For Nursing students

1. Vital Signs
- Khyati Chaudhari

2. Vital Signs
“Vital signs are measures of various physiological status, in order
to assess the most basic body functions. When these values are
not zero, they indicate that a person is alive.”
 All of these vital signs can be observed, measured, and monitored.
This will enable the assessment of the level at which an individual
functioning. Normal ranges of measurements of vital signs change
with age and medical condition.

3. Vital signs
 Vital signs are useful in detecting or monitoring medical problems.
 Vital signs can be measured in a medical setting, at home, at the
site of a medical emergency, or elsewhere.

4. Vital Signs
 Are measurements of the body's most basic functions:
1. Body temperature (Temp).
2. Pulse / heart rate.
3. Respiration.
4. Blood pressure (BP).

5. When to Assess Vital Signs
1. On admission to any healthcare facility.
2. When assessing a patient during home care visits .
3. Any time there is a change in the patient’s condition.
4. Before and after surgical or invasive diagnostic procedures.
5. Before and after activity that may increase risk.
6. Before and after administering medications that affect
cardiovascular or respiratory functioning.

6. When to Assess Vital Signs
7. Before, during & after a transfusion of blood products.
8. When a patient reports nonspecific symptoms of physical distress.

7. Body Temperature

8. Physiological Basis of Body Temperature
 Body temperature is the difference between the amount of heat
produced by the body & the amount of heat loss to the external
environment.
Heat produced – Heat lost = Body Temperature

9. Types of body temperature:
1. Core temperature:
Is the temperature of deep tissues of the body, e.g., cranium,
thorax and abdominal cavity. It remains relatively constant (37Cº or
98.6 Fº).
True core temperature readings can only be measured by invasive
means, such as placing a temperature probe into the esophagus,
pulmonary artery or urinary bladder.

10. Types of body temperature:
 Non-invasive sites such as the rectum, oral cavity, axilla, temporal
artery (forehead) and external auditory canal are accessible and are
believed to provide the best estimation of the core temperature.

11. Types of body temperature:
2. Surface temperature:
Is the temperature of the skin, the subcutaneous tissue and fat. It,
by contrast rises and falls in response to the environmental changes.
When measured orally, the average body temperature of an adult
is between 36.7 Cº( 98 Fº) and 37 Cº( 98.6Fº).

12. Thermoregulation
 Physiological & behavioural mechanisms regulate the balance
between heat lost & heat produced which called thermoregulation.
 Two mechanism-
1. Heat production
2. Heat loss

13. Acceptable ranges for adults
 Temperature range- 36-38 ºC. ( 96.8-100.4 ºF)
 Average Oral/Tympanic – 37 ºC (98.6 ºF)
 Average Rectal – 37.5 ºC (99.5 ºF)
 Average axillary – 36.5 ºC (97.7 ºF)

14. Factors Affecting Body's heat production
1. Age
2. Exercise
3. Hormone level
4. Circadian rhythm
5. Stress
6. Environment

15. Alterations in Body Temperature
 Pyrexia: A body temperature above the usual range is called
pyrexia, hyperthermia, or ( in lay terms) fever. A very high
temperature, e.g. 41ºC (105 ºF) is called hyperpyrexia.
 Febrile: Person suffering from fever.
 Afebrile: when fever ‘breaks’, the patient becomes afebrile.

16. Hyperthermia
 An elevated body temperature related to the inability of the body
to promote heat loss or reduce heat production is hyperthermia.

17. Heatstroke
 Heatstroke is a dangerous heat emergency with a high mortality
rate.
 Heat depresses hypothalamic function.
 Prolonged exposure to the sun or a high environmental
temperature overwhelms the heat loss mechanisms of the body.
 This condition cause heatstroke, defined as a body temperature of
40 ºC (104 ºF) or more.

18. Sign & symptoms of heatstroke
 Giddiness
 Confusion
 Delirium
 Excess thirst
 Nausea
 Muscle cramps
 Visual disturbances
 Incontinence
 The most important sign of heat
stroke is hot, dry skin.

19. Heat exhaustion
 Heat exhaustion occurs when profuse diaphoresis results in excess
water & electrolyte loss. Caused by environmental heat exposure,
the patient exhibits signs & symptoms of fluid volume deficit.
 First aid includes transporting him/her to a cooler environment &
restoring fluid and electrolyte balance.

