{"id":112,"date":"2018-06-05T11:34:24","date_gmt":"2018-06-05T15:34:24","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-3-vital-signs\/"},"modified":"2019-09-30T12:44:26","modified_gmt":"2019-09-30T16:44:26","slug":"2-4-vital-signs","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/2-4-vital-signs\/","title":{"raw":"2.4 Vital Signs","rendered":"2.4 Vital Signs"},"content":{"raw":"Temperature, pulse, respiration, blood pressure (BP),\u00a0and\u00a0oxygen saturation (SpO2<\/sub>), are measurements that\u00a0indicate a person's hemodynamic status.\u00a0These\u00a0are the five vital signs most frequently\u00a0obtained by healthcare practitioners (Perry, Potter, & Ostendorf, 2018).\u00a0Vital signs can reveal important information about a person's health status including changes in a patient's condition. As such the nurse's responsibility is to consider patterns and trends in vital signs in anticipation of changes in health status, need for further investigation, and intervention (Perry, Potter & Ostendorf, 2018). Checklist 15 outlines the steps to take when checking vital signs.\r\n\r\n \r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n<\/strong>\r\n

<\/a>Checklist 15: Vital Signs<\/h3>\r\n
Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/h5>\r\n\u00a0<\/strong><\/td>\r\n<\/tr>\r\n

\r\n<\/strong>\r\n
Safety considerations:<\/h5>\r\n
    \r\n \t
  • Always compare findings with the patient's baseline.<\/li>\r\n \t
  • Consider growth and development in relation to vital signs. Vital signs vary depending on age.<\/li>\r\n \t
  • Consider factors that may be influencing vital signs. The pathophysiology behind these factors is beyond the scope of this textbook.<\/li>\r\n \t
  • Report concerns to the appropriate healthcare professional.<\/li>\r\n \t
  • Consider infection control practices.<\/li>\r\n<\/ul>\r\n\u00a0<\/strong><\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

