This document discusses vital signs, including body temperature, pulse, respiration, and blood pressure. It provides details on measuring and assessing each vital sign, such as approved measurement sites and normal ranges. Factors that can influence vital sign readings are also reviewed, along with terminology and procedures. The goal of routinely measuring vital signs is to evaluate the internal functions of the body.

1. Presented by:
DR.A.KENNEDY .MBBS,D.L.O,M.S[GEN]
CHIEF MEDICAL OFFICER,
ATTHI HOSPITAL.
Vital Signs

2. Introduction
⚫Assessing vital signs or cardinal sign is a
routine medical procedure. And somehow
determines the internal functions of the body
⚫Vital signs composes of the following:
◦ Body temperature
◦ Pulse
◦ Respiration and
◦ Blood pressure

3. Body Temperature

4. ⚫Body temperature
◦ It is a balance between the internal and external
environment of the body, or
◦ It is the balance between the heat produced by the
body and the heat lost from the body.
◦ It is measured in heat units, called degrees

5. Two types of Body temperature
⚫CORE Temperature- it is the temperature of
the deep tissues of the body, such as the
cranium, thorax, abdominal cavity and pelvic
cavity.
⚫It remains relatively constant (37 °C/ 98 °F)
⚫An accurate measurement is usually done using
a pulmonary catheter.

6. ⚫SURFACE temperature- is the temperature
of the skin, the subcutaneous tissues and fat
⚫It constantly rises and falls in relation to
the environment
⚫It varies from 20 °C (68 °F) to 40 °C (104 °F)

7. Sites commonly used in taking BT
⚫Oral- most common
⚫Axilla –mostly used in infants and children
⚫Rectal- second choice
⚫Tympanic membrane- most favorable site

8. Factors affecting Body temperature
⚫1. Age – infants greatly influenced by the
temperature, children more labile than adult
and elderly are extremely sensitive to
environmental change due to decreased
thermoregulatory control
⚫2. Diurnal variations (circadian rhythms) –
Body temperature normally change throughout
the day, varying as much as 1.0 °C between early
morning and late afternoon

9. ⚫The point of highest body temperature is
usually reached between 8pm and 12 midnight
and the lowest point is reached during sleep
between 4
a.m. and 6 a.m.
⚫3. Exercise
⚫4. Hormones –women usually experience more
hormone fluctuations than men, progesterone
secretion in women raises body temperature.
⚫5. Stress- epinephrine and nor epinephrine
increases metabolic activity and heat
production

10. Alteration in Body temperature
⚫ Pyrexia, hyperpyrexia or fever- increase body
temperature
◦ febrile with fever
◦ Afebrile without fever
🞄 Types of fever
🞄 Intermittent-alternate body temperature (time)
🞄 Remittent- wide range of temperature fluctuation
🞄 Relapsing- short febrile periods few days then normal
🞄 Constant- continuous
⚫ Hypothermia- decrease in core temperature below
the low limit of normal

11. Types of Thermometer
⚫1. Mercury in glass
◦ Oral thermometer have a long, slender tips
◦ Rectal thermometer have a short, rounded tips
⚫2. Electronic thermometer
◦ Digital thermometer
⚫3. Chemical thermometer
⚫4. Temperature sensitive strip
⚫5. Infrared thermometer
◦ Tympanic thermometer

12. Oral thermometer (Glass)

13. Digital Thermometer

15. Digital thermometer is commonly
used in infants and children, insert it
at the axillary region

16. closed the arm and wait for timer to
bustle

17. Remember when taking BT in infants and children make
sure that the patient is not in distress mood because any
change in the activity will directly affect the BT reading.

18. Insert the tip at the sublingual fossa
Oral Temperature

19. Positioned the thermometer

20. Let stay for 1 to 2 minutes, tell the
patient to close the mouth

21. Temperature conversion
⚫°C = (Fahrenheit – 32 ) x 5/9
◦ Convert 100 °F
⚫°F = (Celsius x 9/5) + 32
◦ Convert 40 °C
◦ Normal/ Average temperature is between 36-37.9 °C
or 96.8 – 100.3 °F

22. Pulse Rate

23. Pulse
⚫Is a wave of blood created by contraction of left
ventricle of the heart
⚫Generally, the pulse wave represents the stroke
volume output and the compliance of arteries.
⚫Stroke volume output is the amount of
blood that enters the arteries with each
ventricular contraction.
⚫Compliance its the ability of the arteries
to contract andexpand.

