1. Measuring Vital Signs
Chapter 18

2. Introduction to Vital Signs
Vital Signs are important indicators of your patient’s health status! They show whether or not the patient is in homeostasis (balance… wellness)
Vital Signs include:
Body Temperature (T)
Pulse (heart rate) (P)
Respiration rate (R)
Blood Pressure (B/P)

3. Other measures of well-being:
Presence/absence of Pain
Because pain is subjective, using a pain scale can help accuracy of reporting
Oxygen concentration
Measured through Pulse oximetry (measures oxygen concentration in the arterial blood)
Overall physical/mental status

4. Temperature It is a measure of body heat
Heat is created and released by normal body functions
Heat is produced by (these make the body warmer)
Muscles
Glands
Oxidation of food
Heat is released by (these cool the body off)
Respiration
Perspiration
Excretion

5. Fever A fever is not an illness… it is a sign of an illness!
Fevers are fighting FOR the person.. They are not necessarily a bad thing
Most pathogens thrive at A fever raises this temperature a couple of degrees making it harder for these germs to live.
A fever activates the body’s immune system so it makes more white blood cells and antibodies.

6. Cause of Elevated Body Temperature
Usually an infection with a pathogen (like a virus or bacteria)
Colds/Influenza/Bronchitis/Upper Respiratory Infections (URIs) like tonsillitis or laryngitis or sinus infections
Strep throat
Ear infection (otitis media)
Gastroenteritis (stomach “flu”)
Infectious mononucleosis (Epstein-bar virus)
Urinary tract infections (UTI… Bladder infection… Kidney infection)
Something more serious like appendicitis, meningitis, AIDS, CA (cancer), autoimmune disorders
OR SOMETIMES it’s a FUO (Fever of Unknown Origin)

7. Factors Affecting Temperature
Increase
Decrease
Exercise
Digestion of food
Increased room temp.
Illness
Infection
Excitement
Anxiety
Sleep
Not eating (fasting)
Cold room temp
Decreased muscle activity
Depression
Factors Affecting Temperature

8. Vocab related to Temperature
Febrile: Pt. has a fever. Temperature more than 1 degree above the patient’s normal temperature.
Afebrile: Temperature within normal range. (a means without… so afebrile means without a fever… normal)
Hypothermia: Below the normal (usually less than 95 degrees)

9. Types of Thermometers Glass Aural (ear) Electronic/Digital
Glass tube with heat-sensitive liquid in it.
As the liquid heats up it moves up the tube
Read this thermometer by looking at the calibrated lines on the glass
Aural (ear)
Probe placed in ear. Reads temperature in about 1 sec.
Good for children (easy) but may have accuracy issues in children less than 6 years old
Electronic/Digital
Probe covered with a disposable shield.
Goes in mouth (oral)
Quick and easy to use.

11. Read the Glass thermometers

12. Newer Thermometers… Temporal artery thermometer
No-touch infrared thermometer

13. Where to Take A Temperature
Oral (mouth)
Most common site
Normal range
Rectal
Most accurate
Average range (one degree higher than oral)
Aural (ear)
Same temperature range as Oral
Axillary (armpit)
Least accurate… so use only when other routes cannot be used
Normal Range (one degree lower than oral)

14. Pulse Pulse is a measure of the heartbeat
It is caused by the pressure of the blood pushing against the wall of an artery as the heart contracts.
Indicates how well the blood is circulating through the body
Pulse is measured in beats per minute (BPM)

15. Radial Pulse:
-Found in the side of the wrist under the thumb.
-Place your fingers over an artery and squeeze gently against the bone.

16. How To Count Pulse Rate
Pulse is always measured in beats per minute (BPM)
So… you can…
Count for 1 full minute
Especially important if pulse is irregular
Count for 30 seconds and multiply by 2
Example: If you counted 42 beats in 30 seconds, then
42x2 = 84 BPM
Count for 15 seconds and multiply by 4
Example: If you counted 22 beats in 15 seconds, then
22x4= 88 BPM

17. Pulse When checking the pulse, note the Rate Rhythm Volume
Number of beats per minute (BPM)
Rhythm
Regular or irregular?
Irregular heart rhythms are called arrhythmias
Volume
Strength of each beat
Normal or Bounding (forceful) or Thready (weak)