20. Hypothermia
 Heat loss during prolonged exposure to cold overwhelms the ability
of the body to produce heat, causing hypothermia.
 Hypothermia is classified by core temperature measurements.
 It is sometimes unintentional such as falling through the ice of a
frozen lake.
 Occasionally hypothermia is intentionally induced during surgical or
emergency procedures to reduce metabolic demand & need of the
body for oxygen.

21. Mild Hypothermia
 Accidental hypothermia usually develops gradually & goes
unnoticed for several hrs.
 When skin temperature drops below 35 ºC (95 ºF), the patient
suffers uncontrolled
Shivering
Loss of memory
Depression &
Poor judgement

22. Moderate Hypothermia
 As the body temperature falls below 34.4 ºC (94 ºF)
Heart rate
Respiratory rate
Blood pressure
The skin becomes cyanotic
Cardiac dysrhythmias
Loss of consciousness
Unresponsive to painful stimuli

23. Severe Hypothermia
 In case of severe hypothermia < 30 ºC (80 ºF)
Person demonstrates clinical signs similar to death.
When you suspect hypothermia, assessment of core
temperature is critical.
A special low-reading thermometer is required because
standard devices do not register below 35 ºC (95 ºF).

24. Frostbite
 Frostbite occurs when body is exposed to subnormal temperatures.
 Ice crystals from inside the cell & permanent circulatory & tissue
damage occurs.
 Areas particularly susceptible to frostbite are the earlobes, tip of the
nose &
fingers and toes.
 The injured area becomes white, waxy & firm to the touch.
 The patient loses sensation in affected area.

25. Frostbite
 Interventions include gradual warming measures, analgesia &
protection of the injured tissue.

26. Common types of fevers
1. Intermittent Fever: during this type of fever, the body temperature
alternates at regular intervals between periods of fever and periods
of normal temperatures.
2. Remittent Fever: during this type of fever, a wide range of
temperature fluctuations occurs over the 2 hour period, all of which
are above normal.

27. Common types of fevers
3. Relapsing Fever: In a relapsing fever, short febrile periods of a few
days are interspersed with periods of 1 or 2 days of normal
temperature.
4. Constant Fever: during a constant fever, the body temperature
fluctuates minimally but always remains elevated.

29. Conversion Formulas
 Sometimes a health professional staff need to convert a Celsius
reading to Fahrenheit, or vice versa.
a. To convert from Fahrenheit to Celsius, deduct 32 from the
Fahrenheit, and then multiply by 5/9
ºC= (ºF -32) × 5/9
 For example, convert 98.6 Fahrenheit to Celsius reading
C= ( 98.6- 32) × 5/9
C=( 66.6) × 5/9
C = 37 Celsius degree.

30. Conversion Formulas
b. To convert from Celsius to Fahrenheit, multiply the Celsius reading by the fraction
9/5 and then add 32 .
 For example, convert 37 Celsius degree to Fahrenheit reading
 F = ( 37 × 9/5) + 32
 F = ( 66.6) + 32
 F = 98.6 ºF

31. Pulse

32. Pulse
 The pulse is the palpable bounding of blood flow noted at various
points on the body.
 Blood flows through the body in a continuous circuit.
 The pulse is an indicator of circulatory status.
 The unit for measuring pulse is beats per minute.

33. Characteristics of Pulse
1. Quality.
2. Rate.
3. Rhythm.
4. Volume (strength or amplitude).
 Pulse quality refers to the ‘‘feel’’ of the pulse, its rhythm and
forcefulness.

34.  Pulse rate is an indirect measurement of cardiac output obtained
by counting the number of apical or peripheral pulse waves over a
pulse point.
 - A normal pulse rate for adults is between 60 and 100 beats per
minute.
 - Bradycardia is a heart rate less than 60 beats per minute in an
adult.
 - Tachycardia is a heart rate in excess of 100 beats per minute in
adult.

35. 3. Pulse rhythm is the regularity of the heartbeat. It describes how
evenly the heart is beating:
Regular (the beats are evenly spaced).
Irregular (the beats are not evenly spaced).
Dysrhythmia (arrhythmia) is an irregular rhythm caused by an
early, late, or missed heartbeat.

36. 4. Pulse volume is a measurement of the strength or amplitude of
force exerted by the ejected blood against the arterial wall with
each contraction.
 It is described as normal (full, easily palpable).
 Weak (thready and usually rapid) or Strong (bounding).

