2. Objectives for Today
◼ Vital Signs
◼ Describe purpose, methods, sites and norms for vital signs for:
◼ Temperature
◼ Pulse
◼ Respiration
◼ Blood Pressure
◼ Demonstrate and correctly assess:
◼ Temperature
◼ Pulse
◼ Respiration
◼ Blood Pressure
◼ Correctly use and document terms to describe vital signs
3. Vital Signs
◼ Important indicators of general health and
physiological status
◼ Indicative of response to exercise
◼ Particularly important to establish baseline
values in certain populations
◼ All can be affected by factors such as age,
disease, cardiovascular status, etc.
4. Four Primary Vital Signs
◼ Body Temperature
◼ Pulse Rate (heart rate)
◼ Respiratory Rate
◼ Blood Pressure
5. Body Temperature
◼ Indicates temperature or degree of heat
within body
◼ Body temperature reflects Balance
between heat produced and heat lost from
the body.
◼ Relatively constant value in humans
regardless of environmental temperature
6. Normal Values: Temperature
◼ Normal Range of oral core/body temp
◼ 96.8 to 99.3˚F (36 to 37.3 ˚C)
◼ 98.6 ˚F most accepted average value
7. Body Temperature
◼ Abnormalities ◼ Hyperthermia
◼ > 106º F
◼ Signs: muscle cramps,
nausea/vomiting,
headache, sweating
profusely, mental
confusion
◼ Hypothermia
◼ <94º F
◼ Signs: shivering,
numbness and
bluish/grayness of the
skin
10. Physical Activity and Body
Temperature
◼ Rises with activity
◼ Caution with activity during adverse conditions
◼ Patients with temperature abnormalities will
need to be monitored more closely
11. Four Primary Vital Signs
◼ Body Temperature
◼ Heart/Pulse Rate
◼ Respiratory Rate
◼ Blood Pressure
12. Pulse
◼ Pulse is the wave of the heart created by the contraction
of left ventricle of heart.
◼ Indicates the heart rate
◼ Palpated at various sites or measured through
auscultation with stethoscope
◼ Recorded in beats per minute (bpm)
◼ Quality & Pattern of Pulse important
13. Pulse
◼ Cardiovascular function
◼ During exercise or treatment: Capability of
cardiovascular system to distribute blood during
physical stress
◼ After exercise or treatment: Capability of
cardiovascular system to replenish(fill up again),
restore, and recover
14. Assessment of Pulse
◼ Normal rates and ranges
◼ Adults: 60-100 beats
per minute (bpm)
◼ Athletes: 40-60 bpm
◼ Neonates (1-28 days):
120-160 bpm
◼ Children (1-8 y.o):
80-100 bpm
◼ Elderly: Resting HR
may be slower
◼ Abnormalities
◼ Tachycardia (Fast HR)
◼ HR > 100 bpm at rest (Adult)
◼ Bradycardia (Slow HR)
◼ HR < 60 bpm at rest (Adult,
not an athlete)
15. Pulse: Quality & Pattern
◼ Bounding (+3): Palpable, forceful
◼ Normal (+2): Palpable
◼ Weak/Thready (+1): Difficult to palpate
◼ Absent (0): Not discernible (detectable)
17. Assessment of Pulse
◼ Radial
◼ Index and middle finger over radial region of distal
wrist
◼ During initial evaluation, radial and apical
(auscultation) may be simultaneously evaluated
◼ Any difference is considered the pulse deficit
◼ If difference exists, only apical pulse should be used to
evaluate the patient.
18. Assessment of Pulse
◼ Carotid
◼ Between larynx and SCM
(sternocleidomastoid) muscle
◼ Dorsalis Pedis
◼ 1st and 2nd lower digits
◼ Brachial
◼ Medial to bicipital tendon
20. ◼ Important to apply light pressure
◼ Gently place pads of index and middle fingers on the pulse point
◼ Do NOT use the thumb to measure pulse
◼ Timing
◼ Most accurate interval is 60 seconds
◼ 1 Count Method
◼ Count begins with 1st beat after a time interval has been established
◼ Units of Measurement
◼ BPM (beats per minute)
Measuring Pulse-Technique
21. Physical Activity and Pulse Rate
◼ HR should initially increase rapidly
◼ Recovery time ~3-5 minutes to resting
◼ Conditioned people show less change in HR, and return
to resting levels more quickly
◼ Resting pulse → preactivity pulse → recovery pulse rate
22. Factors Affecting Pulse
◼ Age
◼ Gender
◼ Activity
◼ Autonomic nervous system
◼ Environment
◼ Medication
25. Four Primary Vital Signs
◼ Body temperature
◼ Pulse rate
◼ Respiratory rate
◼ Blood pressure
26. Respiratory Rate
◼ Inhalation
◼ Diaphragm and intercostal muscle contract
◼ Chest expands → air into lungs
◼ Exhalation
◼ Diaphragm and intercostal muscle relax
◼ Chest volume decreases→ air leaves lungs
27. Respiratory Rate
◼ One breath = one inhalation and one exhalation
◼ Measure Quantity:
◼ Respiratory Rate (RR): breaths per minute
◼ Chest Rise and Fall (30 seconds multiplied by 2 OR 60 seconds)
◼ Measure Quality:
◼ Rhythm
◼ Depth
◼ Character
◼ Sounds
28. Respiration
◼ Quantity: Document without use of units (ex. RR= 12)
Normal resting rates (breaths/min)
◼ Neonates: 40-60
◼ Infants: 25-50
◼ Child: 15-30
◼ Adults: 12-20
◼ Abnormal: < 10 or > 20 for an adult.
