UNIVERSITY OF THE PHILIPPINES MANILA

SCHOOL OF HEALTH SCIENCES

Extension Campus in Tarlac Province

COMMUNITY HEALTH 52
(FUNDAMENTALS OF HEALTH CARE 1)
Unit 3: Detection of Common Signs and Symptoms of Illness

PART 1:

INTRODUCTION

Having the ability to assess a patient’s health condition is a competency that every midwife or health worker must
possess as they are the first contact or at the grassroots level in the health care system. To do this, a midwife must
be knowledgeable about what to look for in the patient’s vital signs. For this unit, you will learn how to detect
deviations from health through a patient’s/client’s vital signs. You will also begin learning the skills of taking the
vital signs through simulation activities in this learning unit.

Learning Objectives
This learning unit aims to achieve the following outcomes:
 State the vital signs and their normal values.
 Enumerate factors that affect the vital signs.
 Measure the vital signs by following the correct procedure.
 Detect deviations from health based on accepted standards

Let us first define what vital signs are:

VITAL SIGNS:

 Also known as “cardinal signs”

 Includes temperature, pulse, respiration, blood pressure and pain
 Measurement provides data to determine the client’s usual state of health
 Change in vital signs can indicate change in physiologic function of the body.
 Assessment of vital signs will enable the health worker to:
 Identify the problem precisely
 Plan for the right intervention

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  What are the techniques we use to assess vital signs?
a. Inspection – for this technique you will utilize your vision, smell and hearing to assess normal
conditions and deviations. Assess for color, size, location, movement, texture, symmetry, odors, and
sounds.
b. Palpation – requires you to touch the patient with different parts of your hands, using varying degree
of pressure. It is important that you remember to keep your fingernails short and your hands warm;
wear gloves when palpating mucous membranes or areas in contact with body fluids; and to palpate
tender areas last.
c. Auscultation – involves listening for various lung, heart and bowel sounds with the use of a
stethoscope.

VARIATIONS IN NORMAL VITAL SIGNS BY AGE

The table below will help you in determining the standard vital signs value per age group. This could guide
you in determining what is normal or otherwise for your clients/patients.

Age Oral Temp. Pulse Respiration BP

(°C) *F (bpm) (cpm) (mmHg)
newborn 36.8 80-180 30-80 73/55

1 year 36.8 80-140 20-40 90/55

5-8 37 75-120 15-25 95/57

10 37 50-90 15-25 102/62

Teen 37 50-90 15-20 120/80

Adult 37 60-100 12-20 120/80

Older adult (>70) 37 60-100 15-20 Possible increased

diastolic

As reflected from the table above, the normal values for each vital sign is set within a certain range except
for the body temperature which is presented with the average normal value for each age group. Let us investigate
each of the vital signs above.

BODY TEMPERATURE

 The balance between the heat produced and the heat lost from the body
 Measured in heat units called “degrees” Celsius and Fahrenheit
 There are two kinds of body temperature:
a. CORE TEMPERATURE
 Temperature of the deep tissues of the body (abdominal & pelvic cavity)
 Remains relatively constant within the range of 36.0°C to 37.5°C or 97°F to 99.5°F
b. SURFACE TEMPERATURE
 Temperature of the skin, subcutaneous tissue & fat
 Rises & falls in response to the environment Conversion

Celsius to Fahrenheit

PHYSIOLOGY OF BODY TEMPERATURE °F = °C (9/5 ) + 32

Fahrenheit to Celsius
The body continually produces heat as a by-product of metabolism.
Heat balance is achieved when the amount of heat produced by the body °C = (°F – 32) 5/9
equals the amount of heat lost.

 Maintained within a fairly-constant range by the thermoregulatory center in the hypothalamus

 Hypothalamus receives messages from thermal receptors in the skin & compares it with its temperature
set point
 The system that regulates body temperature has three main parts:
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 a. Sensors or sensory receptors – majority are found in the skin. The skin contains more
receptors for cold than warmth.
*When the skin becomes chilled, 3 physiologic processes takes place to increase heat
production:
- shivering occurs to increase heat production
- sweating is inhibited to decrease heat loss
- vasoconstriction decreases heat loss
b. Hypothalamic integrator – the center that controls the core temperature. It is in the pre-optic
area of the hypothalamus.
*When the sensors in the hypothalamus detect heat, they send out signals intended to
reduce the temperature, i.e., to reduce heat production and increase heat loss.
*When the cold sensors are stimulated, signals are sent out to increase heat production and
decrease heat loss.
c. Effectors – adjusts the production and loss of heat
*Cold sensitive receptors of the hypothalamus – vasoconstriction, shivering, and the release
of epinephrine – increases cellular metabolism and hence heat production
*Warm sensitive receptors of the hypothalamus – sweating and peripheral vasodilatation –
facilitate heat loss.

