Fundamental of nursing unit number 5 Vital signs

1. Nursing Skills (Vital Signs)
Misbah Khan
Lecturer DIONAM,DUHS
Unit V

2. Objectives
At the completion of this unit learnerswill be able to:
▪ Define Vital Signs.
▪ Define terms related to Vital sign.
▪ Describe the physiological concept of temperature,respiration and bloodpressure.
▪ Describe the principles and mechanisms for normal thermoregulationin the body
▪ Identify ways that affect heat productionand heat loss in the body.
▪ Define types of body temperatureaccording to its characteristics.
▪ Identify the sign and symptoms of fever.
▪ Discuss the normal ranges for temperature, pulse, respiration and bloodpressure.
▪ List the factors affecting temperature, pulse, respiration.
▪ Describe the characteristics of pulse and respiration.
▪ List factors responsiblefor maintaining normal blood pressure.
▪ Describe various methods and sites used to measure T.P & B.P.
▪ Recognize the signs of alert while taking TPR and B.P.

3. Vital Sign
• Vital signs are the “signs of life,” providing a way of connecting
the external inspection with the internal functioning of the client’s
organs.
• This is also known as cardinal signs

4. Vital Signs or Cardinal Signs are:
• Body temperature
• Pulse
• Respiration
• Blood pressure
• Pain

5. Body Temperature

6. Body Temperature
• Body temperature is the balance between heat produced in the
body and heat loss from the body.
• Body temperature is measured in heat units called degrees.

7. Mechanisms For Normal Thermoregulation

8. • Heat is lost from the body through:
– Conduction
– Convection
– Radiation
– Evaporation
Mechanisms For Normal Thermoregulation
(Heat Loss)
Conduction: Conduction is the process of losing heat through
physical contact with another object or body. For example, if you
were to sit on a metal chair, the heat from your body would transfer to
the cold metal chair.

9. • Convection: the process of losing heat through the movement
of air or water molecules across the skin. The use of a fan to
cool off the body is one example of convection.
• Radiation: This involves the transfer of heat from one object to
another, with no physical contact involved. For example,
infrared rays, the sun transfers heat to the earth through
radiation.
• Evaporation: the process of losing heat through the conversion
of water to gas (evaporation of sweat).
The primary heat loss process for aqua enthusiastsis convection,
however, in an outdoorpool on hot day evaporationwill also play a
primary role in heat loss.

12. Types of Temperature
• Core Temperature
Temperature of the deep tissues of the body such as abdominal or
pelvic cavities. It is relatively constant
• Surface Temperature
Temperature of the skin and subcutaneous tissue. It fluctuates
depending on the blood supply to the skin and the amount of heat
loss to the external environment.

13. Regulation of Body Temperature
• The system that regulates body temperature has three main parts:
➢ Sensors in the periphery and in the core
➢ An integrator in the hypothalamus
➢ An effector system that adjusts the production and loss of heat.
Most sensors or sensory receptors are in the skin. The skin has more
receptors for cold than warmth. Therefore, skin sensors detect cold
more efficiently than warmth. When the skin becomes chilled over
the entire body, three physiological processes to increase the body
temperature take place:
1. Shivering increases heat production.
2. Sweating is inhibited to decrease heat loss.
3. Vasoconstriction decreases heat loss.

14. Behavioral
• When an individual perceives he is hot or cold, he
changes his behavior such as:
– Moves to the shade or sun
– regulates the thermostat
– removes extra clothes or puts on sweater.

15. • The normal range for adults is
considered to be between 36°C
and 37.5°C (96.8°F to 99.5°F).

