The complete vital signs by a Nurse for every patient at every contact ranging from first contact at the out-patient department to the assessment of residents on admission.

1. THE VITAL SIGNS
NR. SAMBO, NICKY MARIAH
LECTURER JOS UNIVERSITY TEACHING
HOSPITAL

2. OUTLINE
• Introduction
• Types of vital signs
• Body Temperature.
• Pulse Rate.
• Respiration Rate.
• Blood Pressure.
• Blood Oxygen.
• Blood Glucose Level
• Height and Weight. (BMI)
• Urinalysis
• Pupil Size
• Conclusion.

3. INTRODUCTION TO VITAL SIGNS
• Vital signs are parameters that 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.
• It should be recorded and or noted and reported
incase of abnormally.

4. The Vital Signs
• Body Temperature.
• Pulse Rate.
• Respiration Rate.
• Blood Pressure.
• Blood Oxygen.
• Blood Glucose Level.
• BMI.
• Urinalysis

5. TEMPERATURE
• It’s the degree of hotness or coldness of the body
using thermometers
• The normal body temperature of a person varies
depending on gender, recent activity, oral
consumption, time of day, and in women, the
stage of the menstrual cycle.
• Normal body temperature can range from
97.8 degrees F (or Fahrenheit, equivalent to 36.5
degrees C, or Celsius) to 99 degrees F (37.2
degrees C) for a healthy adult.

6. Body temperature can be taken in any
of the following ways:
Orally
Rectally
Axillary
Ear
Skin

7. Abnormality of body temperature
• Hyperthermia: A fever is indicated when body
temperature rises about one degree or more
over the normal temperature of 98.6 degrees
Fahrenheit.
• Hypothermia: Hypothermia is defined as a drop
in body temperature below 95 degrees
Fahrenheit.

8. PULSE
• The pulse rate is a measurement of the heart
rate, i.e., times the heart beats per minute.
• Taking a pulse not only measures the heart rate,
but also can indicate the following:
Heart rhythm
Strength of the pulse
• The normal pulse for healthy adults ranges from
60 to 100 beats per minute.

9. Factors that affect pulse rate
• Exercise,
• Illness,
• Injury,
• Emotions.
• Females ages 12 and older, tend to have faster
heart rates than do males.
• Athletes, who do a lot of cardiovascular
conditioning, may have heart rates near 40 beats
per minute and experience no problems e.g
runners.

10. The Pulse Points And Their Locations
Places on the body where it is possible to feel the
arterial pulse are close enough to the surface of the skin
also called pulse points.
• Carotid.
• Radial.
• Apical.
• Femoral.
• Popliteal.
• Temporal.
• Brachial.
• Posterior Tibial.
• Dorsalis Pedis

11. What to assess in pulse
• Rate: A normal rate for an adult is between 60-100
beats per minute. However, depending on patient
history this may differ. Therefore, it is important to
watch a pulse rate trend over time.
• Rhythm: Patients without underlying arrhythmias
should have a regular pulse.
• Symmetry: Pulse strength should be equal
bilaterally.
• Contour: The pulse should feel smooth and
wavelike
• Strength: Normal pulses should be easily felt with
gentle palpation

12. How to describe pulse
• The pulse strength is described either
numerically or by using a descriptions of;
• 4+ (bounding),
• 3+ (increased),
• 2+ (normal),
• 1 + (weak),
• 0 (absent).
• Pulses that are stronger or weaker than normal
may be signs of underlying pathology.

13. RESPIRATION
• The respiration rate is the number of breaths a
person takes per minute.
• Oxygen from the outside environment to the cells
within tissues, and the removal of carbon dioxide
in to the environment.
• The rate is usually measured when a person is at
rest and simply involves counting the number of
breaths for one minute by counting how many
times the chest rises and fall.
• Normal respiration rates for an adult person at rest
range from 12 to 16 breaths per minute.

14. Variations in respiration
• Apnea,
• Orthopnea,
• Dyspnea hyperpnea,
• Hypoventilation,
• Hyperventilation,
• Tachypnea,
• Kussmaul respiration,
• Cheyne-Stokes
respiration,
• Sighing respiration,
• Eupnea,
• Biot respiration,
• Apneustic breathing,
• Central neurogenic
hyperventilation, and
• Central neurogenic
hypoventilation.

15. Causes of changes in respiration
• Respiration rates may increase with fever,
disease conditions of the heart or lungs, and
emotional conditions.
• When checking respiration, it is important to
also note whether a person has any difficulty
breathing.