FACTORS OF HEAT PRODUCTION

These are ways by which the body produces heat. If you look closely, all the factors listed below is related to
an increase in basal metabolic rate.

 Basal metabolic rate

 The rate of energy utilization in the body required to maintain essential activities such as
breathing.
 Metabolic rates decrease with age. The younger the person, the higher the BMR.
 Muscle activity
 Such as exercise and shivering increase the metabolic rate
 Shivering
 Increases metabolic rate
 Thyroxin output
 Increased thyroxin output increases the rate of cellular metabolism throughout the body.
 This effect is called “chemical thermogenesis” – the stimulation of heat production in the body
through increased cellular metabolism.
 Epinephrine, Norepinephrine, and Sympathetic stimulation
 Release of neurotransmitters (epinephrine, norepinephrine) increases the rate of cellular
metabolism in many body tissues

FOUR PROCESSES OF HEAT LOSS

Heat is lost from the body through the following mechanisms or processes.

 Radiation
 Transfer of heat from the surface of one object to the surface of another without contact between
the two objects, mostly in a form of infrared rays.
 Convection
 The dispersion of heat by air currents.
 The body usually have a small amount of warm air adjacent to it.
 Evaporation
 Continuous evaporation of moisture from the respiratory tract and from the mucosa of the mouth
and from the skin
 Conduction
 The transfer of heat from one object to another (of lower temperature) with direct contact. It
normally accounts for minimal heat loss.

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FACTORS AFFECTING BODY TEMPERATURE

 Age – “infants are greatly influenced by temperature of the environment” – this is due to the immaturity
of the thermoregulatory function of the hypothalamus
 Circadian rhythms – body temperature normally changes throughout the day. The point of highest body
temperature is usually reached between 8:00 pm and midnight. The point of lowest body temperature is
reached during sleep between 4:00 and 6:00 am.
 Exercise – hard work or strenuous exercise can increase body temperature to as high as 38.3°C to 40°C.
 Hormones – women experience hormonal fluctuation. Progesterone secretion at the time of ovulation
raises body temperature above the basal temperature.
 Stress – stimulation of the sympathetic nervous system can increase the production of epinephrine and
norepinephrine, thereby increasing metabolic activity and heat production.
 Environment – extremes in environmental temperature can affect a person’s temperature regulatory
systems.

ALTERATIONS IN BODY TEMPERATURE

There are 2 primary alterations in body temperature: pyrexia and hypothermia.

 Pyrexia or Fever
 A body temperature above the usual range (normal body temperature is 36°C to 37.5°C) or above the
normal circadian range (>38°C).
 Hyperpyrexia
 A very high fever such as 41°C (105.8°F)
 Hypothermia
 A core body temperature below the normal lower limit of normal (<35°C)
When referring to a person you may use the following terms:
 Febrile
 The term used to refer to a client who has fever
 Afebrile
 One who has no fever

COMMON SITES in Assessing Body Temperature:

 Oral
 More frequently used site
 Reflects changing body temperature more quickly than the rectal method
 Advantages: accessible and convenient
 Disadvantages:
 Glass thermometers can break if bitten
 Inaccurate if client has just ingested hot or cold food or smoked cigarette
 Rectal
 Considered very accurate
 Reflects core body temperature
 Contraindication:
 Clients undergoing rectal surgery, diarrhea, or diseases of the rectum, have clotting
disorders, or have significant hemorrhoids
 Axilla
 Preferred site for measuring temperature
 Safe and non-invasive

 Tympanic membrane
 Another site which reflects core body temperature
 Advantage:
 Readily accessible
 Very fast
 Disadvantage:

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  Can be uncomfortable
 Risk of injuring the tympanic membrane if probe is inserted too far

How do we assess body temperature?

