VITAL SIGNS VITAL SIGNS King Saud UniversityKing Saud University

Nursing CollegeNursing College

Vital SignsVital Signs

V/S also termed cardinal signs, reflect the body’s physiologic status and provide information critical to evaluating homeostatic balance .

They include: They include: – TemperatureTemperature– PulsePulse– RespirationRespiration– Blood pressureBlood pressure– Pain (considered the 5Pain (considered the 5thth vital sign) vital sign)

When to Assess Vital SignsWhen to Assess Vital Signs Upon admission to any healthcare agency.Upon admission to any healthcare agency. Based on agency institutional policy and Based on agency institutional policy and

procedures.procedures. Any time there is a change in the patient’s Any time there is a change in the patient’s

condition.condition. Before and after surgical or invasive Before and after surgical or invasive

diagnostic procedures.diagnostic procedures. Before and after activity that may increase Before and after activity that may increase

risk.risk. Before administering medications that affect Before administering medications that affect

cardiovascular or respiratory functions.cardiovascular or respiratory functions.

Maintenance of Body Maintenance of Body TemperatureTemperature

Thermoregulatory center in the Thermoregulatory center in the hypothalamus regulates body temperature.hypothalamus regulates body temperature.

The center receives messages from cold The center receives messages from cold and warm thermal receptors in the body.and warm thermal receptors in the body.

The center initiates responses to produce or The center initiates responses to produce or conserve body heat or increase heat loss.conserve body heat or increase heat loss.

Heat ProductionHeat Production Primary source is metabolism.Primary source is metabolism. Hormones, muscle movements, and Hormones, muscle movements, and

exercise increase metabolism.exercise increase metabolism. Epinephrine and nor-epinephrine are Epinephrine and nor-epinephrine are

released and alter metabolismreleased and alter metabolism Fever: increases the cellular metabolic rate Fever: increases the cellular metabolic rate

& thus increases the body temperature.& thus increases the body temperature.

Heat loss occur through:Heat loss occur through:

ConductionConduction - heat escapes from or enters into your - heat escapes from or enters into your body e.g. when lying on a cold or hot surface. body e.g. when lying on a cold or hot surface.

ConvectionConvection - cooler air currents remove heat from - cooler air currents remove heat from the surface of your skin, warmer air currents make the surface of your skin, warmer air currents make the skin hotter. the skin hotter.

EvaporationEvaporation - evaporative cooling occurs when - evaporative cooling occurs when water (from perspiration or swimming) leaves the water (from perspiration or swimming) leaves the skin surface as a vapour, lowering the body skin surface as a vapour, lowering the body temperature by taking the heat from the body. temperature by taking the heat from the body.

RadiationRadiation - e.g. acquisition of heat from solar - e.g. acquisition of heat from solar radiation or losing heat from the skin. radiation or losing heat from the skin.

Age: new born have unstable body temp Related to immature thermoregulatory mechanism. Elderly body temp drops as a person age going up as they are more sensitive to temp changes.

Environment: environment temp not affecting core temp. if the core temp 25C or 77F death may happen.

Time of the day. Exercise Stress Hormones such as progesterone. Circadian rhythm (Lowest 1-4 Am, Max at 4-6 Pm)

Factors affecting body tempFactors affecting body temp

Site: OralOral( most common, easy & convenient, wait 15-30 min if the patient has hot or cold drinks).

Rectal:Rectal:( most reliable) AxillaryAxillary: safe, non-invasive but least accurate TympanicTympanic: non-invasive, safe & accurate.

Type of the thermometer: Electronic versus traditional ones.

Factor affecting body temp measurement

Commonly used Terms:Commonly used Terms:

Pyrexia or fever.Pyrexia or fever. Hyperthermia.Hyperthermia. Hypothermia.Hypothermia. Febrile.Febrile. Afebrile.Afebrile.

Temperature Conversion

The body temp. is measured in degrees on two scales: Celsius (Centigrade) & Fahrenheit.

C=(Fahrenheit temp-32) x 5/9F= (Celsius temp x 9/5)+32Convert:Celsius (C) Fahrenheit (F)36 ?? 97.7

Pulse is a wave of blood created by the contraction of left ventricle of the heart through the arteries.

It is an index of the heart’s rate and rhythm The pulse rate is the number of heartbeats per min. Closure of the heart valves creates the sound heart A normal adult heart rate= 60-100 beats per min. Rates are slight faster in women, and more rapid in

children and infants. Tachycardia = HR over 100/m Bradycardia= HR below 60/m

PulsePulse

Heart rhythm( the pattern of beats, regular or irregular) is the time interval between each heart beat. Normal HR is regular.

Irregular heart rhythm = arrhythmia or dysarrhythmia

Cardiac out put= HR/min multiplied by stroke volume( the amount of blood ejected with one contraction).

C.O.P.=HRXSV

Cont. Pulse Cont. Pulse

PulsePulse PhysiologyPhysiology Regulated by the autonomic nervous Regulated by the autonomic nervous

system through cardiac sinoatrial node (SA system through cardiac sinoatrial node (SA node)node)

Parasympathetic stimulation — decreases Parasympathetic stimulation — decreases the heart ratethe heart rate

Sympathetic stimulation — increases the Sympathetic stimulation — increases the heart rateheart rate

Pulse rate = number of contractions over a Pulse rate = number of contractions over a peripheral artery in 1 minuteperipheral artery in 1 minute

Age: as age increases, the pulse rate decreases. Autonomic nervous system ( parasympathetic

decrease HR, sympathetic increase HR) Medication Exercise Fever Stress Hypovolemia Postural changes.

