VITAL SIGNSVITAL SIGNSTanya Napoli, RN

BSN

Discuss the physiologic processes that affect temperature, pulse, respirations, and blood pressure.

Identify alterations in vital signs. Educate patients/family members about

assessing vital signs at home.

A person’s temperature, pulse, respirations, and blood pressure comprise vital signs.

The nurse/MA is responsible for reporting accurate vital sign data and any abnormal readings.

Frequency of vital sign assessment is dependent upon institutional policy and the patient’s condition.

The heat of the body measured in degrees. Normal core body temperature ranges from

36.0 C to 37.5 C (97.0 F to 99.5 F). Maintained by the thermoregulatory center

in the hypothalamus Body’s primary heat source is metabolism –

heat is a byproduct of cellular activity Body heat is lost primarily via the skin.

Factors affecting body temperature◦ Circadian rhythms◦ Age◦ Gender◦ Environmental temperature

Hypothermia – body temperature below 36.0 C Hyperthermia – body temperature above37.5 C, not

related to fever

A patient with a normal body temperature is considered afebrile.

An increase in body temperature due to illness or trauma is called a fever. ◦ A patient with a fever is considered febrile.◦ Onset may be sudden or gradual◦ Symptoms include shivering, headache, thirst,

flushing of the skin, and increased pulse rate.

Interventions to reduce fever◦ Administration of antipyretics (aspirin or

acetaminophen)◦ Cool sponge baths or shower◦ Cool packs◦ Cooling blankets◦ Removing blankets◦ Offer/force fluids if not contraindicated

Equipment – types of thermometers◦ Electronic/digital ◦ Tympanic membrane ◦ Glass ◦ Disposable

Assessment sites◦ Sublingual

Surface temperature Must be able to close mouth around probe Need to wait 15 to 30 minutes after drinking or

smoking Contraindicated?

◦ Tympanic Considered a core temperature Easily accessed Ear canal must be large enough to accommodate

probe Contraindicated?

Assessment site◦ Rectal

Core temperature, most accurate Uncomfortable for patients Contraindicated?

◦ Axillary Surface temperature Site of choice for newborns

A throbbing sensation that can be palpated over a peripheral artery or auscultated over the apex of the heart (the apical pulse).

Pulse rate is the number of pulsations palpated or heard in one minute.

Normal pulse rate for adolescents and adults is 60 to 100 beats per minute.

What are some factors that would affect pulse rate?

Tachycardia – pulse rate of 100 to 180 beats per minute, sustained tachycardia will eventually lead to decreased cardiac output.

Bradycardia – pulse rate below 60 beats per minute.◦ Can be normal ◦ May be related to medications◦ When should you be concerned about

bradycardia?

Pulse amplitude refers to the quality of the pulse and is indicative of left ventricular strength.

The rhythm of the pulse is described as regular or irregular. An irregular pulse pattern is referred to as a dysrhythmia.

A pulse deficit occurs when the apical pulse and peripheral pulses do not match.

Assessment sites◦ Apical pulse is assessed over the apex of the

heart using a stethoscope. Count for a full 60 seconds. Necessary when giving certain medications, such as

digoxin PMI- Point of maximal impulse- Mitral Valve/Bicuspid

◦ Peripheral pulse can be palpated over several arteries. When would it be important to palpate a pedal

pulse?

A. Exercise- increased activity- heartbeat increases 20-30 beats per minute to meet the body’s needs. It should return to normal 3 minutes after activity has stopped.

B. Age- the younger you are, the faster the rate. C. Sex- females; 10 bets per minute more rapid

than a man. D. Physical Condition of the body- athletes

slower, as a result of a more efficient circulatory system.

***Heart rate increases when the sympathetic nervous system is stimulated by feelings such as; anxiety, fear, pain or anger.

Radial- thumb side, inner surface of wrist.Brachial- (antecubital)inner medial surface of elbow. - you can palpate and ausculate to

listen to the BP.Carotid – neck (either side of the trachea)Femoral- midway in groin Dorsalis Pedis- instep of footPopliteal- back of the knee

A respiratory cycle involves both inspiration and expiration.◦ The number of complete cycles per minute

comprise the respiratory rate.◦ Normal rate is 12 to 20 cycles per minute.◦ What are some factors that affect respiratory

rate?

Depth and rhythm are also assessed◦ Depth of respirations varies from shallow to deep.◦ Normal respirations have a regular rhythm.

Tachypnea – refers to a rapid respiratory rate, usually shallow in depth.◦ Caused by increased metabolic demand

Bradypnea – refers to a decrease in respiratory rate.◦ May have a pathological cause or can be a side

effect of certain medications Apnea – refers to periods without

respirations. Dyspnea – refers to difficult or labored

respirations

A measurement of the force of the blood against the arterial walls.

Systolic pressure – measurement of the force on the arterial walls as the left ventricle contracts.

* Heart Contracting- Top Number

Diastolic pressure – measurement of the force on the arterial walls as the left ventricle relaxes.

* Heart Relaxing- Bottom Number

Pulse pressure – the difference between the systolic an diastolic pressure.

The sounds heard during blood pressure assessment are called Korotkoff sounds.◦ The first sound (or beat) represents the systolic

pressure.◦ A change in or cessation of the loud, distinct

sounds represents the diastolic pressure.

Peripheral resistance describes the resistance to blood flow resulting from the arterioles always being partially contracted.◦ This allows continuous flow of blood into the

capillaries.◦ The elasticity of the artery walls combined with

arteriole resistance helps maintain normal blood pressure

Blood pressure is also affected by several hormonal and humoral mechanisms as the body attempts to maintain homeostasis.

Cardiac output has a direct effect on blood pressure.◦ Cardiac output is equal to the stroke volume

times the heart rate.◦ An increased cardiac output results in increased

blood pressure.◦ Conversely, blood pressure decreases as cardiac

output decreases.

A “normal blood pressure” is less than 120/80 mm Hg.◦ There is a wide range of normal, therefore

baseline readings are critical.◦ An elevation or fall or 20 to 30 mm Hg is

significant. Hypertension is sustained blood pressure

above normal.◦ Major risk factor for heart disease and stroke

Hypotension – below normal blood pressure◦ May be normal◦ May be pathologic◦ When should you be concerned?

Orthostatic hypotension or postural hypotension occurs when blood pressure drops during rising to a sitting or standing position.

Manual blood pressure is assessed with a stethoscope and sphygmomanometer.◦ Accurate readings depend on using appropriate-

size cuffs Electronic blood pressure monitors sense

vibrations in the artery wall to determine blood pressure.

Most common site is the brachial artery.◦ When would you choose an alternate site?