Further Information<\/h4>\r\n<\/td>\r\n

\r\n

Normal Values<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Temperature:\r\n\r\n\"\"<\/a><\/td>\r\nOral temperature<\/strong>:\u00a0Place the thermometer in the mouth under the tongue and instruct patient to keep mouth closed. Leave the thermometer in place for as long as is indicated by the device manufacturer.\r\n\r\nAxillary temperature<\/strong>:\u00a0Usually 1\u00baC lower than oral temperature. Place the thermometer in patient's armpit and lower the patient's arm over the probe. Leave it in place for as long as is indicated by the device manufacturer.\r\n\r\nTympanic membrane (ear) temperature<\/strong>: Usually 0.3\u00b0C to 0.6\u00b0C higher than an oral temperature. The tympanic membrane shares the same vascular artery that perfuses the hypothalamus. Do not force the thermometer into the ear and do not occlude the ear canal.\r\n\r\nRectal temperature<\/strong>:\u00a0Usually\u00a01\u00baC higher than oral temperature. Use only when other routes are not available. On adults, insert the probe approximately 3.5 cm into rectum toward the umbilicus. Use lubricant.<\/td>\r\nNormal (oral) = 35.8\u00baC to 37.5\u00baC\r\n\r\n \r\n\r\n <\/td>\r\n<\/tr>\r\n
2. Pulse (a.k.a. heart rate):\r\n\r\n\"\"<\/a>\r\n\r\n\"\"<\/a>\r\n\r\n[caption id=\"attachment_3764\" align=\"aligncenter\" width=\"150\"]\"\"<\/a> Figure 2.3 Assessing carotid pulse[\/caption]<\/td>\r\nPulses can be found at many points on the body and all could theoretically be used to assess heart rate. When palpating pulses use moderate pressure, as too much pressure can impair blood flow and occlude the vessel. In some agencies scales are used to document the strength of the pulse from bounding (+4); strong (+3); weak (+2); thready (+1); absent (0).\r\n\r\nIf a pulse is regular, a 30 second count multiplied by two is generally acceptable. If a pulse is irregular, count for 60 seconds\r\n\r\nCommon pulses for assessment include:\r\n\r\nRadial pulse<\/strong>:\u00a0Use the pads of your first three fingers to gently palpate the radial pulse at the inner lateral wrist.\r\n\r\nApical pulse<\/strong>:\u00a0Taken as part of a focused cardiovascular assessment and when the heart rate is irregular.\u00a0Apical pulses are assessed using a stethoscope placed over the 4th\u20135th intercostal space of the midclavicular line on the left side on adults.\u00a0For accuracy, an apical heart rate should be taken for a full minute. When giving medications that are dependent on the heart rate, count the apical pulse for a full minute. Auscultate for rate and regularity.\r\n\r\nNote<\/strong>: It is suggested that beginner nurses concentrate on rate and regularity. With practice, and depending on where you work, your skill level with specific heart sounds may change and need to be more detailed.\r\n\r\nThere are many online resources to support learning about normal and abnormal cardiac sounds. Here's one:\r\nNormal heart rate:\r\n
    \r\n \t
  • Newborn\u20131 month: 100\u2013175<\/li>\r\n \t
  • 1 month\u20132 years: 90\u2013160<\/li>\r\n \t
  • Age 2\u20136 years: 70\u2013150<\/li>\r\n \t
  • Age 7\u201311 years: 60\u2013130<\/li>\r\n \t
  • Age 12\u201318 years: 50\u2013110<\/li>\r\n \t
  • Adult and older adult: 60\u2013100<\/li>\r\n<\/ul>\r\n <\/td>\r\n<\/tr>\r\n
3. Respiration rate:\r\n\r\n\"\"<\/a><\/td>\r\nCount respiratory rate unobtrusively by observing the rise and fall of the patient's chest or abdomen. Consider doing this while you are taking the pulse rate, so the patient is not aware that you are taking the respiration rate.\r\n\r\nIf the respiratory rhythm is regular, count for 30 seconds and multiply times two to determine respiratory rate \/ minute. If the respiratory rhythm is irregular or less than 12 \/ minute, count for a full minute.<\/td>\r\nNormal respiratory rate per minute:\r\n
    \r\n \t
  • Newborn\u20131 month: 30\u201365<\/li>\r\n \t
  • 1 month\u20131 year: 26\u201360<\/li>\r\n \t
  • 1\u201310 years: 14\u201350<\/li>\r\n \t
  • 11\u201319 years: 12\u201322<\/li>\r\n \t
  • Adult & older adult: 10\u201320<\/li>\r\n<\/ul>\r\n <\/td>\r\n<\/tr>\r\n
