1. 1
VITAL SIGNS
Maria Teresita B. Dalusong, PTRP, MHPEd
Vital Signs
Cardinal signs
Important
indicators of the
body’s physiologic
Include
Temperature
Pulse
status
Reflect the
function of the
internal organs
Respiration
Blood pressure
Vital Signs
Factors that affect the vital signs:
time of day
exercise
age
sex
weight
metabolic conditions
general health status
pain
drug intake
Why take the Vital Signs?
Establish database of values for an
individual patient
Assist in goal setting and treatment
l iplanning
Assist with assessment of patient
response to treatment
Contribute to assessment of
effectiveness of treatment activities
VITAL SIGNS
Body Temperature
Pulse rate
Respiration
Blood Pressure
1. Body Temperature
A. Definition
B. Thermoregulatory System
C. Abnormalities in BodyTemperature
F t I fl i T tD. Factors InfluencingTemperature
E. Types ofThermometer
2. 2
1. Body Temperature
Represents a balance between the
heat produced or acquired by the
body, and the amount lost.
Thermoregulatory System
Maintains a relatively constant internal
body temperature
Monitors and acts to maintain
temperatures that are optimal forp p
normal cellular and vital organ function
Components:
Thermoreceptors
Regulating center
Effector organs
Thermoregulatory System
Thermoreceptors
Provide input to the temperature-
regulating center located in theregulating center located in the
hypothalamus
Can be peripheral or central
Thermoregulatory System
Regulating Center
Hypothalamus
Coordinate the heat
production and loss processes
In healthy individuals, normal
temperature is set at 37° C ±
1 °C (98.6 ° F ± 1.8 °F )
Sends input to the effector
organs via nervous pathways
of both somatic and
autonomic nervous system
Thermoregulatory System
Effector Organs
Respond to both increase and
decrease in temperaturedecrease in temperature
Include vascular, metabolic,
skeletal muscle responses
(shivering), sweating
Thermoregulatory System
Conservation of Body Heat
Vasoconstriction of blood
vessels
H th l ti t Hypothalamus activates
sympathetic nerves which results
into vasoconstriction of cutaneous
vessels
3. 3
Thermoregulatory System
Conservation of Body Heat
Decrease in sweat gland activity
To reduce or prevent heat loss by
evaporation, sweat gland activity is
diminished
Sweating is abolished if body
temperature falls below 37° C
(98.6°F)
Thermoregulatory System
Conservation of Body Heat
Cutis anserina (piloerection)
“H i di d”“Hair standing on end”
Can trap a layer of insulating
air near the skin and decrease
heat loss
Thermoregulatory System
Production of Body Heat
Shivering
Primary motor center:y
posterior hypothalamus
Increased tone of muscles up
to a certain threshold level
Thermoregulatory System
Production of Body Heat
Hormonal Regulation
Increase in norepinephrinep p
and epinephrine
Increase in thyroxine
Thermoregulatory System
Loss of Body Heat
Radiation
Transfer of heat by electromagnetic
waves from one object to another
Occurs through air between objects
that are not in direct contact
Thermoregulatory System
Loss of Body Heat
Conduction
Transfer of heat from one objectTransfer of heat from one object
to another through a liquid, solid
or gas
Requires direct molecular
contact between the two objects
4. 4
Thermoregulatory System
Loss of Body Heat
Convection
T f f h t b tTransfer of heat by movement
of air or liquid (water)
Accomplished secondary to
conduction
Thermoregulatory System
Loss of Body Heat
Evaporation
Conversion of liquid to a vaporq p
Through the respiratory tract &
through perspiration
Major mechanism of heat loss
during exercise
Abnormalities in Body Temperature
Increased BodyTemperature
Pyrexia
Elevation of normal body temperature
Caused by pyrogens Caused by pyrogens
100 degrees °F or 38°C
Signs and symptoms: general malaise, headache,
increased pulse and respiratory rate, chills, piloerection,
shivering, loss of appetite, flushed skin which is hot to
touch, nausea, irritability, restlessness, weakness, etc.
