A&P II Lab #3 Name: _______________________

VITAL SIGNS I

INTRODUCTION

Vital signs are measurements or observations of a patient’s essential physiological functions.

Vital sign measurements can be useful in diagnosing disease and provide important information
used to track and manage patient health. Clinically normal ranges of vital signs vary with a
number of patient factors, including age, gender, body mass and general fitness level. For body
temperature, clinically normal values are also dependent on the location and method of
measurements (e.g. oral, rectal or axillary).

Each of these vital signs are homeostatically regulated by the body through complex neural and
endocrine signaling. Dysregulation of any of these complex processes may lead to changes in
vital sign measurements and indicate disease. In order to provide medically meaningful
information, it is important that vital sign measurements be performed correctly. It is also
important to understand the basic physiology underlying vital signs and how they relate to
patient health.

LAB PROCEDURE

In this lab students will work in pairs (or one group of 3 if there is an odd number of students)
to practice performing measurements for three of the major vital signs: ventilation rate, heart
rate, and blood pressure. For each of these exercises, every student must record one of their
lab partner’s vital sign data in the lab worksheet. Therefore students will need to take turns
taking measurements from their lab partner(s).

In addition to checking vital signs, it is common during medical exams for clinicians to monitor
other important indicators of health, such as heart and respiratory sounds. Therefore, in
addition to recording heart rate, you will also practice listening for heart sounds. Body
temperature measurements will not performed in this lab.
Exercise 1 – Ventilation Rate

A number of respiratory functions (such as lung volumes and flow rates) can only be measured
with the use of specialized instruments such as pulmonary plethysmographs or spirometers.
Ventilation rate, however, is a basic vital sign and indicator of respiratory function that can be
easily measured or estimated by simple observation.

Ventilation rate (sometimes called respiration rate, or RR) is simply the number of breaths
taken by a patient or subject over a defined period of time. Typically ventilation rates are
reported as the number of breaths per minute. The normal resting ventilation rate for adults is
12-20 breaths per minute. In children and elderly populations the ventilation rate is higher and
more variable.

In this exercise you and your lab partner(s) will use two different methods to calculate each
other’s ventilation rate, and will then compare values obtained using these different methods.

1) Use a watch or timer to measure your lab partner’s resting ventilation rate (RR) by recording
the total number of breaths taken over a one minute period. Enter this value in the data
table below.

2) Repeat this exercise using a shorter 10 sec. measurement interval, and then estimate the RR
in breaths per minute. Ask your lab instructor if you are not sure how to estimate breaths
per minute from a 10 sec. recording interval.

3) Answer the questions below.

Respiration Rate (RR)

60 sec measurement _____________

10 sec measurement _____________

Did you obtain identical values using the two different methods of estimating RR? Were
the values similar? Explain your observations.
 Which method do you think is more accurate? Explain why you think that would be.

Under which circumstances might it be better to use a shorter or longer recording

Were the RR values you measured considered “clinically normal”? Why or why not?

Exercise 2 – Heart Rate

Heart rate can be calculated using automated or instrumental methods (such as pulse sensors
or EKG) or by manual methods using arterial palpation.

Heart rate (HR) is typically reported in units of beats per minute (bpm). In adults, the normal
resting heart rate is 60-100 bpm. In athletes this number may be significantly lower as a result
of increased cardiovascular efficiency in this population. In pediatric populations the resting HR
is significantly higher, up to 200 bpm in neonates.

In this exercise you and your lab partner(s) will calculate each other’s resting HR by palpating
for an arterial pulse. As before you will perform the measurements use two different sampling
intervals.

1) Practice palpating your partner’s radial artery using two or three fingers in order to detect
the pulse. Ask your lab instructor for assistance if you need help with this. Once you are
comfortable with this technique proceed to the next step.
2) Use a watch or timer to measure your lab partner’s resting heart rate (HR) by recording
the total number of heart beats palpated over a one minute period. Enter this value in the
data table below.

3) Repeat this exercise using a shorter 10 sec. measurement interval, and then estimate the HR
in beats per minute.

4) Answer the questions below.

Heart Rate (HR)

60 sec measurement _____________

10 sec measurement _____________

Did you obtain identical values using the two different methods of estimating HR? Were
the values similar? Explain your observations.

Where the resting HR values you measured considered “clinically normal”? Why or why
not?
Exercise 3 – Heart sounds

Heart sounds are not typically classified as one of the major “vital signs”. However, many
physicians routinely listen for them during medical examinations since they provide important
information about normal cardiac function.

The technique of listening for body sounds is called auscultation. Heart sounds, along with
other body sounds (e.g. breath sounds or abdominal sounds) can detected by auscultation,
usually with the aid of a stethoscope. A more advanced technique, called phonocardiography,
can be used to record and provide a more in depth analysis of these sounds.

