Nursing Education - Vital signs

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Vital Signs
Dr. Binu Babu
Ph.D., M.Sc. (N), MBA
Mrs. Jincy Ealias
M.Sc. (N)

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Introduction
• The traditional vital signs are body
temperature, pulse, respirations, and blood
pressure.
– Monitor functions of the body
– Should be thoughtful, scientific
assessment
– Often, someone other than nurse
measures client's vital signs.

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Body Temperature

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Body Temperature
• Human body temperature is the typical temperature range
found in humans. The normal human body temperature
range is typically stated as 36.5–37 °C. It is categorized in to
core and surface temperature.
– Core
• Deep tissues of the body
• Remains relatively constant
– Surface
• Skin, subcutaneous tissue, fat
• Responds to environment
• Heat balance

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Body Temperature
• Factors affecting body's heat
production
– Basal metabolic rate (BMR)
– Muscle activity
– Thyroxine output
– Epinephrine, norepinephrine, and
sympathetic stimulation/stress response
– Fever

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Body Temperature
• Radiation
– Transfer of heat from surface of one object
to surface of another without contact
• Conduction
– Transfer of heat from one molecule to a
molecule of lower temperature

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Body Temperature
• Convection
– Dispersion of heat by air currents
• Evaporation
– Insensible water loss
– Insensible heat loss

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Regulation of Body
Temperature
• Regulation through:
– Sensors in periphery and core
– Integrator in hypothalamus
– Effector system adjusting heat
production/loss
• Most sensors in skin

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Regulation of Body
Temperature
• Processes to increase body
temperature
– Shivering
– Sweating
– Vasoconstriction

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As long as heat production and heat loss are properly balanced, body
temperature remains constant. Factors contributing to heat production
(and temperature rise) are shown on the left; those contributing to heat
loss (and temperature fall) are shown on the right.

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Range of oral temperatures during 24 hours for a
healthy young adult.

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Factors Affecting Body
Temperature
• Age
• Diurnal variations (circadian rhythms)
• Exercise
• Hormones
• Stress
• Environment

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Alterations in Body
Temperature
• Normal range
– 96.8°F to 99.5°F (36°C and 37.5°C)
• Pyrexia
– Body temperature above normal range
– Hyperthermia, fever
– Hyperpyrexia
• Very high fever
– Client described as febrile if fever, afebrile
if no fever

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• Pyrexia
– Common types
• Intermittent
• Remittent
• Relapsing
• Constant
– Fever spike
– Heat exhaustion
– Heat stroke
• Hypothermia
– Core body temperature
below normal limits
– Accidental hypothermia
as a result of:
• Exposure to cold
environment
• Immersion in cold water
• Lack of adequate clothing,
shelter, or heat

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Terms used to describe alterations in body temperature
(oral measurements) and ranges in Fahrenheit and
Celsius (centigrade) scales.

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Nursing Interventions for
Clients with Fever
• Monitor vital signs.
• Assess skin color and temperature.
• Monitor white blood cell count,
hematocrit value, and other pertinent
laboratory reports for indications of
infection or dehydration.
• Remove excess blankets when the
client feels warm, but provide extra
warmth when the client feels chilled.
• Provide adequate nutrition and fluids
(e.g., 2,500–3,000 mL/ day) to meet
the increased metabolic demands
and prevent dehydration.
• Measure intake and output.
• Reduce physical activity to limit
heat production, especially
• during the flush stage.
• Administer antipyretics (drugs
that reduce the level of fever) as
ordered.
• Provide oral hygiene to keep the
mucous membranes moist.
• Provide a tepid sponge bath to
increase heat loss through
conduction.
• Provide dry clothing and bed
linens.

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Nursing Interventions for Fever
• Provide a warm environment.
• Provide dry clothing.
• Apply warm blankets.
• Keep limbs close to body.
• Cover the client’s scalp with a cap or turban.
• Supply warm oral or intravenous fluids.
• Apply warming pads.

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Assessing Body
Temperature
• Oral
• Rectal
– Considered to be very accurate
• Axillary
– Preferred for newborns
• Tympanic membrane
• Skin/temporal artery

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Oral
Advantages
• Oral Accessible and
convenient
Disadvantages
• Thermometers can break if
bitten.
• Inaccurate if client has just
ingested hot or cold food or fluid
or smoked.
• Could injure the mouth following
oral surgery.
Thermometer Placement
Place the tip on either side of the
frenulum.