18. Factors Affecting Pulse
Increase Pulse
Decrease Pulse
>100 = Tachycardia
Tachy = fast
Cardi = heart
Exercise
Illness (fever)
Anxiety/excitement
Some medications
Shock (decreased blood volume/circulation from illness or severe bleeding)
<60 = Bradycardia
Brady = slow
Cardi = heart
High level of aerobic fitness (being in shape)
Depression
Some medications
Cardiac dysfunction
Sleep
Factors Affecting Pulse

19. Normal Ranges 90-160 BPM 115-130 BPM 80-115 BPM 60-80 BPM Birth
Birth – 1 year
BPM
Children
60-80 BPM
Adults

20. Apical Pulse
This is a pulse that is taken by placing a stethoscope at the apex (pointed end) of the heart and counting the beats per minute
The apex is located about 2-3 inches below the left nipple.
This technique is used
On infants
When the radial pulse is difficult to assess
When he radial pulse is irregular (weak, rapid etc.)
When the patient is taking medications that may alter the heart rate.

21. Respiration
Respiration is taking in oxygen (O2) and expelling carbon dioxide (CO2)
1 inspiration + 1 expiration = 1 Respiration
Respiratory rate = # of breaths in one minute.

23. Counting Respiratory Rate
When you assess the respirations, don’t let the patient know what you are doing. If they do, they may not breathe normally.
Count the number of respirations after you count the pulse.
EXAMPLE: Hold the patient’s wrist while taking a radial pulse. Count for 30 seconds. Remember this number.
THEN, while continuing to hold the wrist, count the number of respirations in 30 seconds.
Multiply both numbers by 2 to get the rate per minute.

24. Factors that Affect Respiration
Exercise
Anxiety
Respiratory disease
Some medications
Pain
Heart disease
Relaxation
Depression
Head Injury
Some medications (narcotic pain medications)

25. Normal Respiration For adults 12-20 respirations per minute is normal
Dyspnea = Difficulty breathing
Dys = bad pnea=breathing
Apnea = Breathing stops
A = without pnea=breathing
When measuring respirations, note the following:
Rate
Number of respirations per minute
Rhythm
Regular or irregular
Quality
Amount of air exchanged and the effort it takes

26. Blood Pressure
Blood pressure is the force of the blood pushing against the walls of the blood vessels.
Systolic pressure:
Pressure in blood vessels when the heart contracts (beats), and the blood is forced out of the left ventricle and into the arteries.
Diastolic pressure:
Pressure in blood vessels when the heart relaxes (so it can refill with blood).
Normally, the systolic pressure is between and the diastolic pressure should be between 60-90

27. Terminology Hypotension : Low blood pressure
Hypertension: High blood pressure
Hypertension as a disease is also called “The Silent Killer”
Asymptomatic: Without symptoms
Sphygmomanometer (most people call it a blood pressure cuff)
Sphygmo refers to pulse
Mano refers to pressure
Meter refers to measure

28. How BP is Measured
The sphygmomanometer (BP cuff) has an inflatable cuff and a gauge which indicates the pressure
The cuff is placed on the arm and inflated. As it squeezes the arm, it stops the flow of blood. A stethoscope is placed over the brachial artery (inside of the elbow). As the pressure is reduced, the flow returns and you will hear the first heart beat. The pressure at the first beat you hear is the systolic pressure
As the cuff continues to deflate, eventually you will no longer hear any sounds. The pressure at the last beat you hear is the diastolic pressure.
These sounds you hear are called Korotkoff sounds

30. Factors that Affect BP Increase BP Decrease BP
Loss of elasticity in the arteries (arteriosclerosis… “hardening of the arteries”)
Exercise
Eating
Stimulants (caffeine)
Anxiety
Hemorrhage (lots of bleeding)
Inactivity
Fasting (not eating)
Suppressants (medications)
Depression
Factors that Affect BP

31. Recording Vital Signs VS are always written in this order:
T P R B/P
/80
Make sure you compare recent vital signs with previous ones.
Look for changes or patterns.
Look for any unusual readings (shallow respirations, weak thread pulse)
Note any vital signs that are outside of the normal range.

32. Video Clip on Vital Signs