Vital signs
 Vital signs, also termed cardinal signs, reflect the body's
physiologic status and provide information critical to evaluating
homeostatic balance.
 Vital signs include four critical assessment areas: temperature,
pulse, respiration, and blood pressure.
 The term "vital "is used because the information gathered is the
clearest indicator of overall health status.
 These four sings form baseline assessment data necessary for an
ongoing evaluation of a client's condition.
 The more critical the client's condition, the more often these
indicators of a client's and evaluated.
 Obtaining the total picture of a client's health status is a major
objective of client care.
Factors influencing vital signs
Age: age influences body temperature .body temperature varies
in newborns and elderly clients' due to thermoregulating system due to
physiological changes of aging.
 Pulse decrease with age.
 Blood pressure increases with age.
 Respirations vary according to age.
Gender: women experience greater temperature fluctuations
than the men, probably due to hormonal changes.
Race and heredity: blood pressure alterations appear to be the
main difference in vital signs, usually as a result of particular
groups being more susceptible to hemodynamic alterations
African Americans are more prone to high blood pressure
resulting from increased blood cholesterol levels.
Medications: some medications can directly or indirectly alter the
pulse, respirations, and blood pressure .For example, narcotic
analgesics can depress the rate and depth of respirations and
lower blood pressure.
Pain: acute pain leads to sympathetic stimulation which in turn
increases the heart rate, respiratory rate, and blood pressure.
Chronic pain decreases the pulse rate.
Temperature
 Temperature represents the balance between heat gain and heat
loss and is regulated in the hypothalamus of the brain.
 Variations in temperature indicate the health status of the boy;
thermostatic function may be altered by pyrogens, nervous
system disease, or injury.
 The temperature of the body's interior (core temperature) is
maintained within + 1or -1 F except in the case of febrile illness
 The surface temperature of the skin and tissues immediately
underlying the skin rises and falls with a change in temperature of
the surrounding environment.
 Core temperature is maintained when heat production equals
heat loss.
 Disease can alter the temperature –regulating center to cause
fever, a body temperature above normal.
 Feeling hot; increased pulse and respirations.
 When the body temperature falls below the normal range, the
client experiences hypothermia and complains of being cold,
shivers, and has cool extremities.
 Hypothermia may be caused by accidental exposure GI (gastro
intestinal hemorrhage)
 The ability of the hypothalamus to reregulate body temperature is
greatly impaired when the body temperature falls below (34.5 C)
and is lost below (29.4 C).
Measuring body temperature
Oral or rectal temperatures reflect the body's core temperature.
Tympanic and axillary temperatures are somewhat variable but are
clinically acceptable for traching important changes.
 The normal range of an oral temperature is 36.5 -37.5 C.
 Body temperature may vary according to age (lower for the aged),
time of day (lower in the morning and higher in the afternoon and
evening) ,amount of exercise ,or extremes in the environment
temperature
The thermometer is the instrument used to measure body heat. Oral
and rectal (also used for axillary temperature) thermometers are
calibrated glass tubes with a bulb containing mercury. When exposed to
heat, the mercury expands, moves up the glass, and records the body
temperature .the thermometer is marked in degrees and tenths of
degrees with either Fahrenheit or Celsius (centigrade) scale and a range
of (34-42.2 C).
Electronic thermometers, now widely used in hospitals, are more
accurate than glass thermometers. In addition, they have disposable
covers, which promote infection control. The electronic thermometer
records the client' score temperature in seconds.
The ear canal provides another noninvasive site for temperature
measurement using infrared thermometers
Heat-sensitive tapes are also used to record temperature .the
chemical strip tape is applied to the skin, and color changes indicate the
temperature level. These tapes are both disposable or nonbreackable .
They are most appropriate for use with normal newborns, small
children, and in situations when proper cleaning of the thermometer is
difficult.
Pulse
 The pulse is an index of the heart's action; by evaluation the rate,
rhythm, and volume.
 The apical pulse rate is the number of heart beats per minute.
With each beat, the heart's left ventricle contracts and forces
blood into the aorta. Closure of the heart valves creates the
sounds heard.
 Pulse deficit: is the difference between the apical rate and the
radial pulse rate.
Heart rate and rhythm
 Normal adult heart rate is from 60 -100 beats per minute (BPM).
 Tachycardia: is a pulse rate over 100 BPM ,client conditions ,such
as congestive heart failure, hemorrhage and shock, dehydration
,and anemia
 Common causes of tachycardia are stressful conditions, hypoxia,
exercise, and fever.
 Bradycardia: is a pulse rate below 60 BPM.
 Common ,cardiac conduction blocks, and increased intracranial
pressure causes are decreased thyroid activity,hyperkalemia
 The heart normally pumps about 5Lof blood through the body
each minute. This cardiac output is calculated by multiplying the
heart rate per minute by the stroke volume (the amount of blood
ejected with one contraction).
Evaluating pulse quality:
The femoral and carotid arteries are used in cases of cardiac arrest to
determine the adequacy of perfusion.
Characteristics of peripheral pulses:
0 =absent
1 + =weak
2 + = normal
3+ = bounding
Major sites to check the pulse:
Respiration
 Respiration is the process of bringing oxygen to body tissues and
removing carbon dioxide.
 The lungs play a major role in this process.
 Breathing consists of two phases, inspiration and expiration.
 Inspiration: is an active process in which the diaphragm descends,
the external intercostals muscles contract, and the chest expands
to allow air to move into the tracheobronchial tree.
 Expiration is a passive process in which air flows out of the
respiratory tree.
 The respiratory center in the medulla of the brain and the level of
carbon dioxide in the blood both control the rate and depth of
breathing.
 The diaphragm and the intercostals muscles are the main muscles
used for breathing and other accessory muscles can be used to
assist with respiration if necessary.
Evaluating respiratory rate:
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The normal rate for a resting adult is 12-18 breaths per minute.
Tachypnea: is a respiratory rate of 24 or above.
Bradypnea: is a rate of 10 or less.
Tidal volume: is the depth of a person's breathing and it is the
amount of air that moves in and out with each breath. The tidal
volume is 500 ml in the healthy adult.
Blood pressure
 The heart generates pressure during the cardiac cycle to
perfuse the organs of the body with blood. Blood flows
from the heart to the arteries, into the capillaries and
veins, and then flows back to the heart.
 Pulse pressure: is the difference between the systolic and
diastolic blood pressure ,which is normally 30-50 mm Hg
 Normal blood pressure in an adult varies between 100
and 140 systolic and 60 – 90 mm Hg diastolic.
 Hypertension: is high blood pressure more than 140/ 90
mm Hg.
 Hypotension: is low blood pressure less than 100 /60 mm
Hg.