4. Non-invasive blood pressure (NIBP):\r\n\r\n[caption id=\"attachment_6407\" align=\"aligncenter\" width=\"150\"]\"DSC_2215\"<\/a> Blood pressure cuff[\/caption]\r\n\r\nInvasive BP readings involve direct readings from an artery and would occur in a critical care area.<\/span><\/td>\r\nThe average blood pressure (BP) for a healthy adult is 120\/80 mmHg, but variations are normal for various reasons.\u00a0The systolic<\/strong> pressure\u00a0is the maximum pressure on the arteries during left ventricular contraction.\u00a0The diastolic<\/strong> pressure\u00a0is the resting pressure on the arteries between each cardiac contraction.\r\n\r\nChoosing the correct BP cuff size<\/strong>: The length of the cuff's bladder should be approximately 80% of the circumference of the upper arm. The width of the cuff should be approx 2\/3 of the upper arm. In other words allow for approximately two finger widths between the axilla and the top of the cuff and two finger widths between the antecubital fossa and the bottom of the cuff.\r\n\r\nThe patient may be sitting or lying down with the bare arm at heart level.\r\n\r\nTwo step method auscultation\u00a0method<\/b>: The two step method will allow you to approximate the BP prior to the reading, thus helping to prevent false low readings.\r\n\r\nApply the BP cuff to the upper arm by ensuring correct size and lining the arrows up to the brachial artery. On the same arm, palpate the radial or brachial artery. Close the pressure bulb. Inflate the BP cuff until the pulse rate is no longer felt. Then inflate an additional 20 to 30 mmHg. This will give you an approximate systolic pressure and help you to determine the maximum inflation point.\r\n\r\nOpen the pressure bulb and deflate the cuff and wait approximately one minute.\r\n\r\nPlace the bell of the stethoscope over the brachial artery, place the stethoscope ear pieces in your ears. Close the pressure bulb. Inflate the cuff to the approximated systolic pressure and deflate the cuff slowly and evenly (approx 2\u20133 mmHg \/ second) noting the points on the manometer at which you hear the first appearance of sound (systolic BP), and the disappearance of sound (diastolic BP).\u00a0After the last sound is heard, quickly deflate the cuff.\r\n\r\nUsing an NIBP<\/strong>: Ensure cuff size is correct. Align the artery with the arrows on the cuff. Operate the machine as per manufacturers instructions.\r\n\r\nAdditional resource:\r\n\r\nDeans, B. (2013, March 20).\u00a0Choosing & positioning a blood pressure cuff<\/em>\u00a0[Video file]. Retrieved from https:\/\/www.youtube.com\/watch?v=II0ioJNLnyg<\/a>.<\/td>\r\nNormal blood pressure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Age<\/strong><\/td>\r\nNormal Systolic Range<\/strong><\/td>\r\nNormal Diastolic Range<\/strong><\/td>\r\n<\/tr>\r\n
Newborn to 1 month<\/td>\r\n45\u201380 mmHg<\/td>\r\n30\u201355 mmHg<\/td>\r\n<\/tr>\r\n
One to 12 months<\/td>\r\n65\u2013100 mmHg<\/td>\r\n35\u201365 mmHg<\/td>\r\n<\/tr>\r\n
Young child (1\u20135 years)<\/td>\r\n80\u2013115 mmHg<\/td>\r\n55\u201380 mmHg<\/td>\r\n<\/tr>\r\n
Older child (6\u201313 years)<\/td>\r\n80\u2013120 mmHg<\/td>\r\n45\u201380 mmHg<\/td>\r\n<\/tr>\r\n
Adolescent (14\u201318 years)<\/td>\r\n90\u2013120 mmHg<\/td>\r\n50\u201380 mmHg<\/td>\r\n<\/tr>\r\n
Adult (19\u201340 years)<\/td>\r\n95\u2013135 mmHg<\/td>\r\n60\u201380 mmHg<\/td>\r\n<\/tr>\r\n
Adult (41\u201360 years)<\/td>\r\n110\u2013145 mmHg<\/td>\r\n70\u201390 mmHg<\/td>\r\n<\/tr>\r\n
Older adult (61 and older)<\/td>\r\n95\u2013145 mmHg<\/td>\r\n70\u201390 mmHg<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n <\/td>\r\n<\/tr>\r\n
5. Oxygen saturation (SpO2<\/sub>):\r\n\r\n[caption id=\"attachment_6406\" align=\"aligncenter\" width=\"150\"]\"DSC_2214\"<\/a> Pulse oximeter sensor[\/caption]<\/td>\r\nA pulse oximeter sensor attached to the patient's finger or earlobe measures light absorption of hemoglobin and represents arterial SpO2<\/sub>.\r\n\r\nRefer to Chapter 5.3 Pulse Oximetry<\/a> for more information.<\/td>\r\nA\u00a0 healthy person should have an SpO2\u00a0<\/sub>of\u00a0 \u2265 97%.\r\n\r\n \r\n\r\n <\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n
Data sources: Hill & Smith, 1990; Jarvis, Browne, MacDonald-Jenkins, & Luctar-Flude, 2014; Lapum, Verkuyl, Garcia, St-Amant, & Tan, 2018; Stephen, Skillen, Day, & Jensen, 2012<\/div>\r\n<\/div>\r\n
\r\n