24. ⚫When adult is resting, the heart pumps 4 to 6
liters of blood per minute. This volume is
called cardiac output,
⚫The cardiac output (CO) is the result of the
stroke volume (SV) times the heart rate
(HR) per minute
⚫CO= SV x HR
⚫Note: in healthy person the pulse reflects the
heartbeat

25. ⚫Peripheral pulse- is a pulse located in
the periphery of the body.
⚫Apical pulse- is a central pulse located at
the apex of the heart.

26. Pulse site
⚫1. Temporal- it is where the temporal
artery located, between the upper, lateral
part of the eye and upper medial part of the
ear
⚫2. Carotid- at the side of the neck, at the
carotid triangle. Located between the
Anterior/front of SCM and below the angle of
the mandible
⚫3. Apical- at the apex of the heart.
◦ In adult this is located on the left side of the chest, no
more than 8 cm (3 in) to the left sternum under the

27. Carotid pulse

28. ◦ 4th, 5th or 6th intercostal space.
◦ In Children 7 to 9 years old, the apical pulse is
located between the 4th and 5th intercostal space.
◦ In Young Children below 4 years old , it is located at
the left side of midclavicular line and
◦ In Children between 4 and 6 years old it is at the
midclavicular line.

29. ⚫4. Brachial- at the anterior part of the arm
in children and at the ante-cubital space
(elbow crease) in adult.
⚫5. Radial – located at the wrist (anterior
part), along with the thumb. It is where the
radial artery is located
⚫6. Femoral – at the inguinal ligament, the
femoral artery is located.

30. Radial and Brachial pulse

31. ⚫7. Popliteal- at the popliteal region, located
at the back of the knee
⚫8. Posterior Tibial- at the medial aspect of
the ankle, it is where the posterior tibial artery
is located
⚫9. Dorsalis pedis- where the dorsalis pedis
artery passes over the bones of the foot, at the
space between the big toe and the 2nd toe.

32. Posterior tibial & Dorsalis pedis Pulse

33. Pulse site Reasons for Use
Radial Readily accessible & routinely used
Temporal Used when radial pulse is not accessible
Carotid Used for infants, in cases of cardiac arrest and to determine
the circulation to the brain
Apical Routinely used in infants and children up to 3 years of age, Used to
determine the discrepancies with radial pulse, and Used in
conjunction with some medication
Brachial Used to measure blood pressure, used for cardiac arrest for
infants
Femoral Used in cases of cardiac arrest, for infants and children, determine
circulation in the leg
Popliteal Used to determine the circulation in the lower leg and leg
blood pressure
Posterior tibial Used to determine the circulation in the foot
Pedal Used to determine circulation in the foot

34. Assessing the Pulse
⚫1. A pulse is commonly assessed by palpation or
auscultation.
⚫2. 3 middle fingers are used for palpating
all pulse site, except for apical pulse.
⚫3. Stethoscope is used in assessing apical
pulse and fetal heart tones.
⚫4. Doppler ultrasound is used for pulses that
is to difficult to assess.

35. 5. The pulse is normally palpated by
applying are moderate pressure with
the three fingers of the hand.
6. The pads of the most distal aspect
of the fingers are the most sensitive
areas of detecting the pulse.

36. ⚫7. When assessing the pulse, there is a need to
take note of the following
⚫1. rate
⚫2. rhythm
⚫3. volume
⚫4. arterial wall elasticity
⚫5. presence or absence of bilateral equality.