In the absence of heart disease, only two heart sounds, referred to as the first and second
heart sounds (or S1 and S2) can typically be detected using this technique. Third and fourth
heart sounds (S3 and S4) can be detected in some patients and often indicate heart disease,
although S3 may be normal in children, athletes or some other populations. Other abnormal
sounds called murmurs may be heard in between normal heart sounds and may also indicate
heart dysfunction.

In this exercise you and your lab partner(s) will use a stethoscope to auscultate each other’s
hearts and listen for heart sounds. In actual clinical practice, heart auscultation is usually
performed systematically over four or five different auscultation points. Here you will perform
a simplified version of this examination.

1) Auscultate your lab partner’s heart with the stethoscope by placing (or having your partner
place) the diaphragm over the general region of the heart and listening for heart sounds. It
may be helpful to start and the apex and move toward the base of the heart or vice versa.
Make sure you have the earpieces positioned correctly--they should point outward in the
anterior direction. Ask your instructor if you need help with using the stethoscope.

2) Identify the two normal heart sounds, and then try listening for any additional sounds.

3) Answer the questions below.

Identify each of the heart sounds normally heard using the stethoscope. Explain what
causes each of these sounds. You may use your textbook, the internet, or other sources
to answer this question.
 What other heart sounds might be heard in some subjects/patients? Explain what this
might indicate.

Exercise 4 – Blood pressure

Blood pressure (BP) refers to the pressure exerted against the walls of blood vessels. Different
parameters of blood pressure measurements have different clinical uses, and include systolic
and diastolic arterial pressure, mean arterial pressure (MAP) and pulse pressure (PP).

The most commonly reported BP measurements are systolic blood pressure (SBP) and diastolic
blood pressure (DBP). These are arterial blood pressures measured during two phases of the
cardiac cycle, during ventricular systole (period when ventricles contract) and during diastole
(period when ventricles relax). Since blood pressure oscillates only in the arteries, venous
blood pressure cannot be used to determine these values.

A number of different methods exist for measuring arterial blood pressure. The most accurate
method is invasive and requires implantation of a pressure transducer within the arterial wall to
directly measure blood pressure. For routine measurements, non-invasive methods are used.
These include automated oscillometric devices that are increasingly used in clinical practices.
However, manual methods are still the most accurate way to non-invasively measure BP and
are performed routinely by physicians, nurses, and technicians in a variety of healthcare
settings. It is important to note that accurate BP measurements using manual methods are
highly dependent on using correct technique, and thus skillful measurements are essential.

In this exercise you will perform blood pressure measurements using two different methods.
Both methods require using a sphygmomanometer to compress the brachial artery and
estimate internal pressure within the artery. A sphygmomanometer is a specialized instrument
for measuring blood pressure, and consists of an inflatable cuff and pressure gauge.

The two blood pressure measurement methods you will perform are referred to as palpatory
and auscultatory techniques. Palpatory blood pressure measurement requires collapsing the
brachial artery under pressure and then palpating for a radial pulse as pressure is released from
the cuff. The pressure at which the radial pulse can be palpated again is recorded as the
systolic blood pressure. Diastolic blood pressure cannot be measured using this technique.
The auscultatory technique is more commonly performed in routine medical examinations
because it provides measures of both SBP and DBP. This technique requires use of a
stethoscope and auscultation of turbulent arterial blood flow sounds (called “Korotkoff
sounds”) to estimate systolic and diastolic pressures. SBP is the pressure observed when
Korotkoff sounds are first heard while decreasing the cuff pressure. DBP is the pressure at
which Korotkoff sounds disappear, indicating the return of smooth laminar blood flow within
the artery.

SBP and DBP and typically reported together in the format of SBP/DBP. In non-hypertensive
patients, SBP (the top number) should be <120 mmHg, whereas DBP should be <80 mmHg.
Reference ranges for different stages hypertension are widely available through various medical
sources. Hypotension can be diagnosed based on abnormally low BP values, but is much less
common.

In this exercise you and your lab partner(s) will perform blood pressure measurements first
using the palpatory method, and then the auscultatory method as follows:

1) Use the palpatory method to measure your lab partner’s SBP. Repeat this procedure two
more times, and record all three measurements in the data table below.

2) Use the auscultatory method to measure your lab partner’s SBP and DBP. Repeat this two
more times and record all three measurements in the data table below.

3) Answer the questions below.

Palpatory method

1st measurement (SBP) _______________

2nd measurement (SBP) _______________

3rd measurement (SBP) _______________

Auscultatory method

1st measurement (SBP/DBP) ________ / ________

2nd measurement (SBP/DPB) ________ / ________

3rd measurement (SBP/DPB) ________ / ________

Were the BP values you recorded consistent between the three measurements? If not,
explain why that might be the case.

Explain the difference between SBP and DBP. What could it mean if either of these
values lie outside of the normal range?

Explain the difference between Korotkoff and heart sounds. How are these sounds used
in clinical practice?
What are the advantages and disadvantages of the auscultatory and palpatory methods
of BP measurement? For each method, propose a clinical scenario demonstrating why
that method would be preferred over the other.