Vital

Signs

1
 Outlines

 Measuring vital sign

 Measuring patients body weight
 Measuring patients height
 Pain assessment
 Specimen collection
 Vital Signs (Cardinal Signs)

Vital signs(V/S)
 Reflect the body’s physiologic status

 Provide information critical to evaluating homeostatic balance

 Physical signs that indicate an individual is alive

 The term “vital” is used because the information gathered is:

 The clearest indicator of overall health status

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 Main vital signs

1. Temperature

2. Pulse

3. Respirations

4. Blood Pressure

5. The fifth vital sign: oxygen saturation

6. Pain
4
 Purposes

 To monitor physiologic function of vital organs

 To detect changes and abnormalities in the condition of the

client

 Helpful in detecting medical problems

 To establish the base line on admission and for future

comparison

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Times to Assess Vital Signs

 On admission – to obtain baseline date

 Change in client’s health status or reports symptoms

 Before and after the administration of certain medications

 Before and after surgery or an invasive diagnostic procedures

 Before and after any nursing intervention

 According to hospital /other health institution policy

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 Cont..

 The sequence for recording vital signs: T-P-R and BP

 All measurements are made while the patient is seated

 The patient should have had the opportunity to sit for

approximately five minutes prior to measuring vital signs

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 1. Temperature

 Temperature: hotness or coldness of the body

 Measurement of the balance b/n heat lost & heat

produced by the body
 An indicator of the body’s metabolic status

 A sign of infection or an invasion of harmful organisms

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Kinds of body temperature
1.Core temperature

 The temperature of internal organs

 The temperature of the deep tissues of the body

 Remains relatively constant

 Remains constant most of the time (37oc): 36.5-37.5oc

 Reflects the temperature of viscera and muscles.

 It is measured at rectal& tympanic site

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 Cont.…
2.Surface temperature

 The temperature of the skin, subcutaneous tissue & fat cells

 Rises & falls in response to the environment

 It doesn’t indicate internal physiology

 It is measured at oral or axillaries’ sites

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 Alterations in body temperature

 May be abnormal due to fever (high temp) or hypothermia (low temp)

 Pyrexia, fever: body temperature above the normal ranges: 37.5 0c -

410c
 Hyper pyrexia: very high fever, such as 41 0 C, > 42 0c leads to death

 Hypothermia: body temperature between 34 0c – 35 0c, < 34 0c is death

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 Factors affecting body temperature

 Age

 Diurnal variations (circadian rhythm)

 Exercise

 Hormones

 Stress

 Environment

 Gender

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Sites to measure temperature

 Oral
 Rectal
 Axillary
 Tympanic
 Forehead /temporal artery
 Thermometer: an instrument used to measure body
temperature

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 1.Oral temperature

 Obtained by putting the thermometer under the tongue

 Measurement is 0.65 less than rectal To.

 0.65 greater than axillary temp.

 Leave 3 to 5 minutes in place

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 Cont….

 This site is inconvenient for:

Unconscious patients

Infants and children

Patients with ulcer or sore of the mouth

Patients with persistent cough

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 Cont.….
Advantage
 Easy access

 Patient comfort

Disadvantage

False reading
 If a person has taken hot or cold food/ drink by mouth

 If the has smoked------wait for at least 15-30min

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 Contraindication

 Pt who cannot follow instruction to keep their mouth closed

 Child below 7 years

 Epileptic, or mentally ill patients

 Unconscious

 Clients receiving O2 therapy

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Cont….

 Clients with persistent cough

 Uncooperative or in severe pain

 Surgery of the mouth

 Nasal obstruction

 If patient has nasal or gastric tubes

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 2.Rectal temperature

 By inserting the thermometer into the rectum

 It gives reliable measurement

 Reflects the core body temperature

 More accurate, > 0.650 c (1 0F) higher than the oral temp

 Hold the thermometer in place for 3 to 5 minutes

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Cont…
Disadvantages
 Injure the rectum

 It needs privacy

 Inappropriate for patients with diarrhea & anal fissure

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21
 Contraindications

 Rectal surgery

 Fecal impaction

 Rectal infection

 Newborn infants

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 3.Axillary temperature
 It is safe and non-invasive

