Vital Signs in Nursing

1. Vital
Signs
Ms. Amrita S Shekhar
HCN, SRHU

3. Learning Objevtives
At the end of the teaching each student
should be able to –
• Definition of Pulse
• Enlist the Indication of taking pulse
• Understand Physiology of pulse
• Enumerate Characteristic of Pulse
• Elaborate Sites of Pulse
• Discuss Abnormal Pulse

4. Pulse
• Pulse rate:- It is the number of times
the ventricles of heart contract per
minute.
It is an indicator of the circulatory
status.
• Pulse rate can be determined by:-
 Palpating the pulse.
 Electrocardiograph.

5. Assessing Radial Pulse
• Left ventricle contracts causing a wave
of blood to surge through arteries –
called a pulse.
• It reveals amount of blood enters the
arteries with each heart contraction.
• Peripheral Pulses:- Pulse is palpable
on various sites i.e. peripheral arteries
around the body e.g. Carotid, brachial,
radial, femoral, popliteal, posterior
tibial, dorsalis pedis
• Apical pulse:- Pulse monitored at the
apex of heart is termed as apical pulse.

6. Pulse gives information
regarding:-
• Functioning of heart and
circulatory system.
• Client’s health status.
• Client’s metabolic rate.
• Emotional Status.
• Client’s physiologic response to:-
Blood loss.
Tissue damage.
Exercise.
Stress.
Fatigue.
Treatment- Surgery, medication.

7. Normal Heart Rate
Age Heart Rate
(Beats/min)
Infants 120-140/min
Toddlers 90-140/min
Preschoolers 80-110/min
School agers 75-100/min
Adolescent 60-90/min
Adult (Male)
Adult (Female)
50-90/min
55-95/min

8. • Pulse deficit –Insufficient contraction
of heart which does not palpable at
peripheral pulse sites is called as pulse
deficit. It can be detected by comparing
the difference between the radial pulse
and the apical pulse simultaneously –
which reflects abnormal rhythms &
heart conditions i.e.. Atrial fibrillation.
• Tachycardia:- Heart rate above normal
limits is termed as tachycardia.
• Bradycardia:- Heart rate below 60/min
is termed as bradycardia.

9. Physiology of Pulse
• Sino atrial (SA) node present in
heart initiates the cardiac
contraction.
• As ventricle contracts approx-60-
70ml of blood is ejected into aorta
(stroke volume), distending the
heart walls and transmitting a wave
throughout the arterial system.
• This wave can be felt in the distal
arteries

10. Factors Affecting the
Pulse
1. Gender:- After puberty, male
person’s pulse rate is lower than
female.
2. Age:-The very young child have a
rapid pulse rate, the adult has a
normal range in pulse rate of 70-80
per minute and the very old one has
a relatively slow pulse rate.
3. Exercise:- The increased muscular
activity will increase pulse rate
temporarily. But opposite is seen in
laborers and athletic bodies due to
greater cardiac size, strength and
efficiency.

11. Factors Affecting the Pulse
cont...
4. Physique:- The short person with
small body build has a slightly more
rapid pulse than the tall heavy
individual.
5.Food:- Ingestion of food cause a
slight increase in pulse rate for several
hours.
6.Chemicals:- Electrolytes such as
sodium (Na+), Potassium (K+) are
responsible for fluctuation of heart
rate. Medication such as digoxin,
atropine decreases the heart rate
whereas adrenaline increases heart
rate.

12. 7.Emotions:- In extreme emotional
condition, sympathetic nervous system get
stimulated, releases hormones and
norepinephrine causes contraction of blood
vessels and ultimately increases heart rate.
But in case of depression/ grief/sorrows,
cardio inhibitory center release acetyl
choline which slows the heart rate.

13. Factors Affecting the Pulse
cont..
8. Position Change:- Positions sitting ,
standing, lying has effect on heart rate.
While standing, most of the blood
pooled down. Thus decreases in
venous return to heart decreases blood
pressure but increases pulse rate.
9. Basal Metabolic rate:- If BMR is low
pulse rate is low. This must be due to
less requirement of the cells for
oxygen.

14. Factors Affecting the
Pulse cont..
10. Body Temperature:- Increased
body temperature stimulates
electrical changes to heart
ultimately increases heart rate.
11.Blood Pressure:- When B.P is
low the pulse rate increased in order
to increase the blood flow. In high
B.P pulse rate decreases.

15. Contd..
12.Pathology:- Diseases of heart,
other body systems also influences
heart rate. As soon heart begins to
fail, it pumps faster to
compensate. Even problems in
electrical conduction of heart
affects the pulse rate.
13. Other Conditions:- Such as
infection, change in blood volume,
increased intra cranial pressure
also fluctuates heart rate.

16. Scientific Principles of taking
Pulse
1. Exercise ,emotion and anxiety
will cause increased pulse rate.
2. Finger tips sensitive to touch will
feel the pulsation. There is
pulsation in thumb: which may
be mistaken for clients pulse. So
thumb is not used to take pulse.

17. Contd..
3. Moderate pressure allow one to
feel superficial radial artery and
its expansion and contraction
during heart beat. Too much
pressure will obliterate the
pulse. Too little pressure will
imperceptible.
4. Characteristic of the pulse vary
with the individuals and
indicate the function of heart,
condition of the patient and
nature of blood vessels.

18. Characteristics of Pulse
• RATE:- It is the number of times the
heart contracts in one minute.
• Rhythm:- It is the pace or intervals
between two pulse beats.
• Tension:- Indicates the amount of
resistance the artery gives when the
finger is pressing against it .The
amount of tension present is due to
pressure of blood in the arteries.

