Vital signs (VS) are critical for assessing a patient's health, establishing baselines, and monitoring treatment responses, including temperature, pulse, respiration, and blood pressure. Trends in these vital signs can indicate changes in a patient's condition, guiding further diagnosis and interventions. Accurate measurement and recording are essential, considering individual patient factors such as age and chronic diseases.

1. Chapter 4
Vital Signs

2.  Vital signs (VS) are used to:
 Determine the general status of the patient
 Establish a baseline
 Monitor response to therapy
 Observe for trends
 Determine the need for further evaluation or
intervention
Overview
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3.  Four classic VS
 Temperature
 Pulse
 Respirations
 Blood pressure
 Additional observations
 Height and weight
 Level of consciousness and responsiveness (sensorium)
 Level and type of pain
 General clinical impression
 Pulse oximetry
 Electrocardiogram (ECG)
Obtaining VS and Clinical
Impression
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4.  Frequency
 Baseline measurement
 For acutely ill inpatients in the ICU
 Patients with conditions affecting only selected
organ systems
 Certain procedures may determine frequency
 VS should always be monitored and recorded as
often as necessary
VS Measurement
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5.  Isolated measurement provides limited
information
 Normal VS for a patient depends on:
 Age
 Presence of chronic disease
 Treatment protocols
 Trend = baseline + measurements over time
 Multiple-day graph
Monitoring Vital Sign Trends
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6.  Shows change in patient’s condition
 Comparing changes in VS, signs, and symptoms
 Establishing differential diagnosis
• Comparing multiple signs and symptoms to arrive at the
patient’s diagnosis
 Determining if patient is improving or deteriorating
 Key to expert assessment:
 Look at the patient, listen, touch, question, validate,
reassess, analyze, and trend
Comparing VS Information
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7.  Routinely measured
 If hospitalized = admission weight
 Document in kilograms (1 kg = 2.2 lb)
 Follow up every 24 to 48 h
 Dehydration or fluid overload
• Follow the intake/output (I&O) chart.
 Scales must be age-appropriate and regularly
calibrated
Height and Weight
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9.  Cardiopulmonary distress
 Anxiety
 Pain level and type
 The “fifth vital sign”
 Level of consciousness (Sensorium)
 oriented × 3
 Glasgow Coma Scale
 Temperature
The Clinical Impression
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10.  An elevation of body temperature above normal
(hyperthermia)
 From normal activities (exercise) = hyperthermia
 From disease (infection) = fever
 >102°F= 38.8 C usually indicates infection
 Not all infections result in fever
 Increases O2 consumption and CO2 production
 O2 consumption and CO2 production increase 10% for
each 1°C elevation in body temperature
 Patients with limited respiratory function may develop
respiratory failure in response to fever
Fever
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11.  Body temperature below normal
 Head injury
 Cold exposure
 Compensatory mechanisms
 Shivering from hypothalamus stimulation
 Peripheral vasoconstriction
 Reduces O2 consumption and CO2 production
 Slow and shallow breathing
• Mechanical ventilator settings may need significant adjustments in the depth and rate of
delivered tidal volumes as the body temperature of the patient varies above & below normal.
* Special respiratory interventions, such as heated aerosol, may be helpful in raising the body
temperature in hypothermic patients.
Hypothermia
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12.  Sites: the mouth, axilla,, ear or rectum
 Fahrenheit and Celsius conversion
 °F = (°C × 9/5) + 32
 °C = (°F − 32) × 5/9
Measuring Body Temperature
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Site Fahrenheit Celsius Time Required
Oral 97.0°-99.5° 36.5°-37.5° 3-5 min*
Axillary 96.7°-98.5° 35.9°-36.9° 9-11 min
Rectal 98.7°-100.5° 37.1°-38.1 2-4 min
Ear Expected to be very close to rectal if measured correctly
*Wait 15 minutes after eating or drinking.

13.  Evaluate:
 Rate, rhythm, and strength
 Normal rate: 60 to 100 beats/min for adults
 Tachycardia = >100 beats/min
 Bradycardia = <60 beats/min
 Arrhythmia: irregular rhythms
 Measurements of pulse rate
 Right radial artery = Most common site
Pulse
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14.  Rhythm: means Relative equality of the intervals between beats
 Regular, regularly irregular, and irregularly irregular
 Bigeminy: beat-beat-pause
 Trigeminy: beat-beat-beat-pause
 Pulse deficit: The difference between the number of auscultated beats and
peripheral
 pulse beats.
 Volume of the pulse: There are slight variations in numeric systems used
to describe pulses; some scales are 0 to 3, others are 0 to 4, and some rating systems add
plus signs (+)
 Pulsus paradoxus: When the systolic pressure drops more than 10 mm Hg
during inhalation at rest because of respiratory muscles movement indicates respiratory
conditions such as asthma and cardiac tamponade.
 Pulsus alternans: is an alternating succession of strong and weak pulses
and usually is not related to respiratory disease but vascular resistance issues.
Pulse Rhythm and Pattern
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15.  Vary by age and condition
 How to measure
 Assess depth and pattern
 Can be done as you assess radial pulse
 Tachypnea
 Bradypnea
Respiratory Rate and Pattern
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16.  Force exerted against arterial walls
 Systolic: peak force during ventricular contraction
 Diastolic: force during ventricular relaxation
 Normal
 Pulse pressure
 Measurement
 Sphygmomanometer
 Indirect measurement
 Length of the bladder
 Korotkoff sounds
Blood Pressure (BP)
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17. Hypertension and Hypotension
 Hypertension
 BP of >140/90 mm
Hg
• Risk factor for heart,
vascular, renal
disease
• Major modifiable risk
factor for stroke,
CAD, CHF, peripheral
vascular disease
• Cause in most cases
is unknown
 Hypotension
 BP of <90/60 mm Hg
• If symptomatic:
dizziness, fainting
• Causes: left
ventricular failure,
blood loss, peripheral
vasodilation
• Orthostatic
hypotension: resulting
from changes in
posture
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18. Errors in Blood Pressure
Measurement
 Erroneously high
 Too narrow a cuff
 Cuff applied too
tightly or too loosely
 Excessive pressure
in cuff during
measurement
 Incomplete deflation
of cuff between
measurements
 Erroneously low
 Too wide a cuff
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19.  Systolic pressure decreases (2 to 4 mm Hg) with
inspiration
 Pulsus paradoxus: if BP drops >10 mm Hg
 Asthma, cardiac tamponade are two common causes
 Pulsus paradoxus in asthma signifies a more severe
case
Effects of the Respiratory
Cycle on BP
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