it nclude vital signs monitoring

1. Nursing Skills (Vital Signs)
Prepared by:
AINA KHAN
BSN,RN
M.Phil in PublicHealth *

2. Objectives
1. Define Vital Signs.
2. Define terms related to Vital sign.
3. Describe the physiological concept of temperature, respiration
and blood pressure.
4. Describe the principles and mechanisms for normal
thermoregulation in the body.
5. Identify ways that affect heat production and heat loss in the
body.
6. Define types of body temperature according to its characteristics
7. Identify the sign and symptoms of fever.

3. Objectives
8. Discuss the normal ranges for temperature, pulse, respiration and
9. Blood pressure
10. List the factors affecting temperature, pulse, respiration.
11. Describe the characteristics of pulse and respiration.
12. List factors responsible for maintaining normal blood pressure.
13. Describe various methods and sites used to measure T.P & B.P.
14. Recognize the signs of alert while taking TPR and B.P

4. Vital Signs
• The vital or cardinal signs are measurements of the body’s
most basic functions. The main vitals routinely monitored by
medical professionals and health care providers include:
1. Body temperature
2. Pulse
3. Respirations
4. Blood pressure
5. Pain degree

6. Body Temperature
Body temperature reflects the balance
between the heat produced and the heat lost
from the body, and is measured in heat units
called degrees.
There are two kinds of body temperature:
core
1. Core temperature is the temperature of
the deep tissues of the body.
2. Surface temperature is the temperature
of the skin, the subcutaneous tissue, and
fat.

7. Physiological Concept of
Temperature
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.
The body continually produces heat as a by-product of
metabolism. When the amount of heat produced by the body
equals the amount of heat lost, the person is in heat balance.

8. Heat Loss
Heat is lost from the body through following mechanism:
1. Radiation
2. Conduction
3. Convection
4. Evaporation.
 Radiation- is the transfer of heat from the surface of one
object to the surface of another without contact between the
two objects, mostly in the form of infrared rays.
 Conduction- is the transfer of heat from one molecule to a
molecule of lower temperature
.

9. Heat Loss
 Convection- is the dispersion of heat by air currents.
 Evaporation – conversion of liquid to a vapor
 Insensible water loss- This continuous and unnoticed water
loss
 Insensible heat loss- continuous heat loss
When the body temperature increases, vaporization accounts for
greater heat loss.

10. Factors that affect Heat
Production
1. Basal metabolic rate
The basal metabolic rate (BMR) is the
rate of energy utilization in the body
required to maintain essential
activities such as breathing. Metabolic
rates decrease with age. In general, the
younger the person, the higher the
BMR.
2. Muscle activity
Muscle activity, including shivering,
increases the metabolic rate.

11. Factors that affect Heat
Production
3. Thyroxin output
Increased thyroxin output increases the rate of
cellular metabolism throughout the body.
4. Epinephrine, norepinephrine, and
sympathetic stimulation/ stress response
These hormones immediately increase the rate
of cellular metabolism in many body tissues.

12. Factors that affect Heat
Production
5. Fever.
Fever increases the cellular
metabolic rate and thus increases
the body’s temperature further.

13. Alterations in Body Temperature
The normal range for adults is considered to be between 36°C
and 37.5°C (96.8°F to 99.5°F). There are two primary alterations
in body temperature:
1. Pyrexia
2. Hypothermia
1. Pyrexia
 A body temperature above the usual range is called pyrexia,
hyperthermia , or (in lay terms) 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 is afebrile.

15. TYPES OF FEVER
Four common types of fevers are
1. Intermittent
2. Remittent
3. Relapsing,
4. Constant.
1. Intermittent fever- During an intermittent fever, the body
temperature alternates at regular intervals between periods of
fever and periods of normal or subnormal temperatures.`
2. Remittent fever- During a remittent fever, such as with a
cold or influenza, a wide range of temperature fluctuations
(more than 2°C [3.6°F]) occurs over a 24-hour period.

16. TYPES OF FEVER
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
above normal. This can occur with typhoid fever.
Fever spike -A temperature that rises to fever level
rapidly following a normal temperature and then returns
to normal within a few hours is called a fever spike.
Bacterial blood infections often cause fever spikes.

19. HYPOTHERMIA
Hypothermia is a core body
temperature below the lower limit
of normal.
The three physiological
mechanisms of hypothermia are
(a) excessive heat loss
(b) inadequate heat production
to counteract heat loss
(c) impaired hypothalamic
thermoregulation.

22. Common sites for measuring
body temperature
Oral
Axillary
Rectal
Tympanic Membrane
Temporal Artery

24. Types of Thermometer

27. Assessing Pulse
The pulse is a wave of blood created by contraction of the left
ventricle of the heart. Generally, the pulse wave represents the
stroke volume output.
Pulse Rate
The number of pulsation felt over a peripheral artery or heard
over apex of heart in one minute.
Peripheral pulse
A peripheral pulse is a pulse located away from the heart, for
example, in the foot or wrist.
Apical pulse
The apical pulse, 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).

28. Stroke volume
the amount of blood that enters the arteries with each ventricular
contraction.
The average amount of blood per contraction is 70ml in adult
Cardiac Output
The amount of blood pumped per minute.
Cardiac output = stroke volume x Pulse Rate
For example
If stroke volume is 70ml and pulse rate is 72 b/min
Then the cardiac output is 5000 ml.

29. Factors Affecting the Pulse
Age
As age increases, the pulse rate gradually decreases overall.
Sex
After puberty, the average male’s pulse rate is slightly lower
than the female’s.
Exercise
The pulse rate normally increases with activity.
Fever
The pulse rate increases (a) in response to the lowered blood
pressure that results from peripheral vasodilation associated
with elevated body temperature and (b) because of the increased
metabolic rate.