37. Age Average Range
Newborn to 1
month
130 80-180
1 year 120 80-140
2 years 110 80- 130
6 years 100 75- 120
10 years 70 50-90
Adult 80 60- 100
Pulse rate/
Minute
Variations in Pulse Rate
Kozier Barbara, et.al. Fundamentals of Nursing , 5th ed. (US Addison-Wesley Publishing
Company, Inc. 1995) p. 438

38. ⚫Rate- referred to tachycardia- (over 100
beats/ minute) bradycardia –(60
beats/minute or less)
⚫Rhythm- is the patterns of beat and the
interval between the beats.
⚫Dysrhythmia or arrhythmia is an example
of irregular rhythm.

39. ⚫Volume- is the pulse strength or the
amplitude, refers to the force of blood with each
beat. E.g. bounding/full; weak/feeble/thready
pulse
Scale Description of pulse
0 Absent
1 Thready or weak; difficult to feel
2 Normal, detected readily, obliterated
by strong pressure
3 Bounding; difficult to obliterate
Kozier Barbara, et.al. Fundamentals of Nursing , 5th ed. (US Addison-Wesley Publishing
Company, Inc. 1995) p. 440

40. Elasticity of the arterial wall
⚫It reflects the expansibility of the arterial wall.
⚫A healthy, normal artery feel straight, smooth,
soft and pliable
⚫While, elderly people often have inelastic
arteries that feels twisted or tortuous
and irregular upon palpation

41. Factors affecting pulse rate
⚫1. Age
⚫2. Sex- after puberty the man’s pulse rate
is slightly lower than the female
⚫3. Exercise
⚫4. Fever- pulse rate increases when metabolic
rate increases
⚫5. Medications
⚫6. Hemorrhage- loss of blood increase pulse rate
⚫7. Stress

42. Respiration

43. ⚫Is the act of breathing; it includes the intake of
oxygen and the output of carbon dioxide
⚫Types
⚫1. External respiration- the interchange of O2
and CO2 between the alveoli and the pulmonary
blood
⚫2. Internal respiration- takes place throughout
the body; it is the interchange of gases between
the circulating blood and the cells of the body
tissues

44. Terminologies
⚫Inhalation or inspiration- the act of intake of
air into the lungs
⚫Exhalation or expiration- the act of breathing
out of gases from the lungs to the environment
⚫Ventilation- movement of air in and out
the lungs
⚫Hyperventilation- refers to very deep and
rapid ventilation
⚫Hypoventilation- refers to very shallow
respiration

45. Types of breathing
⚫1. Costal or thoracic breathing
⚫2. Diaphragmatic or abdominal breathing

46. Costal breathing
⚫It involves the external intercostal muscle and
other intercostal muscle. It can be observed by
the movement of the chest upward and outward
or downward

47. Diaphragmatic breathing
⚫It involves the contraction and relaxation of the
diaphragm, it is observed by the movement of
the abdomen

48. Control Centers for Respiration
⚫1. Medulla oblongata and Pons
⚫2. Chemoreceptors located centrally in the
medulla and peripherally in the carotid
and aortic bodies
⚫NOTE: These centers and receptors respond
to changes in the concentration of O2, CO2
and Hydrogen in arterial blood.
⚫Increased CO2 concentration in the blood
triggers chemoreceptors thus stimulates
respiration

49. Assessing Respiration
⚫1. The client normal breathing pattern is
assessed therefore the client should be at
resting mode.
⚫2. Identify behavior/ activities of the patient
as well as medication or therapies because
these will affect the respiration taking.
⚫3. Identify if there are any health problems such
as heart problems and others

50. Age Average Range
Newborn 35 30-80
1 year 30 20-40
2 years 25 20-30
8 years 20 15-25
16 years 18 15-20
Adult 16 12-20
Respiratory rate/
Minute
Variations in Respiratory
rate
Kozier Barbara, et.al. Fundamentals of Nursing , 5th ed. (US Addison-Wesley Publishing Company,
Inc. 1995) p. 448

51. Respiratory rate
⚫is normally described in breaths per minute
⚫Types:
⚫Eupnea- Normal Breathing
⚫Bradypnea- Abnormally slow
⚫Tachypnea or polypnea- Abnormally fast
⚫Apnea- cessation of breathing