Critical Thinking Exercises<\/h3>\r\n
    \r\n \t
  1. Identify four factors that can influence heart rate.<\/li>\r\n \t
  2. Identify two situations that can influence blood pressure.<\/li>\r\n \t
  3. Discuss why someone with a lung disease like COPD might have lower than normal SpO2<\/sub>.<\/li>\r\n \t
  4. What is a normally accepted range for SpO2<\/sub> in a client with COPD?<\/li>\r\n<\/ol>\r\n

    Attribution<\/h1>\r\nFigure 2.3 Assessing carotid pulse by author is licensed under a\u00a0Creative Commons Attribution 4.0 International License<\/a>.\r\n\r\n<\/div>","rendered":"

    Temperature, pulse, respiration, blood pressure (BP),\u00a0and\u00a0oxygen saturation (SpO2<\/sub>), are measurements that\u00a0indicate a person’s hemodynamic status.\u00a0These\u00a0are the five vital signs most frequently\u00a0obtained by healthcare practitioners (Perry, Potter, & Ostendorf, 2018).\u00a0Vital signs can reveal important information about a person’s health status including changes in a patient’s condition. As such the nurse’s responsibility is to consider patterns and trends in vital signs in anticipation of changes in health status, need for further investigation, and intervention (Perry, Potter & Ostendorf, 2018). Checklist 15 outlines the steps to take when checking vital signs.<\/p>\n

     <\/p>\n\n\n\n\n\n\n\n\n\n

    \n<\/strong><\/p>\n

    <\/a>Checklist 15: Vital Signs<\/h3>\n
    Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/h5>\n

    \u00a0<\/strong><\/td>\n<\/tr>\n


    \n<\/strong><\/p>\n
    Safety considerations:<\/h5>\n
      \n
    • Always compare findings with the patient’s baseline.<\/li>\n
    • Consider growth and development in relation to vital signs. Vital signs vary depending on age.<\/li>\n
    • Consider factors that may be influencing vital signs. The pathophysiology behind these factors is beyond the scope of this textbook.<\/li>\n
    • Report concerns to the appropriate healthcare professional.<\/li>\n
    • Consider infection control practices.<\/li>\n<\/ul>\n

      \u00a0<\/strong><\/td>\n<\/tr>\n

    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    Further Information<\/h4>\n<\/td>\n

    		\n

    Normal Values<\/h4>\n<\/td>\n<\/tr>\n

    1. Temperature:<\/p>\n

    \"\"<\/a><\/td>\n

    		Oral temperature<\/strong>:\u00a0Place the thermometer in the mouth under the tongue and instruct patient to keep mouth closed. Leave the thermometer in place for as long as is indicated by the device manufacturer.<\/p>\n

    Axillary temperature<\/strong>:\u00a0Usually 1\u00baC lower than oral temperature. Place the thermometer in patient’s armpit and lower the patient’s arm over the probe. Leave it in place for as long as is indicated by the device manufacturer.<\/p>\n

    Tympanic membrane (ear) temperature<\/strong>: Usually 0.3\u00b0C to 0.6\u00b0C higher than an oral temperature. The tympanic membrane shares the same vascular artery that perfuses the hypothalamus. Do not force the thermometer into the ear and do not occlude the ear canal.<\/p>\n

    Rectal temperature<\/strong>:\u00a0Usually\u00a01\u00baC higher than oral temperature. Use only when other routes are not available. On adults, insert the probe approximately 3.5 cm into rectum toward the umbilicus. Use lubricant.<\/td>\n

    		Normal (oral) = 35.8\u00baC to 37.5\u00baC<\/p>\n

     <\/p>\n

     <\/td>\n<\/tr>\n

    2. Pulse (a.k.a. heart rate):<\/p>\n

    \"\"<\/a><\/p>\n

    \"\"<\/a><\/p>\n

    \"\"<\/a>
    Figure 2.3 Assessing carotid pulse<\/figcaption><\/figure>\n<\/td>\n
    		Pulses can be found at many points on the body and all could theoretically be used to assess heart rate. When palpating pulses use moderate pressure, as too much pressure can impair blood flow and occlude the vessel. In some agencies scales are used to document the strength of the pulse from bounding (+4); strong (+3); weak (+2); thready (+1); absent (0).<\/p>\n

    If a pulse is regular, a 30 second count multiplied by two is generally acceptable. If a pulse is irregular, count for 60 seconds<\/p>\n

    Common pulses for assessment include:<\/p>\n

    Radial pulse<\/strong>:\u00a0Use the pads of your first three fingers to gently palpate the radial pulse at the inner lateral wrist.<\/p>\n

