VITAL SIGNS

BY
Assist. Prof. FATMA ABBAS SALEM

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 Vital signs
 OBJECTIVES :
1. Identify the components of vital signs .
2. Define key terms related to TPR & BP.
3. Review Physiology Of Body Temperature
Regulation , Respiration, Pulse and
blood pressure .
4. Identify sites of measuring body
temperature.

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 Vital signs objectives cont.
5.Explain the principles and mechanisms of
thermoregulation .
6. Indicate factors affecting temperature ,
respiration pulse and blood pressure .
7. Identify types of thermometers .
8. Identify disadvantages ( contraindications ) of
measuring body temperature from various sites .
9. Identify common sites of palpating pulse .
10 . Assess the characteristics of pulse .

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Vital signs objectives cont.
11. Describe pulse rate alterations .
12. Explain factors influencing pulse rate .
13. Discuss physiology of breathing . Explain
mechanics of breathing .
14. Assess the characteristics of respiration .
15.Explain factors influencing character of
respiration .
16.Determine acceptable range of respiratory
rates for age .
17. Assess diffusion and perfusion .

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 Vital signs objectives cont.
18. Describe alterations in breathing pattern .
19. Discuss physiology of arterial blood
pressure.
20. Discuss factors influencing blood pressure
21. Determine average of optimal blood
pressure for age .

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COMPONENTS OF VITAL SIGNS
1. TEMPERATURE .
2. PULSE .
3. RESPIRATION.
4. BLOOD PRESSURE .
5. OXYEGEN SATURATION .
6. PAIN .

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key terms related to TPR & BP.
Afebrile Febrile
1. Afebrile.
Antipyretics
2. Antipyretics. Auscultatory Gap
3. Fever.
Blood Pressure Hyperthermia
4. Febrile .
Celsius
5. Auscultatory Gap. Hypothermia
6. Bradycardia
Brady cardia . Hypertension
7. Diaphroesis.
Core temperature
8. Core Temp.
Hypotension
9. Hypoxemia.
Convection Tachycardia
10. Hypertension .
Conduction Hypoxemia
Diaphroesis Fever
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Key terms
Pulse defict Dysrhythmia
Thermoregulation Heat exhausation
Shivering Heat stroke
Pyrexia Hypothalamus
Pulse pressure
Postural hypotension
Orthostatic hypotension
Malignant hypertension

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Body Temperature
 Normal Body Temperature (NBT) –
 98.60F(370C)
 Rectal Temp ----- (0.50F to 10F) above
the Oral
 Rectal Temp reflects the internal body Temp

(Core Body Temp)

 Core Body Temp remain almost constant
 Skin Temp (Shell Temp)-----Variable

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Temperature Homeostasis
 Keep the body temp within a very narrow range
 Range of NBT (970F to 990F)

 Temperatures above this:

 denature enzymes and block metabolic
pathways

 Temperatures below this:

 slow down metabolism and affect the brain.

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Heat Balance
 Heat balance maintains the body temp
 Balance between heat production &

heat loss (Heat Balance)

 Heat Balance
 Heat production= Heat loss
 Heat production is called

thermogenesis
 Heat loss is called as thermolysis.

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Heat Production (Thermogenesis
 Produced by :
 BMR
 Specific Dynamic Action of food
 Activity of skeletal muscle
 Shivering
 Exercise
 Chemical Thermogenesis
 Epinephrine &Norepinephrine
 Thyroxine
 Brown Fat-
 Source of considerable heat production
 Abundant in infants

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Heat Loss (Thermolysis)
 Radiation
 Conduction
 Convection
 Evaporation
 Perspiration
 Respiration
 Loss through urine & feces

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Heat Exchange in the Skin

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Thermoregulation
 Temperature is regulated by nervous
feedback mechanisms
 Thermoregulatory center located in the