16. • A body temperature above the usual range is called
pyrexia, hyperthermia, or fever.
• A very high fever, such as 41°C (105.8°F), is called
hyperpyrexia
• The client who has a fever is referred to as febrile
• the one who does not have fever is referred as afebrile
• Hypothermia is a core body temperature below the lower
limit of normal

17. Types of Fever Pattern
• Intermittent Fever: Temperature returns to acceptable value at
least once in 24 hours. The temperature curve returns to normal
during the day and reaches its peak in the evening. E.g.- malaria.
• Remittent Fever: fever spikes & falls without a return to the
normal temperature levels. The temperature fluctuates but does not
return to normal. E.g.- TB, viral diseases, bacterial infections
• Constant Fever: the temperature remains continuously elevated
above 38 degree Celsius & demonstrates little fluctuation.
• Relapsing Fever: short febrile periods of a few days are
interspersed with periods of 1 or 2 days of normal temperature

18. CLINICALMANIFESTATIONS OF FEVER
1. ONSET(COLD OR CHILLPHASE)
• Increased heart rate & respiratory rate
• Shivering
• Complaintsof feeling cold
• Cyanotic nail beds
• “Gooseflesh” appearanceof the skin
• Cessation of sweating
2. COURSE(PLATEAU PHASE)
• Absence of chills
• Skin that feels warm
• Photosensitivity
• Increased pulseand respiratoryrates
• Increased thirst
• Drowsiness, restlessness, delirium,
or convulsions
• Loss of appetite
• Malaise, weakness, and aching
muscles
3. DEFERVESCENCE (FEVER
ABATEMENT/FLUSH PHASE)
• Skin that appears flushed and feels
warm
• Sweating
• Decreased shivering
• Possible dehydration

20. Sites for checking Temperature
• Oral
• Rectal
• Axillary
• Tympanic membrane
• Temporal artery.

21. Pulse

22. 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.
• Compliance of the arteries is their ability to contract and
expand. When a person’s arteries lose their dispensability, as
can happen with age, greater pressure is required to pump the
blood into the arteries

23. Pulse
• The pulse is a wave of blood created by contraction of the left
ventricle of the heart
• The rate of the pulse is expressed in beats per minute
(beats/min)

24. Pulse Sites
A pulse may be measured in nine sites

25. Pulse site
➢ Temporal – forehead
➢ Carotid– neck
➢ Apical -above the apex of heart
➢ Brachial – inner, upper arm
➢ Radial– wrist
➢ Femoral – groin
➢ Popliteal– behind knee
➢ Posteriortibialis– behind inner ankle
➢ Dorsalispedis – top of foot

26. Characteristics of pulse
• Rate
• Rhythm
• Volume

27. Rate
• Tachycardia : An excessively fast heart rate i.e., over 100
beats/min in an adult
• Bradycardia: A heart rate in an adult of less than 60
beats/min.
Number of beats per minute

28. Rhythm
➢ Regular rhythm - interval between heartbeats same.
➢ Irregular rhythm - interval between heartbeats different.
• If an irregularity is present, the pulse should be counted for
one full minute.
Rhythm refers to the regularity of beats.
• the pattern of the beats and the intervals between the beats.

29. Volume
Volume depends upon the amount of blood in the arteries.
• If the arteries contain a large volume of blood---- full or
Bounding in volume.
• If the arteries contain a norm volume of blood ---- satisfactory/
Normal/Strong.
• If the volume of the blood is decreased (as by shock, or loss of
fluid from the body, e.g., diarrhea and vomiting) ---- small weak
pulse or thready.
The force of blood with each beat
• Volume refers to the fullness of the artery.
• also called the pulse strength or amplitude
3+ Full, bounding
2+ Normal/strong
1+ Weak, thready
0 Absent/non-
palpable

30. Factors that Influence Pulse Rate
• Age.
• Exercise.
• Fever.
• Medications.
• Hypovolemia /dehydration..
• Stress
• Position
• Pathology.

31. Normal range of Pulse and Respiration

32. Respiration

33. Respiration
• Respiration is the act of breathing.
• The mechanical act of breathing in air (inspiration) and
expelling air (expiration) from the body
• Ventilation is also used to refer to the movement of air in and
out of the lungs.
➢Inhalation or inspiration---- intake of air into the lungs.
➢Exhalation or expiration ---- breathing out or the movement of
gases from the lungs to the atmosphere.

34. Types of Breathing
• There are basically two types of breathing:
1. Costal (thoracic) breathing: involves the external
intercostal muscles and other accessory muscles. It can be
observed by the movement of the chest upward and outward.
2. Diaphragmatic (abdominal) breathing: involves the
contraction and relaxation of the diaphragm, and it is
observed by the movement of the abdomen.