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Rectal
Advantages
• Rectal Reliable
measurement
Disadvantages
• Inconvenient and more unpleasant for
clients; difficult for client who cannot
turn to the side.
• Could injure the rectum.
• Presence of stool may interfere with
thermometer placement.
Thermometer Placement
• Apply clean gloves.
• Instruct the client to take a slow
deep breath during insertion.
• Never force the thermometer if
resistance is felt.
• Insert 3.5 cm (1.5 in.) in adults.

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Axillary
Advantages
• Axillary Safe and
noninvasive
Disadvantages
• The thermometer may
need to be left in place a
long time to obtain an
accurate measurement.
Thermometer Placement
Pat the axilla dry if very
moist.
The tip is placed in the center
of the axilla.

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Tympanic
Advantages
• Tympanic membrane
Readily accessible;
reflects the core
temperature; very fast
Disadvantages
• Can be uncomfortable and
involves risk of injuring the
membrane if the probe is
inserted too far.
• Repeated measurements may
vary. Right and left
measurements can differ.
• Presence of cerumen can affect
the reading.

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Thermometer Placement
• Pull the pinna slightly
upward and backward
for an adult.
• Point the probe slightly
anteriorly, toward the
eardrum.
• Insert the probe slowly
using a circular motion
until snug.

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Temporal
Advantages
• Temporal artery Safe and
noninvasive; very fast
Disadvantages
• Requires electronic
equipment that may be
expensive or unavailable.
Variation
• in technique needed if the
client has perspiration on
the forehead.

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Thermometer Placement
• Brush hair aside if covering the
temporal artery area.
• With the probe flush on the
center of the forehead, depress
the red button; keep depressed.
• Slowly slide the probe midline
across the forehead to the
hairline, not down the side of the
face.
• Lift the probe from the forehead
and touch on the neck just
behind the earlobe. Release the
button.

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Assessing Body
Temperature
• Types of thermometers
– Goal of eliminating mercury from health
care environments
– Electronic
– Chemical disposable
– Temperature-sensitive tape
– Infrared (tympanic)
– Temporal artery

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Assessing Body
Temperature
• Temperature scales
– Convert from Fahrenheit to Celsius
• C = (Fahrenheit temperature − 32) × 5/9
– Convert from Celsius to Fahrenheit
• F = (Celsius temperature × 9/5) + 32

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Assessing Body Temperature
Purpose
• To establish baseline data for
subsequent evaluation
• To identify whether the core
temperature is within normal range
• To determine changes in the core
temperature in response to specific
therapies
• To monitor clients at risk for
imbalanced body temperature
ASSESSMENT
• Assess Clinical signs of fever
• Assess Clinical signs of hypothermia
• Site and method most appropriate
for measurement
• Factors that may alter core body
temperature
Equipment
• Thermometer
• Thermometer sheath or
cover
• Water-soluble lubricant for
a rectal temperature
• Clean gloves for a rectal
temperature
• Towel for axillary
temperature
• Tissues/wipes

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IMPLEMENTATION
Preparation
• Check that all equipment is functioning
normally.
Performance
• Prior to performing the procedure, introduce
self and verify the client’s identity using
agency protocol.
• Explain to the client what you are going to
do, why it is necessary, and how he or she
can participate.
• Discuss how the results will be used in
planning further care or treatments.
• Perform hand hygiene and observe
appropriate infection prevention procedures.
• Apply gloves if performing a rectal
temperature.
• Provide for client privacy.
• Position the client appropriately
• Place the thermometer
• Apply a protective sheath or probe cover
if appropriate.
• Lubricate a rectal thermometer.
• Wait the appropriate amount of time.
• Remove the thermometer and discard
the cover or wipe with a tissue if
necessary. them.
• Perform hand hygiene.
• Read the temperature and record it on
worksheet.
• If the temperature is obviously too high,
too low, or inconsistent with the client’s
condition, recheck it with a thermometer
known to be functioning properly.
• Wash the thermometer if necessary and
return it to the storage location.
• Document the temperature in the client
record.