30. Factors Affecting the Pulse
Medications
Some medications decrease the pulse rate, and others
increase it.
Hypovolemia /dehydration
Loss of blood from the vascular system increases the
pulse rate
Stress
In response to stress, sympathetic nervous stimulation
increases the overall activity of the heart. Stress increases
the rate as well as the force of the heartbeat.

31. Factors Affecting the Pulse
Position
When a person is sitting or standing, blood
usually pools in dependent vessels of the
venous system. Pooling results in a transient
decrease in the venous blood return to the
heart and a subsequent reduction in blood
pressure and increase in heart rate.
Pathology
Certain diseases such as some heart
conditions or those that impair oxygenation
can alter the resting pulse rate

32. Pulse Site

33. Other terminologies related to
Pulse
When assessing the pulse, the nurse collects the following data:
The rate, rhythm, volume, arterial wall elasticity, and
presence or absence of bilateral equality.
Tachycardia
An excessively fast heart rate (e.g., over 100 beats/min in an
adult) is referred to as tachycardia.
Bradycardia
A heart rate in an adult of less than 60 beats/min is called
bradycardia.
Pulse rhythm
The pulse rhythm is the pattern of the beats and the intervals
between the beats

34. Other terminologies related to
Pulse
Dysrhythmia
A pulse with an irregular rhythm is referred to as a
dysrhythmia or arrhythmia.
Pulse volume
Pulse volume, also called the pulse strength or amplitude,
refers to the force of blood with each beat.

35. Methods of assessing the Pulse
The middle 3 fingers maybe used to palpate all pulse sites
expect apical pulse
The use of Stethoscope for Apical Pulse.
A Dopler Ultrasound may be used to assess pulses that are
difficult to palpate or auscultate
Cardiac Monitor
Pulse deficit- The difference between the apical and radial
pulse rate

36. Respiration

37. 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.
Ventilation- is also used to refer to the movement of air in
and out of the lungs.
There are basically two types of breathing:
1. Costal (thoracic) breathing
2. Diaphragmatic (abdominal) breathing.

38. Types of Breathing
1. Costal breathing -It can be observed
by the movement of the chest upward
and outward.
2. Diaphragmatic breathing -involves
the contraction and relaxation of the
diaphragm, and it is observed by the
movement of the abdomen, which
occurs as a result of the diaphragm’s
contraction and downward movement

39. Mechanics and Regulation of
Breathing
During inhalation –The diaphragm
contracts(Flattens),the ribs moves upward and outward
sternum moves outward, thus enlarging the thorax and
permitting the lungs to expand.
During exhalation- the diaphragm relax, the ribs move
downward and inward and the sternum moves inward
An adult inspiration lasts 1 to 1.5 seconds and expiration
last 2 to 3 second

40. Factors Affecting Respirations
Exercise
Respiratory and
Cardiovascular diseases
Medication
Trauma
Infection
Pain
Stress and Anxiety
Alteration in fluid, electrolyte
and Acid base balance
Increase environmental
temperature

41. Assessing Respirations
Before assessing a client’s respirations, a nurse should be
aware of the following:
1. The client’s normal breathing pattern
2. The influence of the client’s health problems on
respirations
3. Any medications or therapies that might affect
respirations
4. The relationship of the client’s respirations to
cardiovascular function.

42. Terminologies related to
Respiration
Respiratory rate- breaths per minute.
Eupnea-Breathing that is normal in rate and depth is
called eupnea.
Bradypnea- Abnormally slow respirations are referred to
as bradypnea.
Tachypnea -abnormally fast respirations are called
tachypnea.
Apnea -is the absence of breathing
Tidal volume- The volume of air displaced between
normal inhalation and exhalation when extra effort is not
applied.

43. Terminologies related to
Respiration
Hyperventilation- refers to very deep, rapid respirations
Hypoventilation- refers to very shallow respirations.
Respiratory rhythm-Refers to the regularity of the expirations and
the inspirations.
Deep Respiration-are those in which a large volume of Air is
inhaled and exhaled, Inflating most of lungs.
Shallow Respiration- Involves the exchange of small volume of Air
and often minimal use of lung tissue.
Dyspnea- Difficult and Labored breathing.
Orthopnea-Ability to breath only in upright sitting or standing
position

44. BLOOD PRESSURE

45. Blood Pressure
Arterial blood pressure is a
measure of the pressure exerted by the
blood as it flows through the arteries.
The Systolic pressure is the
pressure of the blood as a result of
contraction of the ventricles
The Diastolic pressure is the
pressure when the ventricles are at
rest.
The difference between the diastolic
and the systolic pressures is called
Pulse Pressure.

47. Factors Affecting Blood Pressure
Age
Exercise
Stress
Race
Temperature
Sex
Medication
Obesity

48. Alteration in Blood Pressure
Hypertension
A blood pressure that is persistently above normal is called
hypertension.
An elevated blood pressure of unknown cause is called
primary hypertension.
An elevated blood pressure of known cause is called
secondary 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. It is usually the result of
peripheral vasodilation

49. Methods
Blood pressure can be assessed
1. Directly
2. Indirectly
1. Direct Method- Direct (invasive monitoring)
measurement involves the insertion of a
catheter into the brachial, radial, or femoral
artery. Arterial pressure is represented as
wavelike forms displayed on a monitor.
2. Indirect Method- Two noninvasive indirect
methods of measuring blood pressure
a) Auscultatory
b) Palpatory methods.

50. When taking a blood pressure using a stethoscope, the
nurse identifies phases in the series of sounds called
Korotkoff’s sounds
Auscultatory gap is the temporary disappearance of
sounds normally heard over the brachial artery.
 when the cuff pressure is high followed by the
reappearance of the sounds at a lower level.