Abnormalities in Body Temperature
Increased BodyTemperature
Hyperpyrexia/ hyperthermia
Extremely high fever (above 41.1°Cy g (
or 106°F)
Patient may experience the following:
Disorientation, confusion, convulsion, or
comatose
Abnormalities in Body Temperature
Increased BodyTemperature
Stages of fever
Invasion (onset)
Fastigium or stadium (course)
Difervescence (termination)
Crisis
Lysis
Abnormalities in Body Temperature
Types of Fever
Intermittent – Alternates between periods of
fever and periods of normal bodyT°
Remittent – Elevated bodyT° that fluctuates >2°C
(3 6°F) within a 24-hour period but remain above(3.6 F) within a 24-hour period but remain above
normal.
Relapsing – A.k.a. recurrent fever; periods of fever
are interspersed with normal temperatures that last
at least one day
Constant – bodyT° is constantly elevated with
fluctuations <2°C (3.6°F)
5. 5
Abnormalities in Body Temperature
Lowered BodyTemperature
Hypothermia
Lowered body temperature
Signs and symptoms: decreased Signs and symptoms: decreased
pulse rate and respiratory rate, cold
and pale skin, cyanosis, decreased
cutaneous sensation, depression of
mental and muscular responses and
drowsiness
Abnormalities in Body Temperature
Lowered BodyTemperature
Hypothermia
Thermoregulatory center
Impaired at 34.4° C (94°F)
Completely lost at 29.4°C
(85°F)
Factors Influencing Body Temperature
time of day
lowest at 4-6 AM, highest at 4-8 PM
circadian rhythm : 24 hour cycle of normal
variations in body temperature
age age
emotions
exercise
menstrual cycle
Increased levels of progesterone during ovulation
can cause elevation of body temperature by 0.3 to
0.5 °C (0.9° F)
Factors Influencing Body Temperature
Pregnancy
Body temperature remains elevated by
0.5 °C
external environment
l i f location of measurement
Rectal & tympanic > oral > axillary
Rectal/tympanic = 0.3 – 0.5° C higher
than oral
axillary = 0.6° C lower than oral
ingestion of warm or cold food
Types of Thermometers
Electronic
thermometer
Provides a rapidp
measure of body
temperature
Low chance of
cross- infections
Types of Thermometers
Glass Mercury
Thermometers
Filled with mercury
Calibrated in either (or
both) Celcius or Farenheit)
scales
Range is from 34° C
(93.1°F) to 42.2° C (108°F)
Shapes:
Blunt, rounded
Elongated, slender
6. 6
Types of Thermometers
Disposable Single-use
Thermometers
Consists of calibrated dots
impregnated with temperatureimpregnated with temperature
sensitive chemical
Temperature- Sensitive Strips
Change in color
Readings are non- specific
Practical things to know in taking Body
Temp.
Sites where body temperature are obtained
Most common & convenient location: ORAL
Most accurate measurement: RECTAL
Least desirable sites:AXILLARY OR INGUINAL
Very young patients & unconscious pt who cannot hold Very young patients & unconscious pt who cannot hold
the thermometer in the mouth: RECTAL OR EAR
CANAL
When there is high temp, pt should not be allowed to
exercise or engage in strenuous activity
One should determine the cause of a temperature that is
dropping than N.