In assessing body temperature, you will need the following materials:

 Thermometer
 Cotton balls with antiseptic solution
 Alcohol

Procedure
1. Assemble equipment and supplies needed.
2. Explain to the client what you are going to do, why it is necessary, and how he can cooperate.
3. Wash hands and observe other appropriate infection control procedures.
4. Place the client in appropriate position.
5. Move the patient’s clothing to expose only the axilla.
6. Place the thermometer in the center of the axilla. Have the patient bring the arm down and close to the body.
7. Wait for the appropriate amount of time.
8. Remove the thermometer.
9. Read the temperature
10. Wash the thermometer (if necessary) and return it to the storage.
11. Perform hand hygiene.
12. Document the temperature in the client record.

PULSE
 Palpable bounding of blood flow noted at various points on the body. It is the wave of blood created by the
contraction of the left ventricle of the heart.
 Serves as indicator of circulatory status
 Can be assessed by:
a. Palpation (feeling)
b. Auscultation (hearing)

PHYSIOLOGY
 Regulated by the autonomic nervous system through the cardiac sinoatrial node
 Parasympathetic stimulation of SA node (thru vagus nerve) decreases heart rate
 Sympathetic stimulation of SA node increases the heart rate & force of contraction

FACTORS AFFECTING THE PULSE

 Age – as age increases the pulse rate gradually decreases.

 Gender – after puberty, the average male’s pulse rate is slightly lower than that of the females.
 Exercise – pulse rate normally increases with activity.
 Fever – pulse rate increases: (a) in response to the lowered BP that results from peripheral vasodilatation
associated with elevated body temperature and (b) because of the increased metabolic rate.
 Medications – some medications decrease pulse rate and other increase it.
 Hypovolemia – loss of blood from the vascular system normally increases pulse rate.
 Stress – sympathetic nervous stimulation increases the overall activity of the heart.
 Position changes – when a person is sitting or standing, blood usually pools in dependent vessels of the
venous system. Pooling results in a transient decrease in the venous blood return to the heart and a
subsequent reduction in blood pressure and increase in heart rate.
 Pathology – certain diseases such as some heart conditions or those that impair oxygenation can alter the
resting heart rate.

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 SITES in Assessing the Pulse

From the drawing in the right, you can see that there are
many pulse points where you can generally assess the patient’s pulse.
These sites are used to assess the circulatory status. Among the
different sites, the most used are the radial, brachial, and apical pulse
sites.

SITE LOCATION ASSESSMENT CRITERIA

Temporal Over temporal bone of head, above, and lateral to Used when radial pulse is not accessible; easily
eye. accessible site used to assess pulse in children
Carotid Along medial age of sternocleidomastoid Used in cases of cardiac arrest or physiologic shock.
Used to determine circulation to the brain.
Apical Fourth or fifth intercostals space at left midclavicular Routinely used for infants and children up to 3 years
line of age.
Site used to auscultate for apical pulse.
Brachial Groove between biceps and triceps muscle at Used to measure blood pressure.
antecubital fossa Used during cardiac arrest for infants.
Used to assess status of circulation to lower arm.
Radial Radial or thumb side of the forearm at wrist Common site used to assess character of pulse
peripherally and assess status of circulation to
hand.
Ulnar Ulnar side of forearm or wrist Site used to assess status of circulation to hand;
also used to perform an Allen’s test.
Femoral Below inguinal ligament, midway between the Site used to assess character of pulse during
symphysis pubis and anterior superior iliac spine physiologic shock or cardiac arrest when other
pulses are not palpable.
Used to assess status of circulation to leg.
Popliteal Behind the knee in popliteal fossa Site used to assess status of circulation to lower leg
Posterior Inner side of ankle, below medial malleolus Site used to assess status circulation to foot
tibial
Dorsalis Along top of foot, between extension tendons of Site used to assess status of circulation to foot s
pedis great and first toe

ASSESSING THE PULSE

As mentioned earlier, pulse can be assessed with the use of two techniques:
palpation and auscultation. In assessing the pulse, remember the following
points:
 The middle three fingertips are used for palpating all pulse sites except
the apex of the heart
 A stethoscope is used for assessing apical pulses & fetal heart tones
 With the aid of a stethoscope, place the diaphragm over the space between the fifth and sixth ribs (fifth
intercostal space) to the left midclavicular line.

In assessing the pulse, we collect the following data:

A. RATE (PR or pulse rate) - the number of pulsations felt over a peripheral artery in 1 minute
 Tachycardia – excessively fast heart rate

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  Bradycardia – heart rate lower than normal
B. RHYTHM
 Pattern of the beats and the interval between the beats
 Pulse is characterized by rhythm as either regular or irregular
C. VOLUME
 Also referred as the pulse strength or amplitude
 Refers to the force of blood with each beat
 Described as: strong, weak, thready or bounding, and absent.
 Can range from absent to bounding

How do we take the patient’s or client’s pulse rate?

