215173893-Vital-Signs

Vital Signs
Labskill
Introduction
Vital signs
 Temperature
 Pulse
 Respirations
 Blood pressure
Vital Signs
Provide information about patient’s
overall condition
Taken at each visit and compared to

baseline
Vital Signs: Temperature
Febrile – body temperature above
patient’s normal range
 Fever – sign of inflammation or infection
 Hyperpyrexia – extremely high temperature
Afebrile – normal body temperature

Body temperature varies with time of
day
Vital Signs: Temperature (cont.)
Tympanic Oral
Measurements
 Degrees Fahrenheit
(°F)
Temperature  Degrees Celsius
Routes (centigrade; °C)
Rectal Axillary Normal adult oral

Temporal temperature
 98.6°F
 37°C
Vital Signs: Temperature (cont.)
Route Normal Range ºF / ºC Sites

Oral 98.6 ºF / 37.0 ºC Mouth
Tympanic 99.6 ºF / 37.6 ºC Ear
Rectal 99.6 ºF / 37.6 ºC Rectum
Axillary 97.6 ºF / 36.6 ºC Axilla (armpit)

Vital Signs: Pulse and Respiration
Circulatory Respiratory
Pulse Respirations
Pulse and respirations are related because the heart and lungs
work together. Normally, an increase or decrease in one causes the
same effect on the other.
Vital Signs: Pulse
Pulse – number of times the heart beats in

1 minute
Respiration – number of times a patient

breaths in 1 minute
 One breath = one inhalation and one exhalation
Ratio of pulse to respirations is 4:1

Vital Signs: Pulse (cont.)
Indirect measurement Sites of
of cardiac output measurement
 Adults – radial artery
Problems if  Children – brachial
 Tachycardia artery (antecubital
 Bradycardia space)
 Weak  Apex of heart
 Irregular  5th intercostal space
directly below center
of left clavical
 Apical pulse taken
with a stethoscope
Locate pulse by pressing

lightly with index and
middle finger pads at the
pulse site
Count the number of beats

felt in 1 minute
If regular – may count

beats for 30 seconds and
multiply by 2
Vital signs: Pulse (cont.)
Regular Pulse Rhythm Irregular Pulse Rhythm
 Count for 30 seconds,  Count for one full minute

then multiply by 2  May use stethoscope to
(a rate of 35 beats in 30 listen for apical pulse and
seconds equals a pulse count for a full minute
rate of 70 beats/minute)
Electronic devices
 Blood pressure machines
 Pulse oxymetry
 Infrared light measures
pulse and oxygen levels
Vital Signs: Respiration
Respiratory rate – indication of how well the body
provides oxygen to the tissues
Check by watching, listening, or feeling movement

Vital Signs: Respiration (cont.)
Normal Respiratory Rates
(26-40)
40
35
(20-30)
30
(18-24) (16-24) (12-24)
25 (12-20)
20
15
10
5
0
0-1 yrs 1-6 yrs 6-11 yrs 11-16 yrs ADULT ELDERLY
NOTE: Ranges reflect breaths per minute
Check respirations Count for one full
 Look, listen, and feel minute
for movement of air  Rate
 Rhythm – regular
 Count with a
 Effort (quality) –
stethoscope
normal, shallow, or
deep
NOTE: If patients are aware that you are counting
respirations, they may unintentionally alter their
breathing.
Irregularities – indication of possible
disease
 Hyperventilation – excessive rate and depth
 Dyspnea – difficult or painful breathing
 Tachypnea – rapid breathing
 Hyperpnea – abnormally rapid or deep

breathing
Other irregularities
 Rales (noisy)
 Constriction or blockage of bronchial passages
 Pneumonia, bronchitis, asthma, or other pulmonary
disease
 Cheyne-Stokes respirations
 Periods of increasing and decreasing depth of
respiration between periods of apnea
 Strokes, head injuries, brain tumors, congestive
heart failure
 Apnea – absence of breathing
Vital Signs: Blood Pressure
The force at which blood is pumped
against the walls of the arteries (mmHg)
Two pressure measurements
 Systolic pressure – measure of pressure when
left ventricle contracts
 Diastolic pressure
 Measure of pressure when heart relaxes
 Minimum pressure exerted against the artery walls
at all times
Vital Signs: Blood Pressure (cont.)
120/80
Systolic Pressure Diastolic Pressure
 Contraction of left  Heart at rest

ventricle  Bottom or second
 Top or first number number
Classification of Hypertension
(JNC-7)
BP Classification SBP mm Hg* DBP mm Hg*
Normal < 120 < 80
Prehypertensive 120–139 80–89
Stage 1 hypertension 140–159 90–99
Stage 2 hypertension ≥ 160 ≥ 100
*Classification determined by higher BP category.