    Apical pulse<\/strong>:\u00a0Taken as part of a focused cardiovascular assessment and when the heart rate is irregular.\u00a0Apical pulses are assessed using a stethoscope placed over the 4th\u20135th intercostal space of the midclavicular line on the left side on adults.\u00a0For accuracy, an apical heart rate should be taken for a full minute. When giving medications that are dependent on the heart rate, count the apical pulse for a full minute. Auscultate for rate and regularity.<\/p>\n

    Note<\/strong>: It is suggested that beginner nurses concentrate on rate and regularity. With practice, and depending on where you work, your skill level with specific heart sounds may change and need to be more detailed.<\/p>\n

    There are many online resources to support learning about normal and abnormal cardiac sounds. Here’s one:<\/p>\n

    		Normal heart rate:<\/p>\n
      \n
    • Newborn\u20131 month: 100\u2013175<\/li>\n
    • 1 month\u20132 years: 90\u2013160<\/li>\n
    • Age 2\u20136 years: 70\u2013150<\/li>\n
    • Age 7\u201311 years: 60\u2013130<\/li>\n
    • Age 12\u201318 years: 50\u2013110<\/li>\n
    • Adult and older adult: 60\u2013100<\/li>\n<\/ul>\n

       <\/td>\n<\/tr>\n

    3. Respiration rate:<\/p>\n

    \"\"<\/a><\/td>\n

    		Count respiratory rate unobtrusively by observing the rise and fall of the patient’s chest or abdomen. Consider doing this while you are taking the pulse rate, so the patient is not aware that you are taking the respiration rate.<\/p>\n

    If the respiratory rhythm is regular, count for 30 seconds and multiply times two to determine respiratory rate \/ minute. If the respiratory rhythm is irregular or less than 12 \/ minute, count for a full minute.<\/td>\n

    		Normal respiratory rate per minute:<\/p>\n
      \n
    • Newborn\u20131 month: 30\u201365<\/li>\n
    • 1 month\u20131 year: 26\u201360<\/li>\n
    • 1\u201310 years: 14\u201350<\/li>\n
    • 11\u201319 years: 12\u201322<\/li>\n
    • Adult & older adult: 10\u201320<\/li>\n<\/ul>\n

       <\/td>\n<\/tr>\n

    4. Non-invasive blood pressure (NIBP):<\/p>\n
    \"DSC_2215\"<\/a>
    Blood pressure cuff<\/figcaption><\/figure>\n

    Invasive BP readings involve direct readings from an artery and would occur in a critical care area.<\/span><\/td>\n

    		The average blood pressure (BP) for a healthy adult is 120\/80 mmHg, but variations are normal for various reasons.\u00a0The systolic<\/strong> pressure\u00a0is the maximum pressure on the arteries during left ventricular contraction.\u00a0The diastolic<\/strong> pressure\u00a0is the resting pressure on the arteries between each cardiac contraction.<\/p>\n

    Choosing the correct BP cuff size<\/strong>: The length of the cuff’s bladder should be approximately 80% of the circumference of the upper arm. The width of the cuff should be approx 2\/3 of the upper arm. In other words allow for approximately two finger widths between the axilla and the top of the cuff and two finger widths between the antecubital fossa and the bottom of the cuff.<\/p>\n

    The patient may be sitting or lying down with the bare arm at heart level.<\/p>\n

    Two step method auscultation\u00a0method<\/b>: The two step method will allow you to approximate the BP prior to the reading, thus helping to prevent false low readings.<\/p>\n

    Apply the BP cuff to the upper arm by ensuring correct size and lining the arrows up to the brachial artery. On the same arm, palpate the radial or brachial artery. Close the pressure bulb. Inflate the BP cuff until the pulse rate is no longer felt. Then inflate an additional 20 to 30 mmHg. This will give you an approximate systolic pressure and help you to determine the maximum inflation point.<\/p>\n

    Open the pressure bulb and deflate the cuff and wait approximately one minute.<\/p>\n