2. Pulse
A. Definition
B. Parameters for pulse
C. Factors Affecting Pulse
D. Pulse point/ sites
Pulse
Wave of blood in the artery created by
the contraction of the left ventricle
during the cardiac cycle
Systole- highest point of pressure
Diastole- lowest point of pressure
Parameters for Pulse Assessment
Rate
Number of beats per minute
Normal rate: 60 to 80 beats per minute
Rhythm
Intervals between beats Intervals between beats
Volume
Amount of blood pushed through the
artery
Bounding/full
Weak/thready
Quality or feel of arterial wall
Parameters for Pulse Assessment
Grade Pulse Description
0 Absent No perceptible pulse even with
maximum pressure
1 + Thready Barely perceptible; easily
obliterated with slight pressure;
fades in and out
2 + Weak Difficult to palpate; slightly
stronger than thready; can be
obliterated with light pressure
3 + Normal Easy to palpate; requires
moderate pressure to obliterate
4 + Bounding Very strong; hyperactive; is not
obliterated with moderate
pressure
7. 7
Pulse
Other variations in pulse
Pulsus alterans
Bigeminal pulse
Paradoxical pulse
Factors affecting the Pulse
age
New born = 100 – 130/180 bpm
Child (1 – 7yr old) = 80 – 120 bpm
d lt 60 100 b adults = 60 – 100 bpm
gender
emotional status
In response to grief, fear, anxiety
and pain
Factors affecting the Pulse
exercise
pulse can be a basis for exercise
prescription
Important method of assessing response
t ito exercise
pulse proportional to intensity of
workload
Maximal heart rate: 220 minus age
systemic or local heat
body size
Pulse Points
Superficial arteries located
over a bony surface
Temporal
Superior and lateral to the outer
canthus of the eyey
Carotid
On either side of the anterior
neck below earlobe and between
the SCM and trachea
Brachial
Medial aspect of the antecubital
fossa
Pulse Points
Radial
Radial aspect of the wrist
at the base of the thumb
Femoral
Inguinal region
Popliteal
Behind the knee
Pedal
Dorsal, medial aspect of
the foot
Practical things in taking the pulse
Auscultation is used to determine the heart rate (over
the apex of the heart with the use of stethoscope).
Most common site: radial & carotid
When measuring one’s own pulse; Carotid
PeripheralVascular disease: lower extremities pulsep p
8. 8
3. Respiration
A. Definition
B. Respiratory System
C. Regulatory Mechanism
D Factors influencing RespirationD. Factors influencing Respiration
E. Parameters of Respiration
F. Breath Sounds
G. Patterns of Respiration
Respiration
Supply the body with oxygen for
metabolic activity and to remove
carbon dioxide
The Respiratory System
Inspiration
contraction of the
diaphragm and
intercostal muscles
increases the
intrathoracic space
to give space for the
lungs to expand
The Respiratory System
Expiration
passive during relaxed
accessory muscleaccessory muscle
recoil of the lungs
Regulatory Mechanisms
Respiratory center
Lies in the pons and
medulla
Provides control of
both the rate and the
depth of breathing in
response to the
metabolic needs of
the body
Regulatory Mechanisms
Afferent inputs :
Central Chemoreceptors
located in the respiratory center
sensitive to carbon dioxide and hydrogeny g
ion levels
Peripheral Chemoreceptors
in the carotid bifurcation and arch of
aorta
sensitive to partial pressure of oxygen
9. 9
Factors Influencing Respiration
Age
Newborn: 30 to 50
breaths per minute
Adults: 12 to 18/20
breaths per minute
body position
environment
emotion and
stressbreaths per minute
body size
stature
exercise
stress
drug intake
Parameters of Respiratory Assessment
rate
number of breaths per minute
depth
volume of air exchanged with each breath
rhythm
regularity of inspirations and expirations
character
deviation from normal quiet effortless
breathing
Breath Sounds
wheezing
whistling sound produced by air