Assessing the Peripheral Pulse (palpation):

 You need to prepare a wristwatch (any watch with a second hand) for this procedure.

Procedure

1. Assemble equipment and supplies needed.

2. Explain to the client what you are going to do, why it is necessary, and how she can cooperate.
3. Wash hands and observe other appropriate infection control procedures.
4. Assist the client to a comfortable position.
5. Select the pulse point
6. Palpate and count the pulse. Place two or three middle fingertips lightly and squarely over the pulse point.
7. Assess the pulse rhythm and volume
8. Perform hand hygiene.
9. Document the pulse rate, rhythm, and volume and your actions in the client record.

Assessing the Apical Pulse (auscultation):

To do this, you need to prepare the following materials:

 Watch with a second hand
 Stethoscope
 Antiseptic wipes/cotton balls with antiseptic solution

Procedure

1. Assemble equipment and supplies needed.

2. Explain to the client what you are going to do, why it is necessary, and how she can cooperate.
3. Wash hands and observe other appropriate infection control procedures.
4. Use alcohol swab to clean the diaphragm of the stethoscope. Use another swab to clean the earpieces (if
necessary)
5. Assist the client to a comfortable position, sitting or reclining position and expose the chest area. Move the
patient’s clothing to expose only the apical site.
6. Hold the stethoscope diaphragm against the palm of your hand for a few seconds.
7. Palpate the space between the fifth and sixth ribs (fifth intercostal space) and move to the left midclavicular line.
8. Listen for heart sounds (lub-dub). Using a watch, count the heartbeat for 1 minute
9. Cover the patient and help him/her to a position of comfort.
10. Clean the diaphragm of the stethoscope with an alcohol swab
11. Perform hand hygiene.
12. Document the pulse rate, rhythm, and volume and your actions in the client record.

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RESPIRATIONS

 The act of breathing

 Involves several physiologic events:
 Pulmonary ventilation
 Refers to the movement of air in & out of the lungs
 Involves two mechanisms:
 Inspiration/inhalation – act of breathing in
 Expiration/exhalation – act of breathing out
 External respiration
 Exchange of oxygen and carbon dioxide between the alveoli of the lungs and the circulating blood.
 Internal respiration
 Exchange of oxygen and carbon dioxide between the circulating blood and tissue cells

FACTORS AFFECTING RESPIRATIONS

There are several factors or instances that could either increase or decrease the client’s or patient’s respiratory
rate.
 INCREASE RR:
 Exercise
 Stress
 Increased environmental temperature
 Lowered O2 concentration at increased altitudes
 DECREASE RR:
 Decreased environmental temperature
 Certain medications: narcotics
 Increased intracranial pressure

ASSESSING RESPIRATIONS

 Normally, breathing is carried out automatically and effortlessly

 Respirations are assessed while the client is relaxed
 Before assessing a client’s respiration, remember to check for:
a. The client’s normal breathing pattern
b. Influence of client’s health problems on respirations
c. Medications or therapies that might affect respirations
d. The relationship of the client’s respiration to cardiovascular function

What to do you need to assess?

 RESPIRATORY RATE
 Normally described in breaths per minute or cycles per minute.
 The health worker must observe a full inspiration and expiration when counting ventilation.
 Described as:
 Eupnea - normal rate & depth
 Bradypnea – abnormally slow respirations
 Tachypnea – abnormally fast respirations
 Apnea – absence of breathing for several seconds

 RESPIRATORY DEPTH
 Assessed by observing the degree of excursion or movement in the chest wall
 Normally varies from shallow to deep: normal, shallow, deep

 RESPIRATORY RHYTHM
 Refers to the regularity of breathing (expirations and inspirations)
 It can be determined by observing the chest or abdomen

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  Described as: regular or irregular

 RESPIRATORY QUALITY & CHARACTER

 Refers to those aspects of breathing that are different from normal effortless breathing
 Includes the amount of effort a client must exert and the sound of breathing
 Alterations:
 Ease and Effort:
 Dyspnea – difficult and labored breathing during which the individual has a persistent
unsatisfied need for air and feels distressed
 Orthopnea – ability to breath only in upright sitting or standing positions
 Abnormal breath sounds
 Wheeze – continuous high-pitched musical squeak or whistling sound occurring on
expiration & sometimes on inspiration when air moves through a narrowed or partially
obstructed airway
 Stridor – a shrill, harsh sound heard during inspiration with laryngeal obstruction
 Stertor – snoring respiration due to partial obstruction of the upper airway
 Bubbling – gurgling sounds heard as air passes through moist secretions in RT
 Secretions & Coughing
 Hemoptysis – presence of blood in the sputum
 Productive cough – cough accompanied by expectorated secretions
 Non-productive cough – dry, harsh cough without secretions

How to assess the respiratory rate?