 Is recommended for infants &children

Disadvantage
 Long time

 Less accurate

 The least accurate & least reliable

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4.Tympanic temperature

 Placed in to the client’s outer ear canal

 Reflects the core body temperature

 Readily accessible

 Permits rapid temperature readings in pediatric, or unconscious patients

 Very fast method 1 to 2 seconds

Disadvantages
 May be uncomfortable and involves risk of injuring the membrane

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Cont.…

Disadvantage
 Presence of cerumen (wax) can
affect the reading
 Right & left measurements may
differ

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 2. Pulse
 Pulse is a wave of blood created by the contraction of left ventricle

 Pulse reflects the heart beat

 Stroke volume and the compliance of arterial wall are the two
important factors influencing pulse rate

 When the body’s circulatory needs change, the heart rate

either accelerates or decelerates
 Pulse rate is regulated by autonomic nervous system

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 Cont.…

 Peripheral pulse: a pulse located in the periphery

of the body
 E.g. in the foot, and or neck

 Apical pulse (central pulse): it is located at the

apex of the heart
 The PR is expressed in beats/minute (BPM)

 Pulse deficit-difference between peripheral and 27

Factors affecting pulse rates

Age in infants heart is not well muscular to eject sufficient

amount of blood
 The average pulse rate of an infant ranges from 100 to 160 BPM

 The normal range of adult is 60 to 100 BPM

Sex: after puberty the average males PR is slightly lower

than female

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 Cont.….
Autonomic Nervous system activity
Stimulation of the PNS results in decrease in PR

Stimulation of SNS results in an increased PR

SNS activation occurs on response to a variety of stimuli

including :
 Pain, anxiety ,exercise ,fever, ingestion of caffeinated
beverages, change in intravascular volume

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Cont.…
 Exercise: PR increase with exercise

 Fever: increases PR in response to ed metabolic rate

 Heat: increase PR as a compensatory mechanism

 Stress: increases the sympathetic nerve stimulation

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Cont.…

Position changes
 Sitting or standing position blood usually pools in
dependent vessels of the venous system

 B/c of decrease in the venous blood return to heart and

subsequent decrease in BP increases heart rate

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 Cont.…
Medication
 Digoxin decreases heart rate
 Diuretics may increase pulse rate
 Atropine inhibits impulses to the heart from the PNS,causing

increased pulse rate

 Propranolol blocks SNS- decreased heart rate

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Pulse Sites

Pulse Sites
Readily available and routinely used

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Methods
 Pulse assessed by palpation (feeling) or auscultation (hearing)

 The middle 3 fingertips are used with moderate pressure for

palpation of all pulses except apical

 Assess the pulse for:

 Rate

 Rhythm

 Volume

 Quality

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 Cont.…

Pulse rate:
 Normal 60-100 b/min

 Adult PR > 100 BPM is called tachycardia

 Adult PR < 60 BPM is called bradycardia

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 Cont.…

Pulse rhythm:

 The pattern and interval between the beats, random

 Irregular beats –dysrhythmia

Pulse volume:

 The force of blood with each beat

 A normal pulse can be felt with moderate pressure of

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Cont.…
 Full or bounding pulse forceful or full blood volume destroy
with difficulty
 Weak ,feeble-readily destroy with pressure from the finger tips

Elasticity of arterial wall

 Healthy, normal artery feels, straight, smooth, soft, easily bent

 Reflects the status of the clients vascular system

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 Cont.…
 If the pulse is regular, measure (count) for 30 seconds and multiply by 2

 If it is irregular count for 1 full minute

Each heart beat consists of two sounds

 S1 - is caused by closure of the mitral and tricuspid valves separating the

atria from the ventricles

 S2 -is caused by the closure of the pulmonic and aortic values

 The sounds are often described as a muffled “lub-dub”

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39
 3. Respiration

 Intake of oxygen and removal of carbon-dioxide

 Ventilation -refers to movement of air in and out of the

lung

 Hyperventilation-is a very deep and rapid respiration

 Hypoventilation-is a very shallow respiration

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 Types of Breathing

1. Costal (thoracic)

 Observed by the movement of the chest up ward and down ward

 Commonly used for adults
2.Diaphragmatic (abdominal)

 Involves the contraction and relaxation of the diaphragm

 Observed by the movement of abdomen

 Commonly in children

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 Factors affecting respiration

Age- normal growth from infancy to adult hood results in a larger lung
capacity

 As lung capacity increases, lower respiratory rates are sufficient to

exchange

Medications -narcotics decrease respiratory rate & depth

Stress- strong emotions increases the rate & depth of respirations.