passing through a narrowed bronchi
stridor stridor
harsh high pitched sound due to
narrowing of glottis or trachea
rales
rattling, crackling due to secretions
in air passage
Breath Sounds
sigh
deep inspiration followed by
prolonged audible expirationprolonged audible expiration
stertorous
snoring due to secretions on
trachea and large bronchi
Patterns of Respiration
Dyspnea
difficult or labored
breathing
Tachypnea Tachypnea
increase in RR (>
24 bpm)
Bradypnea
decreased RR (<
10 bpm)
Patterns of Respiration
Apnea
Absence of
respirationp
Hyperventilation
Increased rate
and depth of
respiration
10. 10
Patterns of Respiration
Cheyne-Stokes
respiration
Gradual increase
in rate and depth,p ,
followed by a
gradual decrease
Biot’s respiration
Alternating
periods of apnea
and hyperapnea
Patterns of Respiration
Kussmaul’s respirations
Gasping, labored
pattern
Apneustic breathing
Prolonged inspiration Prolonged inspiration
followed by short,
ineffective expiration
Paradoxical respiration
Lung inflation during
expiration, deflation
during inspiration
4. Blood Pressure
1. Definition
2. Classification of Blood Pressure
3. Regulatory Mechanism
4. Factors Affecting BPg
5. Equipment Used
6. Karotkoff’s Sound
Blood Pressure
Refers to the force the blood exerts
against a vessel wall
Measured at both the highest and lowest
points in the pulse
Arteries > capillaries > veins
Pulse pressure
Blood Pressure Blood Pressure
Normal range of systole:
90 – 135/140mmhg
Normal range of diastolic:
60 – 80mmhg 60 80mmhg
Normal systolic/diastolic value:
120/80mmHg
Hypertensive range:
90++mmHg/135 – 140mmHg
11. 11
FACTORS ASSOCIATED TO
HYPERTENSION:
Obesity
Physical inactivity
Excessive use of nicotine, alcohol, salt
Arteriosclerosis
DM DM
Oral contraceptives
Advance age
Kidney Disease
Regulatory Mechanisms
Vasomotor center
Located at the lower pons and upper
medulla
Tonically active; produces a slow,
continuous firing in all vasoconstrictor
nerve fibers
Provides a normal vasomotor tone
Regulatory Mechanisms
Afferent inputs
baroreceptors
(pressoreceptors)
i i h f sensitive to stretch of a
vessel wall
highly concentrated at
the :
internal carotid arteries
above the bifurcation
walls of the arch of aorta
Regulatory Mechanisms
Afferent Inputs
chemoreceptors
sensitive to decreased arterial oxygen
concentration, increase in carbon,
dioxide and increase in hydrogen ion
concentrations.
lie close to the baroreceptors at the
carotid artery (carotid body) and the
aortic arch (aortic body)
cranial nerves IX and X
Factors Affecting Blood Pressure
blood volume
diameter or elasticity of the arteries
cardiac output
Factors Affecting Blood Pressure
age
Normal average adult BP:
120/80mmHg
Exercise Exercise
Valsalva maneuver
Arm position
12. 12
Equipment
Blood pressure cuff
Airtight, flat rubber
bladder that can be
inflated with air
Adult cuff:
width- 4.5 to 5.5
inches
length: 9 inches
Equipment
Sphygmomanometer
Aneroid
Circular calibrated dial
Mercurial
Mercury- filled calibrated
cylinder
View the meniscus at eye
level
Equipment
Stethoscope
Used to listen to
the soundsthe sounds
Has a diaphragm
and 2 earpieces
Korotkoff’s Sounds
series of sounds heard through the
stethoscope during BP assessment
has 5 phases
Korotkoff’s Sounds
Phases :
Phase 1: 1st clear, rhythmic, tapping
sound, corresponds to systole
Phase 2: murmur or swishing soundg
Phase 3: sounds become crisp and
louder
Phase 4: abrupt muffling, 1st diastole
Phase 5: sounds disappear, 2nd diastole
For the Lab Session:
Bring your materials forVital Signs
Assessment:
Sphygmomanometer
Stethoscope Stethoscope
Thermometer
Watch
13. 13
Practical Application
Baseline values of pt – to takeVS at rest
Type of patients whose base line are important to
determine.
AbnormalValues at rest and its consequences