To do this you will need a wristwatch (or any watch with a second hand).

Procedure

1. While the fingers still in place for the pulse measurement, after counting the pulse rate, observe the patient’s
respirations.
2. Note the rise and fall of the patient’s chest
3. Using a watch with a second hand, count the number of respirations for 1 minute
4. Observe the depth, rhythm, and character of respirations.
5. Perform hand hygiene
6. Document the respiratory rate, depth, rhythm, and character on the patient’s record

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BLOOD PRESSURE

 Refers to the force of blood against arterial walls

 Maximum BP is exerted on the walls of arteries when the left ventricle of the heart pushes blood through
the aortic valve into the aorta.
 It reflects the interrelationships of cardiac output, peripheral vascular resistance, blood volume, blood
viscosity and arterial elasticity.
 There are two (2) blood pressure measurements:
 SYSTOLIC PRESSURE
 The pressure of the blood as a result of contraction of the ventricles
 DIASTOLIC PRESSURE
 The pressure when the ventricles are at rest.

*PULSE PRESSURE – difference between the systolic & diastolic pressure. Refers to the change in blood
pressure seen during the contraction of the heart.

 Measured in millimeters of mercury (mmHg)

 Recorded as a fraction:
Numerator = systolic pressure
Denominator = diastolic pressure

FACTORS AFFECTING BLOOD PRESSURE

 Age – the pressure rises with age, reaching a peak at the onset of puberty and then tends to decline
somewhat.
 Exercise – physical activity increases cardiac output, hence blood pressure.
 Stress – stimulation of the sympathetic nervous system increases cardiac output and vasoconstriction of
the arterioles, thus increasing the blood pressure reading.
 Race – African American males over 35 years have higher BP than European American males of the same
age.
 Gender – after puberty, females usually have lower BP than males of the same age.
 Medications – may increase or decrease BP
 Obesity – may predispose hypertension
 Diurnal variations – BP is lowest early in the morning, then rises throughout the day and peaks in the late
afternoon or early evening.
 Disease process – any condition affecting cardiac output, peripheral vascular resistance, blood volume,
blood viscosity, and arterial elasticity has direct effect on the BP.

ASSESSING BLOOD PRESSURE

 EQUIPMENT:
 Blood pressure cuff
 Sphygmomanometer
 Stethoscope

 METHOD:
There are two methods in assessing the blood pressure, the
most common of the two is the non-invasive indirect method of
assessing the blood pressure.
 Direct (invasive monitoring)
 Non-invasive Indirect method – auscultatory and palpatory

CONSIDERATIONS IN TAKING THE BP

 BP reading should be made with the eye at the level of the rounded
curve (meniscus) of the manometer
 BP cuff should be of accurate size:
width of cuff = 40% of arm circumference and
2/3 of the arm’s length

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  Patient’s arm should be supported and positioned at the level of the heart
 When electronic BP devices are used, it should be calibrated periodically to check accuracy.

COMMON ERRORS IN ASSESSING BP

ERROR EFFECT
Bladder cuff too narrow High
Bladder cuff too wide Low
Arm unsupported High
Insufficient rest before assessment High
Repeating assessment too quickly High systolic
Low diastolic
Cuff wrapped too loosely or unevenly High

ERRORS EFFECT
Deflating cuff too quickly Low systolic
High diastolic
Deflating cuff too slowly High diastolic
Failure to use the same arm consistently Inconsistent measurement
Arm above the level of the heart Low
Assessing immediately after a meal or while client smoke or has pain High
Failure to identify auscultatory gap Low systolic
Low diastolic

ALTERATIONS

HYPERTENSION
 A BP that is persistently above normal
 Usually asymptomatic; predisposing factor to myocardial infarction (heart attack)
 Types:
a. Essential HPN(Primary Hypertension) – an elevated BP of unknown cause
b. Secondary HPN- an elevated BP of known cause

HYPOTENSION
 A BP that is below normal
 Systolic reading consistently between 85 and 110 mmHg in adult whose normal pressure is higher than
this
 Occurs due to the following cause:
 Analgesics use
 loss of substantial amount of blood volume (in case of bleeding, severe burns, and dehydration)
 failure of heart muscle to pump adequately
 dilatation of arteries in vascular bed

*Orthostatic hypotension – pressure falls when the client changes position, results from peripheral vasodilatation

How do we assess blood pressure?