Exercise -increases the rate & depth of respirations

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 Cont.….
Altitude
 The rate & depth of respirations at higher elevations
(altitude) increase to improve the supply of oxygen
available to the body tissues

Gender-men may have a lower respirations rate than women

 Men normally have a larger lung capacity than women.

Fever- increases respiratory rate

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Assessment

 The client should be at rest

 Assessed by watching the movement of the chest or
abdomen
• Rate
• Rhythm
• Depth and special characteristics of respiration

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 Cont.….
Rate:
 Is described in rate per minute (RPM)

 Healthy adult RR = 12- 20/ min is measured for full minute, if

regular for 30 seconds.
 As the age increases the respiratory rate decreases.

 Eupnea - normal breathing rate and depth

 Bradypnea- slow respiration

 Tachypnea - fast breathing

 Apnea - temporary cessation of breathing

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 Cont.….
Rhythm:
 Regularity of expiration and inspiration

 Normal breathing is automatic & effortless

Depth:
 Described as normal, deep or shallow

 Deep: a large volume of air inhaled & exhaled, inflates most of the
lungs.
 Shallow: exchange of a small volume of air minimal use of lung tissue.

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47
 4. Blood Pressure

 The force exerted by the blood against the

walls of the arteries in which it is flowing.
 Expressed in terms of millimeters of
mercury (mm of Hg).

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 Assess blood pressure
Purpose
 To obtain base line measure of arterial blood pressure
for subsequent evaluation
 To identify and monitor changes in blood pressure

 To determine the clients hemodynamic status

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 Types of BP

Systolic pressure
 The maximum of the pressure against the wall of the
vessel following ventricular contraction.

Diastolic pressure
 The minimum pressure of the blood against the walls of
the vessels following ventricular relaxation

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 cont.….

 BP is measured by using an instrument called BP cuff

(sphygmomanometer) & stethoscope
 The average normal value is 120/80mmHg for adults

 Pulse pressure: is the difference between the systolic

and diastolic pressure

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 Factors to Maintain BP

 Peripheral Resistance
 Pumping action of the heart
 Blood volume
 Viscosity of the blood
 Elasticity of vessel walls

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 Factors Affecting Blood Pressure

 Fever

 Stress

 Arteriosclerosis

 Exposure to cold

 Obesity

 Hemorrhage

 Low hematocrit

 External heat

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 Sites for measuring blood pressure

 Upper arm-brachial artery-the common

 Thigh-popliteal artery

 Fore arm-radial artery

 Leg-posterior tibial or dorsal pedis

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 Cont.….
 Hypertension persistently high BP, measured for greater
than three times
 Persistently less than normal range is called hypotension

 A single measurement is not necessarily significant to

confirm hypertension

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 Classification of BP
Blood pressure in mm Hg

Category Systolic Diastolic

Normal <120 <80

Pre-hypertension 120-139 80-89

Hypertension =>140 =>90

Category of blood pressure according to the USA Joint

National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC-7)

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Classification of hypertension
Stages of hypertension Systolic Diastolic

Stage 1 140-159 90-99

Stage 2 =>160 =>100

Category of stage of hypertension according to the USA

Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC-7)

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58
Cont..

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Equipment
Stethoscope
Blood pressure cuff of the appropriate
size
Sphygmomanometer

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61
 Procedure to measure BP

1.Explain the procedure to the patient & remove any

light cloth from patient’s arm

2.Position the patient on lying or sitting position

Ensure that the sphygmomanometer is at the level
of the heart with the arm supported & the palm
facing upwards

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 Cont….

3.Apply cuff snugly/securely around the arm

2.5cm above the antecubital space/fossa/at the level
of the heart
 For every cm the cuff sites above or below the level
of the heart the BP varies by 0.8mmHg

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 Cont…
4.Palpate the radial pulse and inflate the cuff until the radial
pulse can no longer be felt, this provides an estimation of
systolic pressure.

5.Inflate cuff 30mmHg higher than estimated systolic pressure.

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Cont….

6.Palpate the brachial artery & place the diaphragm of

the stethoscope over the site & the ear pieces on ear,
apply enough pressure to keep the stethoscope in
place.

