NURS 201

Vital signs
T P R BP
Temperature T
Pulse P
Respiration R
Blood pressure BP
- V.s are indicators of vital organ/system function (hypothalamus, heart, lungs and blood
vessels)
- Are all regulated through homeostatic mechanisms
- A change in any sign might indicate alteration in the function of the vital organ/system
When to access vital signs?
Anything that has to do with surgical procedure | before, during and after| if he/she has a
high temperature, you can’t operate on them
- Based on agency or institutional policy
What is body temperature?
measuring the balance of the heat lost or gained
metabolic result of
the temp that is the balance of the heat gained – heat lost
less than 36 hypothermia -> excess of heat lost or
someone is in shock; we cover the person to maintain heat in the body so that the cells
function
temp high -> fever or hyperthermia  it will disturb body functions  we need to drop the
temp by uncovering the patient – let the heat leave the cells- turn on tap water especially in
the groin area and axillary area – antipyretics
core body temp= medium in which the cells are ]
axillary is a reliable and safe way to measure the temp - anal not that safe
tympanic and rectum reflect the core body temp
older adults expect temp to be lower
tympanic ->small adaptor that goes in the ear cannel, mainly for children
temporal-> on surface of the skin, very close to the surface, not used in clinical settings only
in diet clinic (very expensive)
oral: digital or glass thermometer bec of mercury inside and the glass may break
axillary: digital or glass (not anymore)
if patient is receiving oxygen, you can’t test the temp orally; use axillary
use rectal in icu
respiration:
inspiration and expiration considered one breath
focus on rate and depth of breathing
rate: number
depth: how deep or shallow
respiration is smooth and effortless
don’t tell the person that you are taking his respiration
baby breath more
infection: it increases the oxygen supply
upnea : normal rate
bradypnea is decreased rate
trachypnea
apnea : no breathing
dyspnea p silent difficulty in breathing
orthopnea ( ortho sitting or lying position) patient has difficulty in breathing when he is
sittung – cant breath well when the patient is laying on the body, you have to move the
patient in a sitting position

tachypnea very rapid the rate is quick

alkalosis
pulse: slide 34
rhythmic / dysrhythmic (extra heart beat)
every cardiac cell in the heart has the ability to generate a Pulse, unless there is an
abnormality === Na disturbance
aptitude: volume -> reflects the strength of the myocardium
from 60 to 100 is normal
epinephrin -> decrease because it acts on the autonomic ns
concord (with hypertension)  beta blocker (stimulates the B1 in the SA node -> decreases
the impulsesdecreases the heart rate)
parasympathetic  decrease the impulses decreases the heart
heart failure -> the contraction ability of the heart is low; the heart tries to compensate by
pumping more blood - heart rate increases
infection  heart rate increase
decrease in metabolic rate  with exercise and sleep
doppler ultrasound stethoscope the ones that have a weak pulsation
carotid when the patient is unconscious / only for emergency because you might block
the circulation
brachial area
dorsal pedis -> good for diabetic patients
popliteal -> difficult (we use the two hands)
you place the diaphragm on the apical area of the heart and count the ribs for infants
with heart problem
bradycardia less than 100 -new born with heart failure
0 absent
+1 weak
+2 normal
+3 bounding
With blood pressure we care about the left ventricle
Contraction- systolic
Relaxation- Diastolic
When the left ventricle relaxes the pressure of the blood on the arterial wall
Systole has a higher value
When I take the bp of the person I focus on three points
1) Strength/status of ventricular contraction –(LV) - HF
2) Status of arterial system – the adults their vessels lose resistance- hypertension-
cholesterol – high blood pressure
3) Blood volume - 5/6 L of blood, if a person loses 1 L of blood you directly see a drop in
blood volume

Circadian rhythm -> physiological

Cortisol level of the body reaches its peak in the morning-> it wakes you up in the morning
Cortisol level in the night is low-> that’s why you sleep
As you sleep the cortisol level increases

Elevate bp  change in lifestyle  what we do in the clinics

Most accurate is the sphygmomanometer- its heavy
Patient arm has to be at level - systolic might drop
Raise the mercury to the level
Put your hand on the radial artery as you inflate, when you don’t feel the pulse anymore
add 30; deflate very slowly so that the mercury goes down slowly
The first sound you hear is the systolic- it is followed by the tapping sound that increases in
intensity when the artery is opened