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EVALUATION
• Compare the temperature measurement to baseline data,
normal range for age of client, and client’s previous
temperatures.
• Analyze considering time of day and any additional
influencing factors and other vital signs.
• Conduct appropriate follow-up such as notifying the primary
care provider if a temperature is outside of a specific range
or is not responding to interventions, giving a medication, or
altering the client’s environment.

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Pulse

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PULSE
• The pulse is a wave of blood created by
contraction of the left ventricle of the heart.
• The pulse wave represents the stroke
volume output or the amount of blood that
enters the arteries with each ventricular
contraction.

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• Cardiac output is the volume of blood
pumped into the arteries by the heart and
equals the result of the stroke volume (SV)
times the heart rate (HR) per minute.
• Stroke volume (SV) is the amount of blood
ejected by the left ventricle in one
contraction.
• For example, 65 mL x 70 beats per minute =
4.55 L per minute.

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• A peripheral pulse is a pulse located away
from the heart, for example, in the foot or
wrist.
• The apical pulse, in contrast, is a central
pulse; that is, it is located at the apex of the
heart. It is also referred to as the point of
maximal impulse (PMI).

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Factors Affecting the Pulse
• Age
• Sex
• Exercise
• Fever
• Medications
• Hypovolemia/dehydration
• Stress
• Position
• Pathology

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Variations in Pulse and Respirations by Age
Age Pulse Average
(and Ranges)
Respirations
Average
(and Ranges)
Newborn 130 (80–180) 35 (30–60)
1 year 120 (80–140) 30 (20–40)
5–8 years
100 (75–120) 20 (15–25)
10 years 70 (50–90) 19 (15–25)
Teen 75 (50–90) 18 (15–20)
Adult 80 (60–100) 16 (12–20)
Older adult 70 (60–100) 16 (15–20)

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Assessing the Pulse
• Tachycardia
– Excessively fast heart rate (over 100 bpm)
• Bradycardia
– Heart rate of less than 60 bpm in adults
• Pulse rhythm
– Pattern of beats and intervals between
beats

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Assessing the Pulse
• Pulse rhythm
– Irregular rhythm
• Dysrhythmia
• Arrhythmia
• Pulse volume
– Strength or amplitude
– Ranges from absent to bounding

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Characteristics of the
Pulse
• Arterial wall elasticity
– Expansibility or deformity
• Presence or absence of bilateral
equality
– Compare corresponding pulse
– If distal pulse is palpable, more proximal
pulses will be also.

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Sites for assessing pulse.

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• Temporal : The site is above and
lateral to the eye where the
temporal artery passes over the
temporal bone of the head.
• Carotid: At the side of the neck
where the carotid artery runs
between the trachea and the
sternocleidomastoid muscle.
• Apical: At the apex of the heart.
• Brachial: At the inner aspect of
the biceps muscle of the arm or
medially in the antecubital space.
• Radial: At the thumb side of the
inner aspect of the wrist where the
radial artery runs along the radial
bone.
• Femoral: Where the femoral
artery passes alongside the
inguinal ligament.

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• Popliteal: Where the popliteal artery passes
behind the knee.
• Posterior tibial: On the medial surface of the
ankle where the posterior tibial artery passes
behind the medial malleolus.
• Dorsalis pedis: Where the dorsalis pedis artery
passes over the bones of the foot, on an imaginary
line drawn from the middle of the ankle to the
space between the big and second toes.

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Reasons for Using Specific - Pulse Site
SN Pulse Site Reasons for Use
1 Radial Readily accessible
2 Temporal Used when radial pulse is not accessible
3 Carotid Used during cardiac arrest/shock in adults
Used to determine circulation to the brain
4 Apical Routinely used for infants and children up
to 3 years of age
Used to determine discrepancies with
radial pulse
Used in conjunction with some medications
5 Brachial Used to measure blood pressure
Used during cardiac arrest for infants
6 Femoral Used in cases of cardiac arrest/shock
Used to determine circulation to a leg
7 Popliteal Used to determine circulation to the lower leg
8 Posterior tibial Used to determine circulation to the foot
9 Dorsalis pedis Used to determine circulation to the foot

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Apical Pulse Assessment
• Clients with irregular or
unavailable peripheral
pulse, clients with
cardiovascular,
pulmonary, renal
disease
• Done prior to
administering
medications that affect
heart rate
• Also used for newborns,
infants, and children up
to 2–3 years old

