also confirm at every visit: correct dose drawn, correct site and rotation, correct timing relative to meals, and safe storage. Watch them do it rather than asking whether they can — see Skilled Language — Writing What You Actually Did.

A diabetic patient on insulin with no glucometer, expired strips, or no record of readings is an urgent problem to solve that visit, not a note for next time. See Diabetes.

Address hypertension and hypotension differently

They are not two ends of one problem with one response. Treat them as separate clinical situations with separate approaches — positioning, fluid status, medication timing, and fall risk all point in different directions depending on which one you are looking at.

Teach the parameters, not just the numbers

Taking the vital sign is the smaller half of the visit. The patient needs to know:

What their own normal range is — their parameters, not a textbook's
Which readings mean call the PCP
Which readings mean seek immediate medical attention
Where to write the readings down between visits

Assess and document the patient's awareness and understanding of their specific parameters. A patient who can state their own numbers and what to do about them is a patient who is closer to discharge. That is skilled teaching, and it belongs in the note.

What to document

The values themselves, and whether they are within normal limits for this patient
For anything outside parameters: who you notified, at what time, and what came of it
Any new or changed orders
The patient's understanding of their own parameters and when to call
Your clinical response during the visit — what you did, and how the patient responded