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 Cont…
7.Deflate the cuff 2-4mmHg per second.

The first pulse heard is the- systolic reading,

continue to deflate until there is a change in tone
to a muffled beat-this is the diastolic reading.

8.Deflate & remove cuff roll neatly and replace.

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 Cont…
9.Record the systolic and diastolic pressure on
vital sign sheet and compare the present
reading with previous reading.

10.Report or treat any change

11.Clear ear pieces and bell of the stethoscope

with antiseptic swab and return all equipments.

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Measuring height
Height
Measurement of height is expressed in inches (in.),
feet(ft), centimeters (cm), or meters (m)

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 Measuring height

e r
e t
i om
ad
St
Ste
ps

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 Measuring patient's body weight

Weight
 Measurement is expressed in ounces (oz),pounds
(lb), grams (g), or kilograms (kg)
 The participant is standing still in the centre of
platform
 10 cm gap between the heels
 The weight equally distributed on both legs

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Body mass index(BMI)

Is a measure of body fat based on height and weight

that applies to adult men and women.

MI Categories:
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater
Pain assessment

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What is pain?

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Pain assessment

Pain

 An unpleasant sensory & emotional experience

associated with actual or potential tissue damage.

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Pathophysiology of Pain

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Conti…
 Pain can be classified

 Nociceptive or neuropathic based on underlying pathology

 Acute or chronic based on time duration

Nociceptive pain:
 Arises from damage or inflammation of tissue

 It is usually throbbing, aching, and localized

 This pain typically responds to opioids & non-opioid medications

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Conti…
Types of nociceptive pain include:

Somatic: Dull, aching, well localized.

 In bones, joints, muscles, skin, or connective tissues.

Visceral: diffuse, deep, aching, poorly localized.

 Internal organs such as the stomach or intestines.
 It can cause referred pain in other body locations separate from the

stimulus

 Cutaneous: in the skin or subcutaneous tissue.

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Conti…
Neuropathic Pain:
 Arises from abnormal or damaged nerves.

 Neuropathic pain is usually intense, shooting, burning, or

described as “pins & needles” and paresthesia.
 Peripheral or Central
Peripheral:
 Follows damage or abnormal changes of peripheral nerve fibers
e.g. Phantom limb pain, post herpetic neuralgia…
 It is described as burning, electric shock, tingling, sharp, shooting

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Classification…

Central neuropathic pain

 Results from malfunctioning nerves in the CNS.

E.g. spinal cord injury pain, post stroke pain…

 Generally, neuropathic pains typically responds to adjuvant
medications (antidepressants, antispasmodic agents, skeletal
muscle relaxants).

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Classification…

Acute Pain
 Is protective, temporary, usually self-limiting, and resolves with
tissue healing

Chronic Pain
 It is ongoing or recurs frequently, lasting longer than 6 months &
persisting beyond tissue healing
 Is not protective

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Pain Assessment
 Accurate assessment of pain is essential to effective treatment.

 Without appropriate assessment, it is not possible to intervene in

a way that meets the patient’s needs.
 The American Pain Society (APS) recommends that nurses
should consider pain as the “5th vital sign.”
 That way it will be routinely assessed whenever other vital signs
are assessed.

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Conti..

The goals of a nursing pain assessment are to:

 Describe the patient’s pain experience in order to

 Identify and implement appropriate pain management

techniques

 Help in setting appropriate diagnosis

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Pain Assessment…
General mnemonic to collect information regarding pain: WHATS UP?
 W: Where is the pain? Be specific
 H: How does the pain feel? Is it shooting, burning, dull, sharp?
 A: Aggravating and alleviating factors. What makes the pain better?
Worse?
 T: Timing. When did the pain start? Is it intermittent? Continuous?
 S: Severity. How bad is the pain on a 0 to 10.
 U: Useful other data. Are you experiencing any other symptoms
associated with the pain or pain treatment? Itching, nausea, sedation,
constipation?
 P: Perception. What is the patient’s perception of what caused the pain?

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Pain Scales
 The purpose of pain scales is:

 To quantitate pain severity, guide the selection & administration of an

analgesic agent, and reassess the pain response to determine the need for
repeated doses or more effective analgesics.