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Apical Pulse Assessment
• Apical-radial pulse
assessment
– Locate apical and
radial sites
– Pulse deficit
– Two-nurse method
may be more
accurate

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Assessing a Peripheral Pulse
PURPOSES
• To establish baseline data
for subsequent evaluation
• To identify whether the
pulse rate is within normal
range
• To determine the pulse
volume and whether the
pulse rhythm is regular
• To determine the equality of
corresponding peripheral
pulses on each side of the
body
• To monitor and assess
changes in the client’s
health status
• To monitor clients at risk
for pulse alterations (e.g.,
those with a history of heart
disease or experiencing
cardiac arrhythmias,
hemorrhage, acute pain,
infusion of large volumes of
fluids, or fever)
• To evaluate blood
perfusion to the extremities

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ASSESSMENT
Assess
• Clinical signs of
cardiovascular
alterations such as
dyspnea, fatigue,
pallor, cyanosis,
palpitations, syncope,
or impaired peripheral
tissue perfusion
• Factors that may alter
pulse rate
• Which site is most
appropriate for
assessment based on
the purpose

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Equipment
• Clock or watch with a sweep second hand or digital
seconds indicator
• If using a DUS: transducer probe, stethoscope
headset, transmission gel, and tissues/wipes

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Assessing pulse:
Radial Brachial

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Assessing pulse:
Carotid Femoral

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Assessing pulse:
Popliteal Posterior tibial

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Assessing pulse:
Dorsalis pedis Tibial pulse

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Blood Pressure

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• Blood pressure is the force or pressure of
the blood against the walls of the blood
vessels.
• Arterial blood pressure is a measure of the
pressure exerted by the blood as it flows
through the arteries. It is the result of the
ejection of blood from the left ventricle into
the aorta.

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• Blood pressure is mentioned in terms of
systolic blood pressure over diastolic blood
pressure.
• Systolic blood pressure is the highest
pressure attained in arteries during systole
and diastolic blood pressure is the lowest
arterial pressure during diastole

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• The systolic pressure is the pressure as a
result of contraction of the ventricles. When
the left ventricle contracts and pushes blood
into the aorta the pressure produced within
the arterial system is called the systolic blood
pressure.
• In adults it is about 120 mmHg.

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• The diastolic pressure is the pressure when
the ventricles are at rest.
• When complete cardiac relaxation occurs and
the heart is resting after the ejection of blood,
the pressure within the arteries is called
diastolic blood pressure.
• In an adult it is about 80 mmHg.

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• Arterial blood pressure is
measured with a sphygmomanometer.
• Blood pressure is recorded as a fraction:
systolic pressure over the diastolic pressure,
and expressed in millimeters of mercury
(mm Hg).
• A typical blood pressure for a healthy adult is
120/80 mmHg.

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Pulse pressure
• The difference between systolic and diastolic
blood pressures is the pulse pressure.
• A normal pulse pressure is about 40 mmHg.

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Factors Affecting Blood Pressure
• Age: The pressure rises with age, reaching a peak
at the onset of puberty, and then tends to decline.
• Exercise: Physical activity increases the cardiac
output and hence the blood pressure.
• Stress: Stimulation of the sympathetic nervous
system increases cardiac output and
vasoconstriction of the arterioles, thus increasing
the blood pressure.
• Race: African Americans tend to have higher
blood pressures than European Americans. The
exact reasons are unclear.

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• Sex: Females have lower blood pressures than
males due to hormonal variations. After menopause,
women have higher blood pressures.
• Medications: Many medications, including caffeine,
may increase or decrease the blood pressure.
• Obesity: Predispose to hypertension.
• Positions: Sitting, standing or lying down position
cause slight variation in BP.
• Diurnal variations (time of day): Pressure is
lowest early in the morning, when the metabolic
rate is lowest, then rises throughout the day and
peaks in the late afternoon or evening.

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• Medical conditions: Any condition affecting
the cardiac output, blood volume, blood
viscosity, and/or compliance of the arteries
has a direct effect on the blood pressure.
• Temperature: Because of increased metabolic
rate, fever can increase blood pressure.
However, external heat causes vasodilation
and decreased blood pressure. Cold causes
vasoconstriction and elevates blood pressure.