    Place the bell of the stethoscope over the brachial artery, place the stethoscope ear pieces in your ears. Close the pressure bulb. Inflate the cuff to the approximated systolic pressure and deflate the cuff slowly and evenly (approx 2\u20133 mmHg \/ second) noting the points on the manometer at which you hear the first appearance of sound (systolic BP), and the disappearance of sound (diastolic BP).\u00a0After the last sound is heard, quickly deflate the cuff.<\/p>\n

    Using an NIBP<\/strong>: Ensure cuff size is correct. Align the artery with the arrows on the cuff. Operate the machine as per manufacturers instructions.<\/p>\n

    Additional resource:<\/p>\n

    Deans, B. (2013, March 20).\u00a0Choosing & positioning a blood pressure cuff<\/em>\u00a0[Video file]. Retrieved from https:\/\/www.youtube.com\/watch?v=II0ioJNLnyg<\/a>.<\/td>\n

    		Normal blood pressure<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
    Age<\/strong><\/td>\nNormal Systolic Range<\/strong><\/td>\nNormal Diastolic Range<\/strong><\/td>\n<\/tr>\n
    Newborn to 1 month<\/td>\n45\u201380 mmHg<\/td>\n30\u201355 mmHg<\/td>\n<\/tr>\n
    One to 12 months<\/td>\n65\u2013100 mmHg<\/td>\n35\u201365 mmHg<\/td>\n<\/tr>\n
    Young child (1\u20135 years)<\/td>\n80\u2013115 mmHg<\/td>\n55\u201380 mmHg<\/td>\n<\/tr>\n
    Older child (6\u201313 years)<\/td>\n80\u2013120 mmHg<\/td>\n45\u201380 mmHg<\/td>\n<\/tr>\n
    Adolescent (14\u201318 years)<\/td>\n90\u2013120 mmHg<\/td>\n50\u201380 mmHg<\/td>\n<\/tr>\n
    Adult (19\u201340 years)<\/td>\n95\u2013135 mmHg<\/td>\n60\u201380 mmHg<\/td>\n<\/tr>\n
    Adult (41\u201360 years)<\/td>\n110\u2013145 mmHg<\/td>\n70\u201390 mmHg<\/td>\n<\/tr>\n
    Older adult (61 and older)<\/td>\n95\u2013145 mmHg<\/td>\n70\u201390 mmHg<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/td>\n<\/tr>\n

    5. Oxygen saturation (SpO2<\/sub>):<\/p>\n
    \"DSC_2214\"<\/a>
    Pulse oximeter sensor<\/figcaption><\/figure>\n<\/td>\n
    		A pulse oximeter sensor attached to the patient’s finger or earlobe measures light absorption of hemoglobin and represents arterial SpO2<\/sub>.<\/p>\n

    Refer to Chapter 5.3 Pulse Oximetry<\/a> for more information.<\/td>\n

    		A\u00a0 healthy person should have an SpO2\u00a0<\/sub>of\u00a0 \u2265 97%.<\/p>\n

     <\/p>\n

     <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    \n
    Data sources: Hill & Smith, 1990; Jarvis, Browne, MacDonald-Jenkins, & Luctar-Flude, 2014; Lapum, Verkuyl, Garcia, St-Amant, & Tan, 2018; Stephen, Skillen, Day, & Jensen, 2012<\/div>\n<\/div>\n
    \n

    Critical Thinking Exercises<\/h3>\n
      \n
    1. Identify four factors that can influence heart rate.<\/li>\n
    2. Identify two situations that can influence blood pressure.<\/li>\n
    3. Discuss why someone with a lung disease like COPD might have lower than normal SpO2<\/sub>.<\/li>\n
    4. What is a normally accepted range for SpO2<\/sub> in a client with COPD?<\/li>\n<\/ol>\n

      Attribution<\/h1>\n

      Figure 2.3 Assessing carotid pulse by author is licensed under a\u00a0Creative Commons Attribution 4.0 International License<\/a>.<\/p>\n<\/div>\n","protected":false},"author":397,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-112","chapter","type-chapter","status-publish","hentry"],"part":102,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/112","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":26,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/112\/revisions"}],"predecessor-version":[{"id":5102,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/112\/revisions\/5102"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/102"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/112\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=112"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=112"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=112"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=112"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}