16. BLOOD PRESSURE
• Blood pressure is the force of blood pushing
against blood vessel walls. It’s measured in
millimeters of mercury (mm Hg).
• A blood pressure reading
is the measurement of the
force of blood against the
walls of the arteries as the
heart pumps blood
through the body.

17. BLOOD PRESSURE CONT..,
• Blood pressure is typically expressed as the
reflection of two numbers, systolic pressure and
diastolic pressure.
• The systolic blood pressure is the maximum
pressure on the arteries during ventricular
contraction. Systole causes the ejection of blood
out of the ventricles and into the aorta and
pulmonary arteries.
• The diastolic blood pressure is the resting pressure
on the arteries during diastole, when the ventricles
are filling with blood

18. BLOOD PRESSUREREADINGS
• Blood pressure measurements are obtained using a stethoscope and
a sphygmomanometer.
• For a manual blood pressure reading, the blood pressure cuff is placed
around a patient’s extremity, and a stethoscope is placed over an proximal
artery.
• For most blood pressure readings, the cuff is usually placed around the
upper arm, and the stethoscope is placed over the brachial artery. The cuff
is inflated to constrict the artery until the pulse is no longer palpable, and
deflated gradually.
• AHA recommends the blood pressure cuff be inflated at least 30 mmHg
above the point at which the radial pulse is no longer palpable. The first
appearance of sounds, called Korotkoff sounds, are noted as the systolic
blood pressure reading.
• The blood pressure cuff continues to be deflated until Korotkoff sounds
disappear. The last Korotkoff sounds reflect the diastolic blood pressure
reading.
• It is important to deflate the cuff slowly, at least 2-3 mmHg per second to
ensure the absence of pulse is noted promptly and the reading is accurate.
• Blood pressure readings are documented as systolic blood
pressure/diastolic pressure, example, 120/80 mmHg.

19. Sizes of Blood Pressure Cuffs
• There are various sizes of blood pressure cuffs. An
undersized cuff will cause an artificially high blood
pressure reading, and an oversized cuff will
produce an artificially low reading.
• The width of the cuff should be 40% of the person’s
arm circumference, and the length of the cuff’s
bladder should be 80–100% of the person’s arm
circumference.
• NOTE: only about half of the blood pressure cuff is
the bladder and the other half is cloth with a hook
and loop fastener to secure it around the arm.

20. Automatic Blood Pressure Equipment
• Automatic blood pressure monitors are often used in health
care settings to efficiently measure blood pressure for
multiple patients or for a single patient’s blood pressure at a
specific frequency such as every 10-15 minutes.
• Process: appropriately position the patient and place the
correctly sized blood pressure cuff on their bare arm or
other extremity. Press the start button on the monitor.
• The cuff will automatically inflate and then deflate at a rate
of 2 mmHg per second. The monitor digitally displays the
blood pressure reading when done.
• If the blood pressure reading is unexpected, it is important
to follow up by obtaining a reading using a manual blood
pressure cuff.
• Additionally, automatic blood pressure monitors should not
be used if the patient has a rapid or irregular heart rhythm,
such as atrial fibrillation, or has tremors as it may lead to an
inaccurate reading.

22. THE PARTS OF STETOSCOPE AND
SPHYGMOMANOMETRE

23. Determinants of blood pressure
• Cardiac output.
• Blood volume.
• Total peripheral resistance.
• Viscosity of the blood,
• The elasticity of vessel walls

24. VARIATIONS IN BLOOD PRESSURE
• Hypertension
• systolic blood pressure greater
than 130 mmHg or a diastolic
blood pressure greater than 80
mmHg
• ‘Silent killer,' rarely shows
symptoms.
• Common among African-
American, >55yrs, overweight,
inactive, heavy alcoholics and
smokers.
• Monitoring blood pressure by
understanding whether high
blood pressure, heart disease, or
diabetes runs in the family.
• The Nurse will calculate an
average blood pressure based on
two or more blood pressure
readings obtained on two or
more occasions. Before
diagnosing the patient
• Hypotension
• Blood pressure reading of 90/60
mmHg or lower.
• Hypotension can be of significant
concern because of the potential
lack of perfusion to critical
organs.
• it may be associated with age,
pregnancy, hormonal problems
,some over the counter
medications, heart failure or
arrhythmias, widening of blood
vessels, heat exhaustion, heat
stroke, or liver disease.
• To Combat hypotension; eat a
diet higher in salt, staying
hydrated with nonalcoholic
beverages, and exercising
regularly.