These are:
 Visual Analog Scale (VAS)

 Verbal Descriptor Scale (VDS)

 Numerical Rating Scale (NRS)

 Wong Baker Faces Pain Scale

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Pain Scales…

Visual Analog Scale (VAS):

 Is most commonly a straight 10 cm line without
demarcations that has the words “no pain” at the left-
most end and “worst pain” (imaginable) at the right-
most end.
 Patient places a mark that best describes pain intensity

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 Pain Scales…
VAS:

Advantages:
 It is quick to use and relatively easy to understand for most patients

 It avoids the imprecise use of descriptive words to describe pain

Disadvantages:
 It attempts to assign a single value to a complex, multidimensional experience

 Some patients have trouble deciding how to represent their pain sensation

 They often have no real concept of what “worst pain” actually means because every
experience of pain is different

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Pain Scales…
Verbal Descriptive Scale (VDS):

 Is a list of words, ordered in terms of severity from

least to most
 Patients are asked to either circle or state the word
that best describes their pain intensity at that
moment in time

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Pain Scales…

VDS:

Advantage:
 Simple for patients to understand and quick to use

Disadvantage:
 Forces patients to select words that are not of their
own choosing to describe their pain
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Pain Scales…
Numerical Rating Pain Scale (NRS):
 Offers the individual in pain to rate their pain score

 The user has the option to verbally rate their scale from 0 to 10 or to place a mark on a line
indicating their level of pain
 0 indicates the absence of pain

 10 represents the most intense pain possible

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Pain Scales…
Wong Baker Faces Pain Scale
 Combines pictures & numbers to allow pain to be rated by the user
 A numerical rating is assigned to each face, of which there are 6 in total
 It can be used in children over the age of 3, and in adults
 The faces range from a smiling face to a sad, crying face

0 2 4 6 8 10

Pain scale: Wong Baker Faces Pain Scale

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 Management of
Pain

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Pharmacological Pain Management

 Medications that relieve pain are called analgesics.

 There are three main categories of analgesics: opioids,

nonopioids, and adjuvants.
 1990 the WHO developed the WHO analgesic ladder, which
involves choosing among three levels of treatments based on
intensity of pain.

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Pharmacological…

Fig: WHO Pain Relief Ladd

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Pharmacological…
Table: Non opioid drugs
Nonopioid Analgesics

Drug Nursing Considerations

Non-salicylate  Doses >4 g/day may cause hepatotoxicity.
acetaminophen  Acute overdose: acute liver failure.
(Tylenol)  Chronic overdose: liver toxicity.

Salicylates Possibility of upper GI bleeding.

Aspirin
NSAIDs Increased risk of serious GI adverse events
(ibuprofen, diclofenac, (bleeding, ulceration, perforation), especially
ketorolac in older adults.
(Toradol))

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 Specimen collection

Laboratory examination of specimens such as urine,

 blood

stool

sputum

wound drainage

provides important extra information for

diagnosing health problems.
Cont…

Lab examination also provides a measure of the

response to therapy.

Nurses often assume responsibility for specimen

collection.
Nurses responsibility associated with specimen
collection

Provide client comfort, privacy and safety

Explain the purpose of the specimen collection
and the procedure for obtaining the specimen
Use correct procedure for obtaining the
specimen
note relevant information on the lab request slip
Cont…

Transport the specimen to laboratory promptly

(fresh specimens provide more accurate results)
Report abnormal laboratory finding to the health
care provider in a timely manner
Stool specimen

 Taking small pieces of stool from patient for

bacteriological or parasitological analysis
Purposes
To determine the presence of occult (hidden)
blood.
To analyze for dietary products and digestive
secretions
To detect the presence of ova and parasites
To detect the presence of bacteria etc
 Urine specimen

The nurse is responsible for collecting urine

specimen for a number of tests like:

Random urine specimen for routine urinalysis

Clean catch or midstream urine specimens for

urine culture
Cont..

• Timed urine specimen (collection of all urine

produced and voided over specific period of
time e.g. 24Hr) for variety of tests that depend
on client health condition
Cont..

• Urine specimen may be collected via straight catheter

insertion
Random collection (routine Urinalysis

Purpose

• To diagnose illness

• To monitor the disease process

• To evaluate the efficacy of treatment

Cont…
Precaution

Ø Label specimen containers or bottles before the

client voids

Ø Note on the specimen label if the female client is

menstruating at that time
Mid stream (clean-voided) urine
specimen

 is method of collecting part of urine stream by

avoiding first and last part of urine in receptor.