Hypothalamus
 Thermoregulatory regulatory responses

include
 Autonomic
 Somatic
 Endocrine
 Behavioural changes

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Body Temperature Control System
 Hypothalamus
 Acts as a thermostat
 Receives nerve impulses

from cutaneous
thermoreceptors
 Thermoreceptors Cold
&Heat
 Hypothalamus- also has

thermoreceptors called
central thermoreceptors
 These detect changes in

blood temperature
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Thermoregulatory regulatory
responses
 Exposure to Cold  Exposure to Heat
1. Shivering 1. Vasodilatation
2. Increase voluntary
2. Sweating
activity
3. Increase in
3. Increase TSH
secretion Respiration
4. Increase 4. Anorexia
Catecholamines 5. Apathy
5. Vasoconstriction
6. Decrease TSH
6. Horripilation
secretion
7. Curling up

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Temperature alterations
I. Fever : or pyrexia occurs because heat-loss
mechanisms are unable to keep pace with
excess heat production resulting in an
abnormal rise in body temperature .

A fever is usually not harmful if it is below 39

degree . And a single reading does not always
indicate a fever .

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Temperature alterations
II. Hyperthermia :
An elevated body Temperature Related To
Body’s Inability To Promote Heat Loss Or
Reduce Heat Production.

III. Malignant hyperthermia:

is hereditary condition of uncontrolled heat
production occurring when susceptible persons
receive certain anesthetic drugs .

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 Temperature Alterations
III. Heat stroke :
Heat depresses hypothalamic function
prolonged exposure to the sun or high
environmental temperatures .

IV. Heat Exhaustion : Occurs When Profuse

Diaphoresis results in excess water and
electrolyte loss.

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 Patterns Of Fever
 Sustained : a constant body temperature
continuously above 38 c .

 Intermittent : fever spikes interspersed with

usual temperature levels, temp. returns to
acceptable value at least in 24 hrs .

 Remittent : fever spikes and falls without a

return to normal temperature levels .

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Patterns of fever
Relapsing :
Periods of febrile episodes and periods with
acceptable temperature values .

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Temperature alterations
Hypothermia :
Heat loss during prolonged exposure to cold
overwhelms the body’s ability to produce heat .

Classification :
Mild ( 34-36 c)
Moderate ( 30-34c)
Sever ( ∠ 30 c)
 Frostbite : occurs when the body is exposed

to subnormal temperatures.
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Assessing Radial Pulse
 Left ventricle contracts causing a wave of bld to surge
through arteries – called a pulse. Felt by palpating
artery lightly against underlying bone or muscle.
 Carotid, brachial, radial, femoral, popliteal, posterior
tibial, dorsalis pedis.
 Assess: rate, rhythm, strength – can assess by using
palpation & auscultation.

 Pulse deficit – the difference between the radial pulse

and the apical pulse – indicates a decrease in
peripheral perfusion from some heart conditions ie.
Atrial fibrillation.

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Procedure for Assessing Pulses
 Peripheral – place 2nd, 3rd & 4th fingers lightly on skin
where an artery passes over an underlying bone. Do not
use your thumb (feel pulsations of your own radial artery).
Count 30 seconds X 2, if irregular – count radial for 1 min.
and then apically for full minute.

 Apical – beat of the heart at it’s apex or PMI (point of

maximum impulse) – 5th intercostal space, midclavicular
line, just below lt. nipple – listen for a full minute “Lub-
Dub”
 Lub – close of atrioventricular (AV) values – tricuspid &
mitral valves
 Dub – close of semilunar valves – aortic & pulmonic valves

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Assess Rate ,Rhythm ,Deepth
 Rate – N – 60-100, average 80 bpm
 Tachycardia – greater than 100 bpm
 Bradycardia – less than 60 bpm

 Rhythm – the pattern of the beats (regular or irregular)

 Strength or size – or amplitude, the volume of bld pushed

against the wall of an artery during the ventricular contraction
 weak or thready (lacks fullness)
 Full, bounding (volume higher than normal)
 Imperceptible (cannot be felt or heard)