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Regulation of blood pressure
1. Regulation by cardio vascular center
2. Neural regulation
3. Hormonal regulation
4. Auto regulation

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1. Regulation by
cardiovascular center
The cardiovascular (CV) center in the medulla
oblongata controls neural, hormonal, and local negative
feedback systems that regulate blood pressure.
Groups of neurons within the CV center regulate
heart rate, contractility (force of contraction) of the
ventricles, and blood vessel diameter. Some neurons
stimulate the heart (cardiostimulatory center); others
inhibit the heart (cardioinhibitory center).
Some neurons control blood vessel diameter by
causing constriction (vasoconstrictor center) or dilation
(vasodilator center) which is referred as the vasomotor
center. All group of neurons in the CV center neurons
communicate one another and function together.

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• The cardiovascular center receives input both from
higher brain regions and from sensory receptors
(proprioceptors, baroreceptors, and
chemoreceptors).
• Output from the cardiovascular center flows along
sympathetic and parasympathetic neurons of the
ANS.
Sympathet
ic impulse
via cardiac
accelerator
nerves
Reach
heart
Sympathetic
stimulation
Increases
heart
rate and
contractili
ty
Increases
BP

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• The cardiovascular center also sends
impulses to smooth muscle in blood vessel
walls via vasomotor nerves. This produce
sympathetic stimulation and results in
vasoconstriction. Thus increases BP.
Para
sympath
etic
impulse
Via
vagus
nerve
Reach
heart
Inhibitory
action
Decreas
e heart
rate
Decrease
BP

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2. Neural regulation
• The nervous system regulation of BP is a negative
feed back mechanism via baroreceptor reflexes and
chemoreceptor reflexes.
i. Baroreceptor reflexes
Baroreceptors are pressure-sensitive sensory
receptors, located in the aorta, internal carotid
arteries and other large arteries in the neck and
chest. They send impulses to the cardiovascular
center to help regulate blood pressure.
The two most important baroreceptor reflexes are
the carotid sinus reflex and the aortic reflex.

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• Baroreceptors in the wall of the carotid
sinuses initiate the carotid sinus reflex
helps to regulate blood pressure in the brain.
Nerve impulses from the carotid sinus reach
the cardiovascular center via
glossopharyngeal nerves.
• Baroreceptors in the wall of the aorta initiate
the aortic reflex, which regulates systemic
blood pressure. Nerve impulses from aortic
baroreceptors reach the cardiovascular
center via vagus (X) nerves.

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ii. Chemoreceptor Reflexes
Chemoreceptors are sensory receptors that monitor
the chemical composition of blood located close to the
baroreceptors of the carotid sinus and arch of the
aorta. Chemoreceptors detect changes in blood level
of O2, CO2, and H+.
Hypoxia (lowered O2 availability), acidosis (an increase
in H+ concentration) or hypercapnia (excess CO2)
stimulates the chemoreceptors to send impulses to the
cardiovascular center.
In response, the CV center increases sympathetic
stimulation to arterioles and veins, producing
vasoconstriction and increases blood pressure.

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3. Hormonal regulation
Hormonal regulation of BP is done by
i.Renin–angiotensin–aldosterone system
ii.Epinephrine and norepinephrine
iii.Antidiuretic hormone (ADH)
iv.Atrial natriuretic peptide

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When renal blood flow is reduced or blood
volume decreases or BP drops the enzyme
renin is secreted by kidney cells. Renin converts
the plasma protein angiotensinogen, produced
by the liver, to angiotensin 1. Angiotensin
converting enzyme (ACE) converts angiotensin
1 to angiotensin 2. Angiotensin 2 causes
vasoconstriction and increases blood pressure.
Also angiotensin 2 stimulates secretion of
aldosterone which causes vasoconstriction and
increases blood pressure.

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ii. Epinephrine and norepinephrine
In response to sympathetic stimulation, the adrenal
medulla releases epinephrine and norepinephrine.
These hormones increase cardiac output by increasing
the rate and force of heart contractions. Thus increases
BP.
Increase BP
Increase CO
Increase heart rate and contractions
Release of epinephrine and norepinephrine
Sympathetic stimulation

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iv. Atrial natriuretic peptide
Atrial natriuretic peptide (ANP) is
released by cells in the atria of the heart.
ANP lowers blood pressure by causing
vasodilation and by promoting the loss of
salt and water in the urine, which reduces
blood volume.