19. Contd…….
• Volume or Strength:- It reveals the
amount of blood ejected against arterial
wall with every heart contraction. Normal
adult have same strength. It is graded as
weak, thready, feeble, bounding pulse and
stoke volume quality.
• Quality of pulse strength is affected by
drugs, exercise and fear etc.

20. Common sites for assessing
pulse
No. Pulse site Location Reason for use
1. Radial Inner aspect of wrist
along radial bone.
Below base of thumb
Readily accessible
2. Temporal Between lateral eye
and hairline above the
zygomatic
.Increase radial pulse
is not accessible in
adults.
.Infants and children
commonly used.
3. Carotid Between trachea and
sternocleidomastoid
muscles below angle
of jaw
.In case peripheral
pulses are not
palpable.
. Emergencies i.e.
cardiac arrest

21. CONTD…
No Pulse site Location Reason for use
4. Apical Checked through
palpation as well as
auscultation of heart. just
below the left nipple
•To detect accurate
heart rate.
•Dysrhythmia
•Pulse deficient
•Used in conjunction
with medication
•Routinely used for
infants and children of
3 yrs.old
5. Brachial Inner aspect of antecubital
fossa.
•To measure blood
pressure --during
cardiac arrest in
infants
6. Femoral Below inguinal fold
between anterior iliac
spine and symphysis
pubis.
Cardiac arrest.

22. CONTD…
No Pulse site Location Reason for use
7. Popliteal •Palpated in Popliteal
fossa, area behind knee,
just lateral to medial
tendon.
•Palpated by flexing
knee.
•Determine circulation
to lower extremities.
•Used for infants,
children
•Effectiveness of
arterial perfusion
during CPR.
8. Posterior tibial Behind medial
malleolus (ankle bone)
on inside of the ankle.
•Determine circulation
to lower leg.
•A circular blood
pressure in leg.
•Determine circulation
to the foot.
9. Pedal or Dorsalis
pedis
It is palpated on top of
foot, slightly lateral to
the tendon of big toe.
Determine circulation
to the foot.

24. ABNORMAL PULSE
1. Abnormal Rate: -
a. Tachycardia: Rapid pulse over 100 per minute may be caused by
drugs as stimulants or disease like typhoid, heart disease etc.
b. Bradycardia: Slow pulse 60 or less may be caused by drugs as
sedatives or diseases like heart diseases, etc.
2. Abnormal Rhythm: Irregularities in rhythm are called
arrhythmias, the intervals between beats may be of different lengths
or the beats may be of unequal force. Common irregularities in rate
and rhythm include premature beats, pauses tachycardia,
bradycardia and chaotic pulse.

25. CHAOTIC PULSE
• Meaning: An irregular pulse beats
Other irregularities in rhythm and rate are:-
1. Intermittent Pulse: This is one in which pulse
beats are missed at regular intervals. There is
difference between apical and radial pulse
which is known s pulse deficit.
2. Tachycardia: discussed already.
3. Bradycardia: discussed already.

26. Abnormal Pulse
4. Atrial fibrillation: It is the irregular
contractions of the ventricles in rhythm
and force caused by the rapid contraction
of the atrium.

27. 5.
Extra systoles: It is the premature contraction of
the heart before the normal cardiac cycle which
is felt s the premature pulse.
6. Ventricular fibrillation: It is the term
given to rapid chaotic electrical activity
initiated by the ventricular ectopic. It is the
rapid twitching of the ventricles.

28. 7. Dangerous arrhythmia: It my result
from ischemia in the ventricles. It is fatal.

29. 8. Bigeminal pulse:
•It is accompanied by an irregular rhythm in which
every other beats come early.
•The second or premature beat feels weak due to
inadequate filling of the ventricles between the two
beats.
•It may be so weak that it fails to produce a
palpable pulse when it is called pulse deficit. It is
seen in myocardial infarction and digitalis toxicity.

30. 9.Pulse alternans: The rhythm is regular
but volume has an alternative strong and
weak character. This may be noticed in the
left ventricular failure, heart block and
digitalis toxicity

31. Abnormal Pulse
10. Bounding pulse: It is an increased stroke
volume usually seen in exercises, anxiety,
anemia, hepatic failure, heart block and water
hammer pulse.

32. 11. Arrhythmia: It is a technical term used for
any variation from normal rhythm.

33. 12. Sinus Arrhythmia: It is the irregularity in the
rhythm and rate of pulse of which the heart rate
speed up during inspiration and slows down during
expiration.

34. ABNORMAL VOLUME
• Pulse may be large or full volume, or
may be of low or small volume (a
fluttering pulse is due to hemorrhage)
a. Collapsing pulse: one which is feeble to
touch, then subsides abruptly. A small
weak pulse that feels like a wire or thread
while touching the arteries. It indicates
decreased stock volume and is seen in
hemorrhagic shock or dehydration.

35. ABNORMAL VOLUME
b. Corrigan's Pulse or water hammer pulse:
Is jerky pulse with full expansion followed by
sudden collapse, e.g. dying patients.
Running pulse is one with weak irregular beats.

36. ABNORMAL TENSION
The pulse may be of high tension or of low
tension.
• Thready pulse is a low tension pulse, e.g.
wiry pulse.
• Dicrotic pulse also is due to low tension.
Dicrotic pulse is one which has two marked
expansions in one beat of the artery. The
contraction is normal but in relaxation, a
second sensation can be felt which resembles
a beat. The first is stronger and the second
sensational is weaker, e.g. Thyroid patients.

37. References
• Potter A.P., Perry A.G. Fundamentals of
Nursing, C.V. Mosby company, Louis 6th
edition ,2013.
• Kozier B et al, Fundamentals of Nursing
concepts, process and practice, Pearson
education , Inc 2nd Indian Print 2014.
• Kaur Lakhwinder ,Kaur Maninder , A text
book of Nursing Foundation , 3rd Edition,
PV Publication.