RR during exercise
◼ Can to 40-50 (breaths/min) for a short time
◼ use of accessory muscle
31. Adventitious Breath Sounds
◼ Stridor
◼ High pitched sound
◼ More common during the inspiratory than the
expiratory phase of breathing
◼ Caused by turbulent gas flow in the upper
airway
– Foreign body in the airway
– Laryngeal tumor
– Upper airway obstruction/narrowing
http://www.youtube.com/watch?v=EMKxnyPs7K8
32. Adventitious Breath Sounds
◼ Crackles (Rales)
◼ Sounds like fine popping or crackling
◼ More common during the inspiratory than the
expiratory phase of breathing
◼ Caused by explosive opening of small airways
◼ Often associated with pulmonary edema,
pneumonia, congestive heart failure
http://www.youtube.com/watch?v=9C5RFb1qWT8
33. Adventitious Breath Sounds
◼ Wheeze (previously rhonchi)
◼ Squeaking, musical noise
◼ Breath sounds heard on EXPIRATION
◼ Caused by narrowing of small airways
◼ Often associated with lung diseases, such as
pneumonia, TB, Asthma, CHF
http://www.youtube.com/watch?v=YG0-ukhU1xE
34. Adventitious Breath Sounds
◼ Rubs
◼ Rough grating or scratching sound
◼ Usually heard on inspiration
◼ Caused by inflamed surfaces of the pleura rubbing
together
◼ Occurs in pleurisy, TB, Pneumonia, Lung cancer
◼ Absent Breath Sounds
◼ Occurs in areas of the lung with an obstruction
http://www.youtube.com/watch?v=t2QE0O_exAQ
35. Physical Activity and RR
◼ Rate and depth increase with exercise
◼ Should return to resting levels once
activity ceases
37. Four Primary Vital Signs
◼ Body temperature
◼ Pulse rate
◼ Respiratory rate
◼ Blood pressure
38. Blood Pressure
◼ Definition: the force exerted by the blood
on the walls of the circulatory system
(primarily the arteries)
◼ Measured with a sphygmomanometer
◼ Listening for Korotkoff’s Sounds
39. Blood Pressure
◼ Systolic blood pressure (SBP)= Highest
blood pressure measured in the arteries
◼ Occurs when the heart is contracting
◼ Diastolic blood pressure (DBP) = Lowest
blood pressure measured in the arteries
◼ Occurs when the heart is filling (relaxing)
◼ Documentation
◼ Written as 120/80 mmHg
◼ Said as "120 over 80"
40. Korotkoff’s Sounds
◼ Sounds occurring in phases during BP
cycle
◼ Phase I and V are most important to
identify
◼ I: First clear sound (systolic)
◼ V: Cessation of sound (diastolic)
41. Measuring Blood Pressure
1. Resting BP → let the
subject rest quietly
2. Proper cuff size
3. Pressure cuff around the
upper arm
4. The stethoscope just
below the antecubital
space over the brachial
artery
47. Blood Pressure- Hypertension
In adults:
Systolic BP Diastolic BP
Prehypertension 120-139 or 80-89
Stage 1 Hypertension 140-159 or 90-99
Stage 2 Hypertension ≥ 160 or ≥ 100
48. Blood Pressure: HTN
◼ Signs/symptoms:
◼ Usually have no signs/symptoms
◼ When BP is extremely high…..
◼ Headache
◼ Fatigue
◼ Difficulty breathing
◼ Confusion
49. BP Red Flags
◼ Systolic BP > 250 mmHg
◼ Diastolic > 115 mmHg
◼ Drop in SBP more than 10 mmHg from baseline
◼ Failure of SBP to increase with increasing
workload
50. Assessment of Blood Pressure
◼ Hypotension
◼ SBP consistently <100 mm Hg
◼ A medical concern only if it causes signs/symptoms
such as dizziness or fainting
◼ Orthostatic/Postural Hypotension:
◼ Decrease in SBP of at least 20 mmHg or DBP
decrease by 10 mmHg within 3 min. of standing
and/or supine to sit
◼ Clinical indication?
51. Physical Activity and BP
◼ Systolic: gradually increases and intensity
of exercise increases
◼ Should return to resting levels in 3-5 minutes
◼ Diastolic: relatively constant
◼ Increase of 10-15 mmHg not considered
abnormal
52. Mean Arterial Pressure (MAP)
◼ Is the average pressure that occurs during a
single cardiac cycle (contraction/relaxation)
◼ MAP= ((DBP x 2) + SBP) / 3
◼ MAP of >60mmHg is necessary to perfuse the
major organs and vessels
◼ May need to hold PT with MAP <60mmHg
53. The 6th Vital Sign
◼ Gait Speed
◼ Self-selected
◼ Predictor of falls and mortality
◼ Correlated with balance, confidence
◼ Reliable, valid, sensitive & specific
Fritz S, Lusardi M. White paper: walking speed: the sixth vital sign. J
Geriatr Phys Ther. 2009,32:2-5.