35. Physiology of Breathing
• During inhalation
– The diaphragm contracts (flattens), the ribs move
upward and outward, and the sternum moves
outward, thus enlarging the thorax and permitting
the lungs to expand.

36. • During exhalation
– the diaphragm relaxes, the ribs move downward and
inward, and the sternum moves inward, thus decreasing the
size of the thorax as the lungs are compressed.
• Normal breathing is automatic and effortless
Physiology of Breathing

37. Terms related to Respiration
• Tachypnea—quick, shallow breaths
• Bradypnea—abnormally slow breathing
• Apnea—cessation of breathing
• Hyperventilation— overexpansion of the lungs characterized by
rapid and deep breaths
• Hypoventilation— underexpansion of the lungs, shallow
respirations
• Cheyne-Stokes breathing —rhythmic waxing and waning of
respirations, from very deep to very shallow breathing and
temporary apnea
• Dyspnea—difficult and labored breathing
• Orthopnea—ability to breathe only in upright sitting or standing
positions

38. Blood Pressure

39. BLOOD PRESSURE
• Arterial blood pressure is a measure of the pressure exerted by the
blood as it flows through the arteries.
• Blood pressure is a measure of the force that your heart uses to
pump blood around your body.
• Blood pressure is measured in millimeters of mercury (mmHg)
and recorded as a fraction: systolic pressure over the diastolic
pressure.

40. Blood Pressure Measurement
• The blood moves in waves, there are two blood pressure
measurements.
➢Systolic Pressure: is the pressure of the blood as a result of
contraction of the ventricles, that is, the pressure of the
height of the blood wave.
➢Diastolic Pressure: is the pressure when the ventricles are
at rest between beats .
For example, if your blood pressure is "140 over 90" or
140/90mmHg, it means you have a systolic pressure of 140mmHg
and a diastolic pressure of 90mmHg.

41. Pulse Pressure :
• The difference between the diastolic and the systolic pressures
is called the pulse pressure.
• A normal pulse pressure is about 40 mmHg but can be as high
as 100 mmHg during exercise.
• A typical blood pressure for a healthy adult is 120/80 mmHg
(pulse pressure of 40).
• Because blood pressure can vary considerably among
individuals, it is important for the nurse to know a specific
client’s baseline blood pressure.

42. Terms Related to Blood Pressure
• Hypertension
A blood pressure that is persistently above normal is called
hypertension
• Hypotension
Hypotension is a blood pressure that is below normal
• Orthostatic
Hypotension is a blood pressure that decreases when the client
sits or stands.

43. Factors Affecting Blood Pressure
• Age
• Exercise
• Stress
• Race
• Gender
• Medications
• Obesity
• diurnal variations
• medical conditions
• temperature.

44. Blood Pressure Assessment Sites
• The blood pressure is usually assessed in the client’s upper
arm using the brachial artery and a standard stethoscope.
• Assessing the blood pressure on a client’s thigh is indicated in
these situations:
– The blood pressure cannot be measured on either arm (e.g.,
because of burns or other trauma).
– The blood pressure in one thigh is to be compared with the
blood pressure in the other thigh.

45. • Blood pressure is not measured on a particular client’s limb in
the following situations:
– The shoulder, arm, or hand (or the hip, knee, or ankle) is
injured or diseased.
– A cast or bulky bandage is on any part of the limb.
– The client has had surgical removal of breast or axillary (or
inguinal) lymph nodes on that side.
– The client has an intravenous infusion or blood transfusion
in that limb.
– The client has an arteriovenous fistula (e.g., for renal
dialysis) in that limb.
Contraindication for Blood Pressure
Assessment Sites

48. References
• Berman, A., Snyder, S., Kozier, B., & Erb, G. L. (2020). Kozier
and Erb's fundamentals of nursing, volumes 1-3 (10th ed.).
• White, L., Duncan, G., & Baumle, W. (2010). Foundations of
adult health nursing (3rd ed.). Cengage Learning