BP indicates blood pressure; DBP, diastolic blood pressure; SBP, systolic
blood pressure
Pickering TG et. al. Circulation. 2005;111:697-716

Changes in systolic and diastolic blood pressure with age.
Chobanian A V et al. Hypertension. 2003;42:1206-1252
Copyright © American Heart Association, Inc. All rights reserved.

Low blood pressure Hypertension
Normal for some
High blood pressure
people
readings
Severely low blood
Major contributor to
pressure readings
heart attacks and
occur with:
strokes
 Shock
 Heart failure
 Severe burns
 Excessive bleeding
Hypotension
Equipment
 Sphygmomanometer  Types of
 Inflatable cuff sphygmomanometers
 Pressure bulb or other  Aneroid
device for inflating cuff  Electronic
 Manometer
 Mercury
Aneroid sphygmomanometers
 Circular gauge for registering
pressure
 Each line 2 mmHg
 accurate
 Must be checked,
serviced, and
calibrated every
3 to 6 months
Electronic sphygmomanometers
 Provides a digital readout of the
blood pressure
 No stethoscope is needed
 Easy to use
 Maintain equipment according to
manufacturer’s instructions
Mercury sphygmomanometers
 A column of mercury rises with an
increased pressure as the cuff is
inflated
 If in use, must be checked,
serviced, and calibrated every
6 to 12 months
Vital Signs: Blood Pressure
(cont.)
Stethoscope Earpieces
 Amplifies body sounds Binaurals
 Earpieces
 Binaurals and tubing
 Chestpiece
Rubber or plastic
 Bell – low-pitched tubing
sounds
Bell
 Diaphragm –
high-pitched sounds Chestpiece
Diaphragm
BP by Palpation
Size using guides on cuff
Position on upper arm centered over
brachial artery
Inflate 30mmHg past pulse
Deflate
Record point at which pulse returns
Record as Systolic/P (135/p)
BP by Auscultation
Size using guides on cuff
Position on upper arm hoses pointing down
Inflate 30mmHg past pulse
Position stethoscope over brachial artery
Deflate
Note first sound and last sound
Record as systolic/diastolic (140/80)
Special considerations in adults

 Post exercise, ambulatory disabilities, obese, known
blood pressure problems
 Anxiety or stress
 Avoid measurement in an arm
 Injury or blocked artery is present
 History of mastectomy on that side
 Implanted device is under the skin
 Proper cuff size – improper size results in inaccurate
reading
Special considerations in children

 Not routinely taken on each visit
 Take before other tests or procedures
 Cuff size important
 Palpatory method not used with
children
 Heartbeat may be heard to zero; record diastolic when
strong heartbeat becomes muffled
Vital Signs:
Orthostatic or Postural Hypotension
Orthostatic or postural hypotension
 Blood pressure becomes low and pulse
increases when the patient moves from lying to
standing
 Indicates fluid loss or malfunction of
cardiovascular system
 Vital signs are taken in different positions
 Positive tilt test – increase in pulse > 10 bpm

and a drop in BP > 20 mmHg

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Vital Signs

Taken at each visit and compared to

Afebrile – normal body temperature

Rectal Axillary Normal adult oral

Route Normal Range ºF / ºC Sites

Tympanic 99.6 ºF / 37.6 ºC Ear

Rectal 99.6 ºF / 37.6 ºC Rectum

Axillary 97.6 ºF / 36.6 ºC Axilla (armpit)

Pulse – number of times the heart beats in

Respiration – number of times a patient

Ratio of pulse to respirations is 4:1

Locate pulse by pressing

Count the number of beats

If regular – may count

Regular Pulse Rhythm Irregular Pulse Rhythm

 Count for 30 seconds,  Count for one full minute

Check by watching, listening, or feeling movement

 Dyspnea – difficult or painful breathing

 Tachypnea – rapid breathing

 Hyperpnea – abnormally rapid or deep

 Contraction of left  Heart at rest

*Classification determined by higher BP category.

Pickering TG et. al. Circulation. 2005;111:697-716

Chobanian A V et al. Hypertension. 2003;42:1206-1252

Copyright © American Heart Association, Inc. All rights reserved.

Special considerations in adults

Special considerations in children

 Positive tilt test – increase in pulse > 10 bpm

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