25. Orthostatic Hypotension
• Orthostatic hypotension (postural hypotension) is a drop in blood
pressure that occurs when changing from a supine or seated position
to upright position. It is a decrease in blood pressure by at least 20
mmHg systolic or 10 mmHg diastolic within 3 minutes of standing.
• Gravity moves blood from the upper body to the lower limbs,
resulting in a temporary reduction of blood in the upper body for the
heart to pump, which decreases blood pressure. The body halt force
of gravity and maintains stable blood pressure and blood flow
normally.
• Transient drop in BP goes unnoticed in most people. In some clients
with orthostatic hypotension may experience light-headedness,
dizziness, or fainting. This is a significant safety concern because of
the increased risk of falls and injury, particularly in older adults.
• When obtaining orthostatic vital signs, the pulse rate may also be
collected. If the pulse increases by 30 beats/minute or more while
the patient stands /sits , this indicates a significant change.

26. Orthostatic Vital Signs
• Have the patient stand upright for 1 minute if capable
• Obtain the blood pressure measurement while the patient
stands using the same arm and the same equipment as
previous measurement that was taken with patient lying or
sitting.
• Obtain the radial pulse again.
• Repeat the blood pressure and radial pulse measurements
again at 3 minutes. Waiting several minutes before
repeating the measurements allows time for the autonomic
nervous system to compensate for blood volume shifts after
position change in the patient without orthostatic
hypotension.
• If the patient has symptoms that suggest orthostatic
hypotension but doesn’t have documented orthostatic
hypotension, repeat blood pressure measurement.
• NOTE: some patients may not demonstrate significant falls
in blood pressure until they stand beyond 3 minutes

28. Oxygen Saturation
• Oxygen saturation is the measure of how much
oxygen is traveling through the body in red
blood cells.
• Normal oxygen saturation for healthy adults is
usually between 95% and 100%

29. How to Measure Oxygen Saturation
• Oxygen saturation is measured in one of two ways:
• Arterial blood gas test (ABG or Sa02) or
• Pulse oximetry (Sp02).
• ABG is usually only done in a hospital, while pulse
oximetry can be done even at home.
ABG
• An ABG value refers to the levels of oxygen and
carbon dioxide in blood running through the veins.
• During an ABG, blood from an artery, such as the
radial or femoral in the wrist or the groin.
• The sample is immediately analyzed.

30. Pulse Oximetry
• A pulse oximetry reading reflects the percentage of
oxygen saturation in arterial blood.
• Unlike the ABG test, pulse oximetry test uses a
sensor to read wavelengths reflected from the
blood.
• The probe is attached to the finger, earlobe, or toes
on the body.
• A pulse oximeter can give results on a screen in
just a few seconds.

31. Oxygen Saturation Levels
• O Sat Result
• < 95%
• 95% to 100%
• Reading ABG Level
• Below Normal < 80mmHg
• Normal > 80 mmHg

32. Conditions that affect oxygen
saturation
• Congenital heart disease
• Altitude
• Poison e.g cyanide
• Heart disease
• COPD
• Disease of the blood
• Anemia
• Asthma e.t.c

33. Blood Glucose Level
• Blood Glucose Level is the measure of glucose
concentrated in the blood.
• Blood glucose monitoring helps to identify
patterns in the fluctuation of blood glucose levels
that occur in response to diet, exercise,
medications, and pathological processes
associated with blood glucose fluctuations, such
as diabetes mellitus.
• Unusually high or low blood glucose levels can
potentially lead to life-threatening conditions,
both acute and chronic.

34. Blood Glucose Level
• Blood glucose is measured in mmol/L (millimoles per
liter) or mg/dL (milligrams per deciliter).
• Normal : 4- 6 mmol/L or 72 -108 mg/dL.
• Blood sugar monitoring is one of the most important
aspects of managing diabetes, especially for people
who have type 1 diabetes and those who take insulin.
• Blood glucose level (BGL) monitoring conducted
outside of clinical facilities, such as the home, are
often referred to as capillary blood glucose (CBG)
tests. In contrast, blood glucose tests performed at
clinical facilities may include CBG and plasma glucose
venous blood tests.