37. Factors Contribute to Increase Pulse Rate
1. Pain.
2. Fever.
3. Stress, exercise .
4. Bleeding.
5. Decrease in blood pressure .
6. Some medications as (adrenalin, aminophylline).

38. Factors May Slow The Pulse
1. Rest .
2. Increasing age.
3. People with thin body size .
4. Some Medications.
5. Thyroid gland disturbances .

39. Pulse point
1. Temporal
2. Carotid
3. Apical
4. Brachial
5. Radial
6. Ulnar
7. Femoral
8. Popliteal
9. Posterior tibial
10. Dorsalis pedis

40. Temporal
 Location –
over temporal bone of head,
above & lateral to eye
 Assessment criteria-
easily accessible site used to
assess pulse in children.

41. Carotid
 Location-
Bilateral, under lower jaw in
neck along medial edge of
sternocleidomastoid muscle.
 Assessment criteria-
easily accessible site used
during physiological shock or
cardiac arrest when other site are
not palpable

42. Apical
 Location-
Left midclavicular line at
fourth to fifth intercostal space.
 Assessment criteria-
Used to auscultate heart
sounds

43. Brachial
 Location-
Inner aspect between groove
of biceps and triceps muscle at
antecubital fossa.
 Assessment criteria-
Used in cardiac arrest for
infants, to assess lower arm
circulation, and to auscultate
blood pressure.

44. Radial
 Location-
Inner aspect of forearm on
thumb side of wrist.
 Assessment criteria-
Accessible; used routinely in
adults to assess character of
peripheral pulse.

45. Ulnar
 Location-
Outer aspect of forearm on finger
side of wrist.
 Assessment criteria-
Used to assess circulation to ulnar
side of hand and to perform the Allen’s
test.

46. Femoral
 Location-
In groin, below inguinal
ligament (midpoint between
symphysis pubis and anterosuperior
iliac spine).
 Assessment criteria-
Used to assess circulation to
legs and during cardiac arrest.

47. Popliteal
 Location-
Behind knee, at center in
popliteal fossa.
 Assessment criteria-
Used to assess circulation to
legs and to auscultate leg blood
pressure.

48. Posterior tibial
 Location-
Inner aspect of ankle
between Achilles tendon and
tibia (below medial malleolus).
 Assessment criteria-
Used to assess circulation to
feet.

49. Dorsalis pedis
 Location-
Over instep, midpoint
between extension tendons of
great and second toe.
 Assessment criteria-
Used to assess circulation to
feet.

50. Acceptable ranges of pulse
 Infant - 120-160 bpm
 Toddler – 90-140 bpm
 Preschooler – 80-110 bpm
 School-age child – 75-100 bpm
 Adolescent – 60-90 bpm
 Adult – 60-100 bpm

51. Pulse deficit
 Pulse deficit is the difference in the apical pulse and the radial
pulse. These should be taken at the same time, which will require
that 2 people take the pulse. One with a stethoscope and one at the
wrist. Count for 1 full minute. Then subtract the radial from the
apical. This is the Pulse Deficit.

52. Respiration

53. Respiration
 Human survival depends on the ability of oxygen to reach body
cells & carbon dioxide to be removed from the cells.
 Respiration is the mechanism the body uses to exchange gases
between the atmosphere & the blood and the blood & the cells.
 The unit for measuring respiration is breaths per minute.

54. Respiration
 Respiration involves –
- Ventilation – movement of gases in & out of the lungs.
- Diffusion – movement of o2 & co2 between the alveoli and RBCs.
- Perfusion. – distribution of the RBCs to & from pulmonary
capillaries.

55. Factors affecting respiration
1. Exercise .
2. Acute pain .
3. Anxiety .
4. Smoking .
5. Body positions .
6. Medications .
7. Neurological injury .
8. Hemoglobin functions .

56. Assessment of respiration includes
1) Depth [by assessing the degree of excursion or movement in the
chest wall; shallow, deep or normal.
2) Rhythm.
3) Rate the nurse observes a full inspiration & expiration when
counting.

57. Acceptable Changes of Respiration
 Newborn – 35-40 bpm
 Infants – 35-50 bpm
 Toddler – 25-32 bpm
 Child – 20-30 bpm
 Adolescent – 16-20 bpm
 Adult – 12-20 bpm

58. Alterations in breathing pattern
 Eupnoea: refers to easy respirations with a normal rate of breaths
per minute that is age specific.
 Bradypnea: is a respiratory rate of 10 or fewer breaths per minute.
 Hypoventilation: is characterized by shallow respirations.
 Tachypnea: is a respiratory rate greater than 24 breaths per minute.
 Hyperventilation: is characterized by deep, rapid respirations.