Purpose

• To take the specimen for culture and sensitivity

• To identify possible microorganism in the urine

Timed urine specimen collection

• is method of collecting urine specimen for specified

period.

• Some tests of renal function and urine composition

require urine to be collected over 2 to 72 hr.

• The 24 hour timed collection is most common

Cont..
Purpose:

• The test allow for the measurement of elements such

as amino acids, creatinine, hormones, glucose and
adrenocorticosteroids, whose levels change over time.

• A timed urine collection can also provide a means to

measure the concentration or dilution of urine.
Cont..
• Used to monitor input and output

• To determine disorders of glucose metabolism e.g. diabetes

mellitus.

• Catheterized urine specimen

 it is a collection of urine specimen by introducing catheter in to the

urethra.

Purpose

• To collect sterile urine specimen

• To have a sample for a patient who has difficulty of passing urine

Taking blood specimen

Vein puncture

it is the procedure of using a needle to withdraw blood

from a vein

Purpose:

for diagnosis and for determining variation in blood

composition if any
Cont..

Site of taking venous blood

Ante cubital vein
 Ulnar vein

Capillary or peripheral blood specimen

it is method of taking small drop of blood from
capillary by pricking the skin.
Cont..
Site for pricking
 Tip of the finger (ring finger of the left hand)
 Lobe of the ear
 Infants plantar surface of the heal and the big toe

Purpose
To detect hemo-parasite
To detect blood cell abnormalities
Arterial specimen by puncture
is an invasive procedure using a needle to withdraw
blood from a peripheral artery (e.g., radial or
femoral).
Purpose
 Done for blood gas analysis to determine
Oxygenation, Ventilation and the effectiveness of
respiratory therapy and Acid-base level of the blood
Sputum Specimens
is method of collection of coughed sputum for

diagnostic purpose( to rule out respiratory pathology).

Sputum is the mucous secretion from lungs, bronchi,

and trachea

Clients need to cough to bring up the sputum from

lungs, bronchi and trachea

.
Cont..
Purposes:
 Examination of sputum may aid in the diagnosis and

treatment of several conditions ranging from simple

bronchitis to lung cancer.
Cont..

Cytology

 cellular examination of sputum may identify aberrant

cells or cancer.

Culture and sensitivity

used to identify specific microorganism and to

determine antibiotics to which they are most sensitive.
Cont..

Acid-fast bacilli (AFB)-used to support the diagnosis of

tuberculosis (TB)
 Suctioning may be indicated to collect sputum from
the client who is unable to spontaneously produce a
sample for laboratory analysis.
Cont..

To collect a sputum specimen, the nurse follows the

following steps:
Offer mouth care to minimize contamination of the
specimen
Ask the client to breath deeply and then cough up 1-
2 tablespoon (15-30ml) of sputum
Wear gloves to avoid direct contact with the sputum
Cont..

Ask the client to expectorate (spit out) the sputum in

to the specimen container
Following sputum collection, offer mouth wash to
remove any unpleasant taste
Label and transport the specimen to the laboratory
Document the collection of sputum on clients chart
Obtaining wound drainage
specimen for culture
o is the technique of taking a sample from wound for
laboratory analysis and culture to identify the specific
microorganisms on the wound.

Purpose:

• To identify the microorganisms potentially causing an

infection and the antibiotics to which they are sensitive

• To evaluate the effectiveness of antibiotic therapy

Throat Culture (swab)

Sample is collected from the mucosa of oropharynx and

tonsillar regions using a swab
To collect the sample the nurse follows the following
steps:
Put on clean gloves
Insert the swab into the oropharynx and move the
swab slowly along the tonsils and areas on the
pharynx that are reddened or contain exudates
Is better if the client sit up and extend his/her tongue
and say “ah” during swabbing
Depression of tongue may be needed in some cases
 Important points

1.Standard precautions are used when collecting

specimen involving any body fluids
2. Routine specimen collection is usually scheduled for
early in the morning
3. Close the container without touching inside of lid
4. Any specimen collected should be transported to the
laboratory immediately to ensure the most accurate
results
5. Sputum specimen collection requires the client to
expectorate or cough up secretions from lower in the
respiratory tract
Thank you!