35. Testing Procedures
• Capillary Blood Glucose (CBG) Testing
• Steps in undertaking a capillary blood glucose test with a glucometer ;
• Collect all necessary equipment. Wash and dry the site to be tested.
• Prepare the skin or site. The recommended testing site on the palm is the
side of the distal fingertips to minimize injury to the underlying bone. Use
of the fifth finger should be avoided, as the tissue may not be deep enough
to prevent said injury. The thumb and first finger should also be avoided as
these are sensitive areas compared to other fingers. Avoid the arm if a
recent ipsilateral mastectomy, if any, was performed or an intravenous
infusion is underway.
• A heel stick stab, if done, can be more painful and may require resampling.
Pain management should be considered in the neonate. The preferred site
on the heel is the lateral or medial plantar surface for babies up to one year
of age.
• Prepare equipment.
• Prime the lancet to no more than 2.0 mm to minimize the risk of bone
injury.
• Remove the glucose testing strip from its container without touching the
sensor tip. Next, insert the glucose testing strip into the glucometer; this
often leads to the glucometer turning itself on.

36. Testing Procedures cont..,
• Firmly apply the lancet to the sample collection site and release the trigger
on the lancet to pierce the skin.
• Recommendations are to wipe away the first drop of blood with clean gauze
or tissue as this drop of blood may contain intracellular or interstitial fluid or
be hemolyzed, both of which could affect the blood sample. Applying
gentle downward pressure close to the puncture site may facilitate blood
flow and collection of the second drop of blood.
• Collect the second drop of blood as it forms by touching the tip of the
glucose testing strip.
• Place the glucometer down and cover the skin puncture site with clean
gauze or tissue. Pressure may be applied to stop further bleeding from the
puncture site.
• The machine normally provides a result at this stage unless there have been
errors during collection; for example, insufficient sample, low battery,
wrong code, or the machine times itself out. If an error displays on the
glucometer, troubleshoot as appropriate.
• Wash hands and replace equipment in storage bag container. Note test
results relative to diet, exercise, and medication use as appropriate.

37. Capillary Blood Glucose (CBG) tests

38. Results, Reporting, and Critical Findings
• Blood glucose is measured in mmol/L (millimoles
per liter) or mg/dL (milligrams per deciliter).
• Normal range: 4 -6 mmol/L or 72 -108 mg/dL.
• Lab-Based Blood Glucose Testing
• Lab-based testing is required for the appropriate
diagnosis of diabetes mellitus.
• Prediabetes
• Impaired fasting glucose range: 5.7- 6.4 mmol/L or
100 -125 mg/dL.
• Impaired oral glucose tolerance test range at two
hours post 75-gram oral glucose ingestion: 7.8 -
11.0 mmol/L or 140 -199 mg/dL.

39. Diabetes Mellitus Diagnosis
• An oral glucose tolerance test can be done to confirm the
diagnosis. Advise the client to eat and drink over 150 grams
per day of carbohydrate foods for the three days before
testing. The client must fast overnight for at least 8 -16 hours
before this test.
• A fasting blood sample is collected, and a sweet drink
containing 75 grams of glucose is given to the client after
collecting the fasting blood sample. A second blood sample is
collected two hours after consuming the glucose drink.
• Oral glucose tolerance test: Glucose tolerance range at two
hours post 75-gram oral glucose ingestion: ≥11.1 mmol/L, or
≥200 mg/dL.
• A random venous blood glucose of at or above 11.1 mmol/L
(≥200 mg/dL) or a fasting blood glucose at or above 7 mmol/L
(≥126 mg/dL) on two or more separate occasions indicates
the client is likely to have diabetes mellitus

40. Other Tests i.e glycated hemoglobin
• HbA1c: Glucose molecules tend to attach to hemoglobin.
• This test interprets the percentage of glucose molecules that
combine with hemoglobin to form glycated hemoglobin.
• Once glucose molecules combine with the hemoglobin, the
glycated hemoglobin remains for the life of the red blood cell.
This reveals the average blood glucose levels in the client over
that time frame.
• Normal HbA1c: 3.5% - 5.6% or 15 -42 mmol/mol.
• Prediabetes is a possible diagnosis when the glycosylated
hemoglobin is between 5.7% and 6.4%.
• A HbA1c result >6.5% usually confirms the presence of
diabetes mellitus.
• Pharmacological intervention is required in clients with
HbA1c levels greater than 7.0%.

42. HEIGHT AND WEIGHT
• Body mass index (BMI) is the measure of height and
weight. It is a significant indicator of health and well-
being of an individual.
• The concept of considering BMI as a vital sign was
suggested over a decade ago; nevertheless, many
health-care professionals do not routinely calculate
BMI of clients.
• The current obesity epidemic, calls for action on early
diagnosis.
• Depending on race, gender and height, the value
changes. The average body weight for;
• Men =70-90 kg,
• Women =50-70 kg.