59. Alteration in movement of chest
 Costal (thoracic) breathing: occurs when external intercostal
muscles and the other accessory muscles are used to move the
chest upward and outward.
 Diaphragmatic(abdominal) breathing: occurs when the
diaphragm contracts and relaxes as observed by movement of the
abdomen.
 Dyspnea: refers to difficulty in breathing as observed by labored or
forced respirations through the use of accessory muscles in the
chest and neck to breathe.

60. Alteration in movement of chest
 Apnea : respirations cease for several seconds. Persistent cessation
is called respiratory arrest.
 Cheyne–Stockes respiration: respiratory rhythm is irregular,
characterized by alternating periods of apnea and hyperventilation.
The respiratory cycle begins with slow, shallow breaths that
gradually increase to abnormal depth and rapidity. Gradually
breathing slows and becomes shallower, climaxing in a 10 to 20
seconds period of apnea before respiration resumes.

61. Alteration in movement of chest
 Kussmaul respiration: respirations are abnormally deep but
regular, similar to hyperventilation. Characteristic of clients with
diabetic ketoacidosis.
 Orthopnea: respiratory condition in which a person must sit or
stand in order to breathe deeply or comfortably.

62. Blood pressure

63. Blood pressure
 Blood pressure is the force exerted by the blood against the wall of
blood vessel.

64. Two measurements
 Systolic blood pressure - Is force exerted by arterial walls during
systole. It is the maximum pressure during ventricle contraction.
 Diastolic blood pressure – is force exerted by blood against
arterial wall during diastole. It is the minimum pressure when the
ventricles are relaxed.

65. Continue..
 Unit of measuring blood pressure is millimeters of mercury
(mmHg).
 Normal blood pressure is 120/80 mm of Hg.
 Here, systolic pressure is 120 mmHg & diastolic pressure is 80
mmHg.
 The difference between systolic & diastolic pressure is called pulse
pressure.
 Normally, the pulse pressure is 40 mmHg.

66. Factors affecting the blood pressure
1. Age
2. Body size/obesity
3. Emotions/stress
4. Gender
5. Ethnicity
6. Diet
7. Smoking
8. Exercise
9. Diurnal variations
10.Medications
11.Chemicals

67. 1. Age
 Blood pressure varies throughout the age.
 As age increases, BP also raises.
 Infant – 65-115/42-80 mmHg
 7 year child – 87-177/48-64 mmHg
 Normal adult – 120/80 mmHg
 Older people, systolic pressure rises with decreased elasticity.

68. 2. Body size/obesity
 It is observed that as the body size increases, BP also fluctuates.
 Havier & taller child have higher BP than the smaller child of same
age.

69. 3. Emotions/stress
 Anxiety, fear, pain, stress, sympathetic nervous system get activated,
causing vasoconstriction, increases heart contraction & ultimately
raises BP.

70. 4. Gender
 After puberty, male have higher blood pressure than females.
 But after menopause, women tend to have high BP than male of
same age.

71. 5. Ethnicity
 African – Americans have higher incidence of high BP than
Europeans – Americans.

72. 6. Diet
 People taking diet rich in salt & unsaturated fatty acids, having
higher BP.
 Cocaine use also increases blood pressure.
 Caffeine intake also increases BP.

73. 7. Smoking
 Due to nicotine BP increases.

74. 8. Exercise
 Regular exercise, decreases the BP.
 Helps in keeping BP normal.

75. 9. Diurnal variations
 Usually, person have low BP in early morning & gradually rises &
peaks in evening.

76. 10. Medications
 Medications such as opioid analgesics, anti-hypertensive drugs
have greater effect o BP.

77. 11. Chemicals
 Such as epinephrine, ADH, angiotensin II cause vasoconstriction,
thus elevating BP.
 Histamine, kinens cause vasodilation, thus decrease BP.

78. Alteration in blood pressure
 Hypertension – elevated systolic pressure or diastolic pressure at
least for 3 consecutive visits. Ex. 190/140 mmHg
 Hypotension – BP falls below normal limits of client. Generally,
systolic pressure falls to 90 mmHg or below.
 Orthostatic hypotension/ postural hypotension – suddenly BP
fall of normotensive client while rising to upright position.