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4. Auto regulation
• The ability of a tissue to automatically adjust its
blood flow to match its metabolic demands is
called autoregulation.
• In heart autoregulation is an important
contributor to increased blood flow through the
tissue.
• Stimuli that cause autoregulatory changes in
blood flow are;
– Physical changes: Warming promotes vasodilation,
and cooling causes vasoconstriction.
– Vasodilating and vasoconstricting chemicals

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Blood Pressure
• Arterial blood pressure
– Measure of exertion of blood as it flows
through arteries
• Systolic
– Contraction of the ventricles
• Diastolic
– Ventricles at rest
– Lower pressure present at all times

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Blood Pressure
• Pulse pressure
– Difference between systolic and diastolic
pressures
• Measured in millimeters of mercury
(mmHg)
• Recorded as fraction, e.g. 120/80
– Systolic = 120, diastolic = 80
• Mean arterial pressure (MAP) measures
what is delivered to body's organs

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Determinants of Blood
Pressure
• Pumping action of heart
– Strong or weak
• Peripheral vascular resistance
– Arteriosclerosis
• Fibrous tissue in arteries
• Arteries lose ability to constrict, dilate
• Blood volume
• Blood viscosity
– Hematocrit

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Hypertension
• Blood pressure persistently above
normal
• Usually asymptomatic, contributes to
heart attack
• Primary
– Unknown cause
• Secondary
– Known cause

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Hypotension
• Blood pressure below normal
• Orthostatic hypotension
– Blood pressure that decreases when client
sits, stands
• Can be caused by analgesics, bleeding,
severe burns, and dehydration

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A, Blood pressure cuff and bulb; B, bladder inside
the cuff.

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Assessing Blood Pressure
• Sphygmomanometer
– Indicates pressure of air within the bladder
of the blood pressure cuff
– Aneroid or digital
• Doppler ultrasound
• Cuff and bladder sizes

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Standard cuff sizes: smaller cuffs are used for infants, small
children, or frail adults; midsize cuffs are used for most
adults; and larger cuffs are used for measuring the blood
pressure on the leg or arm of an adult who is obese.

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Determining that the bladder of a blood pressure cuff is 40%
of the arm circumference or 20% wider than the diameter of
the midpoint of the limb.

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Assessing Blood Pressure
• Sites
– Upper arm (brachial artery)
– Thigh (popliteal artery)
• Indicated when either arm cannot be measured
or when bp in both thighs needs to be
compared

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Assessing Blood Pressure
• Methods
– Direct (invasive monitoring)
– Indirect
– Korotkoff sounds
• Auscultatory
• Palpatory
– Auscultatory gap

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Korotkoff's sounds can be differentiated into five phases.
In the illustration the blood pressure is 138/90 or
138/102/90.

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Respiration

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Respiration
• Respiration is the act of breathing. Inhalation
or inspiration refers to the intake of air into
the lungs. Exhalation or expiration refers to
breathing out or the movement of gases from
the lungs to the atmosphere.

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Respirations
• Respiration
– The act of breathing
• Inhalation (inspiration)
• Exhalation (expiration)
• Ventilation
– Movement of air in and out of the lungs

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Respirations
• Costal (thoracic) breathing
– External intercostal muscles and other
accessory muscles
• Diaphragmatic (abdominal) breathing
– Contraction and relaxation of the
diaphragm observed by movement of the
abdomen

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Respiratory inhalation: left: lateral
view; right: anterior view.

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Respiratory exhalation: left: lateral
view; right: anterior view

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Mechanics and Regulation
of Breathing
• Inhalation
– Diaphragm contracts (flattens).
– Ribs move upward and outward.
– Sternum moves outward.
– Size of the thorax enlarges.

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Mechanics and Regulation
of Breathing
• Exhalation
– Diaphragm relaxes.
– Ribs move downward and inward.
– Sternum moves inward.
– Size of the thorax decreases.