43. HOW TO CALCULATE BMI
• The BMI calculation divides an adult's weight in
kilograms (kg) by their height in metres (m)
squared.
• The formula is BMI = kg/m2
• where kg is a person's weight in kilograms and
m2 is their height in metres squared.
• For example, if you weigh 70kg (around 11 stone)
and are 1.73m (around 5 feet 8 inches) tall
1.73x1.73 = 2.99.
• 70 /2.99 = 23.41BMI

44. BMI CLASSIFICATION

45. HOW TO CONTROL WEIGHT
• Choosing healthier foods (whole grains, fruits and
vegetables, healthy fats and protein sources)
• Limiting unhealthy foods (refined grains and sweets,
red &processed meat and sugary drinks)& Fast foods.
• Increasing physical activity
• Limiting “sit time” e.g television time, screen time.
• Drink water/ beverages that are naturally calorie-free
• Learn to eat fewer calories
• Improving sleep(7 to 8 hours a night)
• Stay active (1.5 -2hrs/week)
• Reduce stress by relaxing

46. Consequences of Obesity
• Health conditions; Heart disease, stroke,
diabetes, high blood pressure, unhealthy
cholesterol, asthma, sleep apnea,
gallstones, kidney stones, infertility, and
many types of cancers, including leukemia, breast,
and colon cancer.
• The social and emotional effects; including
discrimination, lower wages, lower quality of life
and susceptibility to depression.

47. URINALYSIS
• A urinalysis is a test that examines the visual,
chemical and microscopic aspects of urine. It can
help detect many diseases before symptoms
appear. It is simple and non-invasive.
• It can include a variety of tests that detect and
measure various compounds that pass through
urine using a single sample of urine.
• It can also help find serious diseases in the early
stages, like kidney disease, diabetes, UTI or liver
disease.

48. PARTS OF URINE TEST
• Visual exam. Look for; color and clearness. Blood
may make urine look red or the color of tea/cola.
An infection may make urine look cloudy. Foamy
urine can be a sign of kidney problems.
• Microscopic exam. under a microscope; cannot be
seen with the naked eye; red blood cells, or pus
cells), bacteria, or crystals (kidney stones).
• Dipstick test. The strips change color if a substance
is present at a level that is above normal
accordingly. Acidity (pH), Protein, Glucose,
Bilirubin, pus & blood.

49. PUPIL SIZE
• Pupil size measurement complements these other
vital signs by providing information about the
patient's neurological status. For example, a sudden
change in pupil size may signal an intracranial event,
prompting further assessment and intervention.
• The normal pupil size in adults varies;2 to 4 mm in
diameter in bright light to 4 to 8 mm in the dark.
The pupils are generally equal in size. They constrict
to direct illumination and to illumination of the
opposite eye. The pupil dilates in the dark. Both
pupils constrict when the eye is focused on a near
object (accommodative response).

50. PUPIL SIZE cont..,
• The pupil is abnormal if it fails to dilate to the dark
or fails to constrict to light or accommodation.
• The popular acronym PERRLA—pupils equal, round,
and reactive to light and accommodation—is a
convenient but incomplete description of
pupillomotor function. It specifically omits
important clinical data such as the actual size and
shape of each pupil, the speed and extent of
pupillary constriction, and the results of
determining an afferent pupillary defect

51. TECHNIQUE
• Check the size, shape, equality, and position of the
pupils, and their response to a bright light. Because
these phenomena are best tested with the pupils in a
semidilated state, clinical observations should be made
in a dimly lighted room.
• Patients should be encouraged to fixate visually on a
distant object, because if they inadvertently look at
your nose or the flashlight, the attempt to converge will
reflexly evoke miosis, and certain signs may be
overlooked (e.g., anisocoria, light-near dissociation, or
a subtle Marcus Gunn sign).
• For the same reasons, try not to startle or touch
patients with your hands or instruments, as
psychosensory stimulation induces mydriasis, hippus,
and relatively hyperactive pupils.

52. DIFFERENTIALS
• Marcus Gunn (MG) sign;The afferent pupillary
defect.
• Acute ophthalmoplegia
• Adie's tonic pupil (ATP)
• Argyll Robertson Pupil; "Spinal miosis"
• Sylvian Aqueduct Syndrome
• Horner's Syndrome
• Essential Anisocoria
• Pharmacologically Dilated Pupil

54. References
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(2020) Blood pressure variability: its relevance for
cardiovascular homeostasis and cardiovascular
diseases | Hypertension Research (nature.com)

55. References
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The Highs and Lows of Blood Pressure
• Deborah Leader, (2023) Oxygen Saturation (02
Sat): Normal Ranges and How to Raise It
(verywellhealth.com)

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