1. THE VITAL SIGNS: TEMPERATURE, PULSE, RESPIRATIONS AND BLOOD PRESSURE
Abbreviated: TPR BP or
simply VS

2. THE VITAL SIGNS
Take a moment and close your eyes and concentrate on your breathing, the heat of your body and the flow of blood through your blood vessels as your heart beats.
These are the crucial, automatic processes that occur continuously to maintain your life.
They are indeed vital to life—and thus called the Vital Signs

3. SIGNS VS. SYMPTOMS
Symptoms can only be described / validated by the patient.
Pain, nervousness, dizziness, fatigue
Signs are able to be measured / observed by others besides the patient
Vital signs, wound drainage, color of sputum, blood cell counts

4. The measurement of core body heat
TEMPERATURE
The measurement of core body heat

5. ROUTES TO MEASURE TEMPERATURE
Axillary: Under the arm in the armpit
Orally: By mouth
Rectally: By rectum
Tympanic: In the ear
Temporal: through the skin of the temple

6. TYPES OF THERMOMETERS
Digital Electronic: To be used for oral, rectal, and axillary
Thermoscan - Digital: To be used for tympanic /temporal
Mercury or glass: To be used for oral, rectal, and axillary. Rarely used anymore due to health risks r/t mercury and risk of sharps injury if broken

7. NORMS Orally: 97.6 - 99.6 degrees Fahrenheit
Rectally: degrees Fahrenheit
Tympanic - manufacturers say to measure as for rectal
Axillary: degrees Fahrenheit
Temporally: Manufacturers say to measure as axillary.

8. HOW SHOULD THERMOMETER BE USED?
Tympanic: Special device with plastic covers, placed snugly in ear canal.
Electronic: Oral, rectal & axillary routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary, always retain hold of thermometer.
Mercury: same as electronic. Red ends are rectal; blue ends oral and axillary, always retain hold of thermometer.

9. DURATION FOR TAKING TEMPERATURES
Tympanic: As long as it takes to push a button
Temporal: Until the thermometer beeps
Electronic: Until the thermometer beeps
Mercury Oral: Three minutes
Mercury Rectal: Three minutes
Mercury Axillary: Ten minutes

10. BE CAREFUL ON RECTAL AND AXILLARY TEMPS
Always hold the thermometer in place while measuring temperatures by these routes
Always use lubricant with rectal temperatures
Always remove clothing around axilla and maintain arm pressed to side of torso

11. READING THE THERMOMETER
Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree
Long lines indicate degrees
Short lines indicate 0.2 of a degree
Four short lines between each long line (0.2, 0.4, 0.6, 0.8)
All other types give a digital display to the tenth of a degree.

12. PULSE
The felt wave of blood created by the heart pumping, that travels along the arteries.

13. WHERE TO FIND PULSES Locations called “pulse points”
Felt at areas where the artery is between finger tips and a bony prominence or section
Felt with 2-3 fingers, but never the thumb

14. PULSE POINTS AND THEIR LOCATIONS
Temporal
Carotid
Apical
Brachial
Radial
Femoral
Popliteal
Post Tibial
Dorsal Pedalis

15. HOW TO MEASURE? Measured in beats per minute
Count the felt waves for 60 seconds
Or, count the felt waves for 30 seconds – then multiply by 2

16. NORMS Pulse norms are 60 - 100 beats per minute
Pulses between are in a gray area - high normal
Faster than tachycardia
Slower than 60 – bradycardia
Caveat: well trained athletes may have “normal” pulse rates of 45-60, depending on level of fitness

17. QUALITY OF PULSE Rhythm: regular or irregular
Rate: Bradycardic, Within the normal limits, Tachycardic
Strength: Thready, Weak, Strong, Bounding

18. WHAT AFFECTS PULSE RATES AND QUALITY
Body Temperature
Emotions
Activity Level
Health of the Heart / vascular volume

19. RESPIRATION
The exchange of gases at the alveolar-cellular level that results from the mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

20. RESPIRATION Measured in breaths per minute
Normal range is breaths per minute
Count for 1 full minute or for 30 sec. x 2
Greater than 24 is tachypnea
Less than 12 is bradypnea
Watch for rate, depth, listen for quality of breath (adventitious vs. vessicular sounds), and difficulty in breathing (SOB/labored)

21. METHOD OF MEASURING TPR
If using a mercury thermometer, measure the pulse and respiration while waiting for the temperature
If using another method of measuring the temperature, complete the temperature - then measure the pulse and respiration
Keep your fingers on the pulse while measuring the respiration

22. BLOOD PRESSURE
The measurement of the force of blood against artery walls.
Measured using device called sphygmomanometer and a stethescope.
Measured as a fraction in mm/Hg
Upper number (numerator) called the Systolic blood pressure.
Lower number (denominator) called the Diastolic blood pressure.

23. MEASURING BLOOD PRESSURE
The last sound heard (diastolic blood pressure) – is the measure of the pressure in an artery when the heart (ventricles) relaxes between contractions.
Normal Ranges SBP: , DBP: 60-80
Hypertensive: 140/90 and above
Hypotensive: 80/50 and below
Grey areas: between norms and hyper/hypo

24. CAUSES & S/S HYPOTENSION
Causes may include:
Medications
Illness
Injury
dehydration
Signs & symptoms may include:
Dizziness / light-headedness
Lethargy / fatigue / generalized weakness
might faint

25. CAUSES & S/S HYPERTENSION
Hypertension is called the silent killer because there are often no symptoms.
Causes may include:
family history / high salt diet / overweight
emotional upset /physical pain
illness / medications / fluid overload
Some people might experience:
Headache / Pressure in the head / Tinnitis
General feeling of malaise

26. CAUSES OF HTN-(CON’T)
Genetics: More prevalent in African Americans than other ethnicities
Age: More prevalent in middle-aged and elderly people than younger people
Body size: More prevalent in obese people than thinner people
Lifestyle: More prevalent in heavy drinkers than moderate to non-drinkers
Co-morbidities: People with diabetes, gout or kidney dx .

27. CHARTING
Chart in order: temperature - pulse – respiration – blood pressure.
Do not write T =, etc.
Number for temp with no route designation=oral
Write (Ax) after axillary temperatures
Write (R) after rectal temperatures
Write (Tymp.) for tympanic
Write (Temporal) for temporal

28. ABBREVIATIONS QID - Four times a day SOB - Short of breath
QS - Every shift
QD - Every day
PRN - As needed
Ad Lib - At liberty (as desired)
B/P - Blood Pressure
VS - Vital Signs
HTN-hypertension
SOB - Short of breath
TPR - Temperature, pulse, and respiration
WNL-Within normal limits
VSS-Vital signs stable
P.O. - By mouth
BID -Twice a day
TID -Three times a day

29. TERMS Bradypnea - Slow breathing
Eupnea - Normal breathing
Orthopnea - Sitting upright to breath more easily
Apnea - No breathing
Hyperpnea - Fast, deep breathing
Hypopnea- slow shallow breathing
Tachypnea – Fast breathing
Bradypnea - Slow breathing
Dyspnea - Painful or difficult breathing
Tachycardia - Pulse rate in excess of 100 bpm
Bradycardia - pulse rate less than 60 bpm

30. TERMS Bounding pulse - excessively strong pulse
Weak pulse – softer pulsation than normally felt
Hypertensive – blood pressure 140/90 & above
Hypotensive-blood pressure 80/50 & less
Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is “a piece of thread” running or fluttering under the fingertips.