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Mechanics and Regulation
of Breathing
• Respiration controlled by:
– Respiratory centers
• Medulla oblongata
• Pons
– Chemoreceptors
• Medulla
• Carotid and aortic bodies
– Both respond to O2, CO2, H+ in arterial
blood

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Assessing Respirations
• Be aware of the following:
– Client's normal breathing pattern
– Influence of the client's health problems
on respirations
– Medications, therapies that might affect
respirations
– Relationship of client's respirations to
cardiovascular function

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Assessing Respirations
• Rate
– Breaths per minute
– Eupnea
• Breathing normal in rate and depth
– Bradypnea (slow)
– Tachypnea (fast)
– Apnea
• Absence of breathing

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Factors Affecting
Respirations
• Exercise, stress, high environmental
temperature and low oxygen increase
respiratory rate.
• Low environmental temperature, some
medications, and increased intracranial
pressure decrease respiratory rate.

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Factors Affecting
Respirations
• Depth
– Normal
– Deep
– Shallow
• Tidal volume
– Volume of about 500 mL of air during a
normal inspiration/exhalation

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Factors Affecting
Respirations
• Hyperventilation
– Deep, rapid respirations
• Hypoventilation
– Shallow respirations
• Respiratory rhythm
– Regular
– Irregular
– Cheyne–Stokes breathing

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LUNG VOLUMES
• MINUTE VENTILATION (MV): MV 12 breaths/min 500 mL
/breath = 6 liters/min. total lung capacity.
• TIDAL VOLUME (TV): Volume inspired or expired with each
normal/breath. = 500 ml
• INSPIRATORY RESERVE VOLUME (IRV): Maximum volume
that can be inspired over the inspiration of a tidal volume/normal
breath. Used during exercise/exertion.= Male 3100 ml/ Female
1900 ml
• EXPIRATRY RESERVE VOLUME (ERV): Maximal volume that
can be expired after the expiration of a tidal volume/normal
breath. = Male 1200 ml/ Female 700 ml
• RESIDUAL VOLUME (RV): Volume that remains in the lungs
after a maximal expiration. Male 1200 ml/ Female 1100 ml

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LUNG VOLUMES
• Inspiratory capacity is the sum of tidal volume and
inspiratory reserve volume, IRV + TV (500 ml 3100 ml 3600
ml in males and 500 ml 1900 ml 2400 ml in females).
• Functional residual capacity is the sum of residual volume
and expiratory reserve volume, ERV + RV (1200 ml 1200 ml
2400 ml in males and 1100 ml 700 ml 1800 ml in females).
• Vital capacity is the sum of inspiratory reserve volume, tidal
volume, and expiratory reserve volume, IRV + TV + ERV =
IC + ERV (4800 ml in males and 3100 ml in females).
• Total lung capacity is the sum of vital capacity and residual
volume IRV+ TV + ERV + RV = IC + FRC (4800 ml 1200 ml
6000 ml in males and 3100 ml 1100 ml 4200 ml in females).

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BREATHING PATTERNS
Rate
• Tachypnea—quick, shallow breaths
• Bradypnea—abnormally slow breathing
• Apnea—cessation of breathing
Volume
• Hyperventilation—overexpansion of the lungs
characterized by rapid and deep breaths
• Hypoventilation—underexpansion of the lungs,
characterized by shallow respirations

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BREATHING PATTERNS
Rhythm
• Cheyne-Stokes breathing—rhythmic waxing and
waning of respirations, from very deep to very
shallow breathing and temporary apnea
Ease or Effort
• Dyspnea—difficult and labored breathing during
which the individual has a persistent, unsatisfied
need for air and feels distressed
• Orthopnea—ability to breathe only in upright sitting
or standing positions

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BREATH SOUNDS
Audible Without Amplification
• Stridor – a shrill, harsh sound heard during inspiration with
laryngeal obstruction
• Stertor – snoring or sonorous respiration, usually due to a
partial obstruction of the upper airway
• Wheeze – continuous, high-pitched musical squeak or
whistling sound occurring on expiration and sometimes on
inspiration when air moves through a narrowed or partially
obstructed airway
• Bubbling – gurgling sounds heard as air passes through
moist secretions in the respiratory tract

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CHEST MOVEMENTS
• Intercostal retraction – Indrawing between the ribs
• Substernal retraction – Indrawing beneath the breastbone
• Suprasternal retraction – Indrawing above the clavicles
SECRETIONS AND COUGHING
• Hemoptysis – the presence of blood in the sputum
• Productive cough – a cough accompanied by expectorated
secretions
• Nonproductive cough – a dry, harsh cough without
secretions

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Thank you