Factor affecting pulse

Pulse Sites Temporal Apical Carotid Brachial Radial Popliteal Femoral Posterior tibial Dorsalis Pedis (Pedal)

Assessing the PulseAssessing the Pulse

Equipment: Stethoscope for apical pulse.

Methods: palpation( fingers), auscultation The nurse should be aware of :

- any medication that could affect HR.

- if the patient has been physically active, wait for 10-15 min before taking the pulse.

Is the process of bringing oxygen to body tissues and removing carbon dioxide through the lungs

Resp. functions: to maintain arterial blood homeostasis by maintaining the PH of the blood.( lungs accomplish this by breathing)

Breathing= inspiration + expiration. Inspiration= is an active process in which the diaphragm

descends, the intercostal muscles contract, and the chest expands to allow air to move into the tracheobronchial tree.

Expiration= is a passive process in which air flows out of the respiratory tree.

Normal breathing is almost invisible, effortless, quiet, automatic, and regular.

Respiration Respiration

Resp. center in the medulla of the brain and the level of CO2 in the blood both control the rate and depth of breathing.

The diaphragm and the intercostal muscles are the main muscles used for breathing.

The chest normally expands symmetrically without rib flaring or retraction.

Tidal volume( depth of breathing)= the amount of air moving in and out with each breath.= 500 ml in health adult.

Tachypnea= is an abnormally fast respiratory rate (usually above 20-24/min in adult).

Bradypnea= is an abnormally slow respiratory rate (usually less than 10-12/min in adult).

Apnea= the absence of respiration. Dyspnea= respirations that require excessive effort. Can be painful

and labored

Cont. Respiration Cont. Respiration

Factors affecting respiration

Age 12-20= adult, 20-25= children, up to 40/min = infant

Medication StressExerciseAltitudeGenderBody temp.

Rate and Depth of Breathing Rate and Depth of Breathing Changes in response to body demands.Changes in response to body demands. Controlled by respiratory centers in the Controlled by respiratory centers in the

medulla oblongata and pons of the brainmedulla oblongata and pons of the brain Activated by impulses from chemoreceptors Activated by impulses from chemoreceptors Increase in carbon dioxide is the most Increase in carbon dioxide is the most

powerful respiratory stimulantpowerful respiratory stimulant

Blood pressure( BP)

Is the force that blood exerts against the walls of the vessels.

The heart generates pressure during the cardiac cycle to perfuse the organs of the body with blood.

Blood flow from the heart to the arteries, into the capillaries, and veins, and then back to the heart.

Blood pressure in the arterial system varies with the cardiac cycle, reaching the highest level at the peak of systole and the lowest level at the end of diastole.

The difference between the systolic and diastolic pressure is the pulse pressure, which is normally 30-50mmHg

Physiology of Blood PressurePhysiology of Blood Pressure

Force of the blood against arterial wallsForce of the blood against arterial walls Controlled by a variety of mechanism to Controlled by a variety of mechanism to

maintain adequate tissue perfusionmaintain adequate tissue perfusion Pressure rises as ventricle contracts and Pressure rises as ventricle contracts and

falls as heart relaxesfalls as heart relaxes– Highest pressure is systolicHighest pressure is systolic– Lowest pressure is diastolicLowest pressure is diastolic

Physiologic factors determining BP The contraction of the heart result in a pulsating flow of

blood into the arteries The pressure is the highest when the ventricles of the heart

contract and eject blood into the aorta and pulmonary arteries.

BP during ventricular contraction= cardiac systole/systolic BP

BP during ventricular relaxation= cardiac diastole/diastolic BP

BP is a function of the flow of blood produced by the contraction of the heart & the resistance to blood flow in the vessels

Blood flow= blood flow is essentially equal to cardiac out put (COP)

COP is the produce of stroke volume ((SV) = the amount of blood each ventricle pumps with each heart beat )& heart rate .

COP= SV X HR

Cont. factors determining BP

Resistance= friction among the cells & other blood components & between the blood & the vessels wall caused resistance to blood flow.

The friction within the blood components reflects the blood’s viscosity & is largely due to the number & shape of the blood cells.

HormonesEnzymesMethod of measuring BP

Factors Affecting Blood PressureFactors Affecting Blood Pressure Age, gender, raceAge, gender, race Circadian rhythmCircadian rhythm Food intakeFood intake ExerciseExercise WeightWeight Emotional stateEmotional state Body positionBody position Drugs/medicationsDrugs/medications

Normal Temperatures for Healthy Normal Temperatures for Healthy AdultsAdults

Oral – 37.0ºC, 98.6ºFOral – 37.0ºC, 98.6ºF Rectal – 37.5ºC, 99.5ºFRectal – 37.5ºC, 99.5ºF Axillary – 36.5ºC, 97.6ºFAxillary – 36.5ºC, 97.6ºF Tympanic – 37.5ºC, 99.5ºFTympanic – 37.5ºC, 99.5ºF Forehead – 34.4ºC, 94.0ºFForehead – 34.4ºC, 94.0ºF

Normal ranges for Vital Signs Normal ranges for Vital Signs for Healthy Adultsfor Healthy Adults

Oral temperature — 37.0ºC, 98.6ºFOral temperature — 37.0ºC, 98.6ºF Pulse rate — 60 to 100 (80 average)Pulse rate — 60 to 100 (80 average) Respirations — 12 to 20 breaths/minuteRespirations — 12 to 20 breaths/minute Blood pressure — 110/70 - 130/85 Blood pressure — 110/70 - 130/85