 0----------------- 1+ -----------------2+--------------- 3+ ----------------4+

 Absent Weak NORMAL Full Bounding

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Normal Heart Rate
Age Heart Rate (Beats/min)
Infants 120-160
Toddlers 90-140
Preschoolers 80-110
School agers 75-100
Adolescent 60-90
Adult 60-100

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ASSESSMENT Cont.
 Tension – or elasticity, the compressibility of
the arterial wall, is pulse obliterated by slight
pressure (low tension or soft)

 Stethoscope
 Diaphragm – high pitched sounds, bowel,

lung & heart sounds – tight seal

 Bell – low pitched sounds, heart & vascular

sounds, apply bell lightly (hint think of Bell

with the “L” for Low)

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Respirations
 Assess by observing rate, rhythm & depth
 Inspiration – inhalation (breathing in)
 Expiration – exhalation (breathing out)
 I&E is automatic & controlled by the medulla
oblongata (respiratory center of brain)
 Normal breathing is active & passive
 Women breathe thoracically, while men & young
children breathe diaphramatically ***usually
 Asses after taking pulse, while still holding
hand, so Patient is unaware you are counting
respirations
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Assessing respiration
Rate # of breathing cycles/minute (inhale/exhale-1cycle)
N – 12-20 breaths/min – adult - Eupnea – normal rate
& depth breathing
Abnormal increase – tachypnea
Abnormal decrease – bradypnea
Absence of breathing – apnea
Depth Amt. of air inhaled/exhaled
normal (deep & even movements of chest)
shallow (rise & fall of chest is minimal)
SOB shortness of breath (shallow & rapid)
Rhythm Regularity of inhalation/exhalation
Normal (very little variation in length of pauses b/w
I&E
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Character
Digressions from normal
effortless breathing
Dyspnea – difficult or labored
breathing
Cheyne-Stokes – alternating
periods of apnea and
hyperventilation, gradual increase
& decrease in rate & depth of
resp. with period of apnea at the
end of each cycle.

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Blood Pressure
 Force exerted by the bld against vessel walls.
Pressure of bld within the arteries of the body –
lt. ventricle contracts – bld is forced out into the
aorta to the lg arteries, smaller arteries &
capillaries
 Systolic- force exerted against the arterial wall
as lt. ventricle contracts & pumps bld into the
aorta – max. pressure exerted on vessel wall.
 Diastolic – arterial pressure during ventricular
relaxation, when the heart is filling, minimum
pressure in arteries.

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Blood pressure assessment
 Factors affecting B/P
 lower during sleep
 Lower with bld loss
 Position changes B/P.
 Anything causing vessels to dilate or constrict

- medications

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Blood pressure assessment
Assessment Determine best site & baseline B/P
Nursing Diagnosis Decreased cardiac output
Fluid volume excess
Fluid volume deficit
Planning Expected outcome
Have pt rest 5 min before taking B/Pa
Wash hands
Implementation Palpate brachial pulse
Position cuff 1inch above pulse - Arm at level of heart,
wrap snugly around arm
Manometer at eye level

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B/P Lower Extremity
 Best position prone – if not – supine with
knee slightly flexed, locate popliteal artery
(back of knee).
 Large cuff 1 inch above artery, same

procedure as arm. Systolic pressure in legs

maybe 10-40 mm hg higher
 If unable to palpate a pulse – you may use a

doppler stethoscope

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Oxygen Saturation (Pulse Oximetry)
 Non-invasive measurement of oxygen saturation

 Calculates SpO2 (pulse oxygen saturation) reliable estimate of

arterial oxygen saturation
 Probes – finger, ear, nose, toe
 Patient with PVD or Raynauds syndrome – difficult to obtain.

 Normal – 90-100%
 Remove nail polish
 Wait until oximeter readout reaches constant value & pulse
display reaches full strength
 During continuous pulse oximetry monitoring – inspect skin
under the probe routinely for skin integrity – rotate probe.

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Pain assessment

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