52. Respiratory depths
⚫is established by watching the movement of the
chest.
⚫It is generally describe as normal, deep or
shallow, deep respiration are those in which a
large volume of air is inhaled and exhaled.
Shallow respiration involve the exchange of
small volume of air
⚫NOTE: in normal inspiration and expiration, an
adult takes in about 500ml of air. This volume
is called Tidal volume

53. Respiratory rhythm/ pattern
⚫It refers to regularity of expiration
and inspiration
⚫Types
⚫Regular
⚫Irregular
◦ Dsypnea- difficulty in breathing
◦ Orthopnea- ability to breath in an upright position

54. BLOOD PRESSURE

55. Heart Sound
1. First Sound-occurs at the beginning of
ventricular systole. It is caused by the closure
of the tricuspid and mitral valves
2. Second Sound- marks the beginning of
ventricular diastole and is caused by the
closure of aortic and pulmonary valves.

56. Arterial blood
Pressure
is a measure of the pressure exerted by the blood
as it flows through the arteries.
Two blood pressure measurements
1.Systolic pressure- is the maximum pressure
developed on the ejection of blood from the left
ventricle into the arteries
2.Diastolic Pressure-is the lowest pressure and is
a measure of the peripheral resistance.

57. In measuring the BP
⚫By means of auscultation- the systolic pressure
is taken at the point when beats becomes
audible. As the mercury continues to fall, the
sound of the beats becomes louder, then
gradually diminishes until a point is reached
at which there is a sudden, marked
diminution in intensity.
⚫The average BP is about 120/80 at 20 yrs
old and at the age of 60 is 160/90

58. Aneroid manometer with stethoscope

59. Part of the sphygmomanometer

60. Taking BP
⚫It is measured with a blood pressure cuff, a
sphygmomanometer and a stethoscope
⚫The BP cuff has a bladder than can be inflated
with air, it is covered with cloth and has two
tubes attached to it (sometimes it’s three), one
tube is connected to the rubber bulb.
⚫To introduce air turn the valve clockwise and to
release air turn it counterclockwise, the second
tube to the sphygmomanometer and the third to
stethoscope

61. Auscultatory method of obtaining BP
⚫First the health care provider must determine
the Korotkoff’s sound- this is a series of
sounds heard during BP assessment.
⚫Phases of Korotkoff’s sound
⚫Phase 1- The first faint clear tapping sound is
heard. This sound gradually becomes strong and
deep
⚫Phase 2- This is the period during
deflation when the sounds have a swishing
quality.

62. ⚫Phase 3- The period during which the
sounds are forceful and powerful
⚫Phase 4- The time when the sounds begins to
decrease in intensity, and has a less bounding
force
⚫Phase 5- The pressure level wherein the sound
disappear.

63. Reading Blood Pressure
⚫The first sound heard is the systolic pressure
and the last sound heard is the diastolic
pressure

64. Mercury manometer and cuff Aneroid manometer and cuff

65. 2 types of sphygmomanometer
⚫Aneroid and mercury manometer
⚫Aneroid is a calibrated dial with a needle
that points to the calibrations while the
other is a calibrated cylinder filled with
mercury.

66. Other types
⚫Electric sphygmomanometer
⚫Doppler stethoscope

67. Variations in BP cuff
⚫If the bladder is too narrow, the obtained BP
reading is erroneously elevated; if it is too
wide the reading will be erroneously low
⚫The width should be 40% of the circumference
or 20% wider than the diameter of the
midpoint of the limb on which it is used
⚫The length of the bladder should be sufficiently
long almost to encircle the limb and to cover at
least 2/3 of its circumference

68. Variations in BP by Age
Age Mean BP (mm Hg)
Newborn 73/55
1 year 90/55
6 years 95/57
10 years 102/62
14 years 120/80
Adult 120/80
Elderly (over 70 years) Diastolic pressure may increase
Kozier Barbara, et.al. Fundamentals of Nursing , 5th ed. (US Addison-Wesley Publishing
Company, Inc. 1995) p. 452

69. THANK YOU