To do this, you need to prepare the following equipment:

 Stethoscope
 Sphygmomanometer
 Blood pressure cuff of appropriate size
 Cotton balls with antiseptic solution
 Alcohol

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 Procedure

Fundamentals of Health Care 1Page 12

 1. Assemble equipment and supplies needed. (should be able to identify all equipment)
2. Explain to the client what you are going to do, why it is necessary, and how she can cooperate
3. Wash hands and observe other appropriate infection control procedures
4. Provide for client privacy
5. Select the appropriate arm for application of cuff.
6. Have the client assume a comfortable lying or sitting position.
a. The client should be sitting with both feet flat on the floor.
b. The elbow should be slightly flexed with the palm of the hand facing up and the forearm supported at heart
level.
7. Expose the brachial artery
8. Palpate the location of the brachial artery. Apply the center of the bladder directly over the artery. Place the
lower border of the cuff approximately 2.5 to 5 cm above the antecubital space
9. Wrap the cuff around the arm smoothly and snugly.
10. Check that the needle on the aneroid gauge is within the zero mark.
11. Palpate the pulse at the brachial or radial artery by pressing gently with fingertips
12. Tighten the screw valve on the air pump
13. Inflate the cuff while continuing to palpate the artery.
14. Note the point on the gauge where the pulse disappears.
15. Deflate the cuff and wait for 1 to 2 minutes
16. Assume a position that is no more than 3 feet away from the gauge
17. Cleanse the earpieces and the chest-piece of the stethoscope with alcohol
18. Insert the ear attachments of the stethoscope in your ears so that they tilt slightly forward
19. Place the bell or diaphragm of the stethoscope firmly but with as little pressure as possible over the brachial
artery
20. Pump up the cuff until the sphygmomanometer reads 30 mmHg above the point where the brachial pulse
disappeared
21. Release the valve on the cuff carefully so that the pressure decreases at a rate of 2-3 mmHg per second
22. Note the point on the point on the gauge at which the first faint, but clear sound appears that slowly
increases in intensity. Note this as the systolic pressure
23. Note the pressure at which the sound first becomes muffled. Also observe the point at which the sound
completely disappears. This is the diastolic pressure.
24. Deflate the cuff rapidly and completely
25. Wait one or two minutes before making further determinations
26. Remove the cuff and clean and store the equipment
27. Perform hand hygiene
28. Document blood pressure reading in the client’s record.

Though we have identified “PAIN” as the fifth vital sign, we will not include that in this topic. We have
focused on the four vital signs (temperature, respiration, pulse, and blood pressure) as this will be your guide in
doing your activity and assignment for this learning unit. Kindly see your Study Guide and Assignment Guide
downloaded in Canvas and sent to you at our official messenger group to know more about the activity expected
of you for this unit.
With the procedure checklist included here in the reading material, make the necessary preparations of
how you’ll be able to obtain the equipment/materials you will need. You may also watch the links of videos
included in the study guide for reference.

PART 2:
DETECTION OF COMMON ILLNESS

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INTRODUCTION

In this part of the learning unit, you will now identify common signs and symptoms that suggest illness.
But unlike doctors, we will not focus on the diagnosis (identifying the disease present) but rather on the
identifying cues or evidence suggestive of the presence of illness in our patients – the signs and symptoms of
illness. We will first define common conditions that you may encounter in the community. The learning unit
however will not include interventions as that will be discussed on the next module or learning unit of this course.

OBJECTIVE

At the end of this unit, you will:

 Identify clients needing promotive & preventive health services
 Describe common signs and symptoms of illness.
 Demonstrate ability to use medically appropriate terms in writing in the patient’s records and forms

Let us first define terms:

SIGNS:
 Objective data or information
 Information detectable by an observer or can be tested against an accepted standard
 Can be seen, heard, felt, or smelled

SYMPTOMS:
 Subjective data
 Information apparent only to the person affected and that can be described or verified only by that person

A. CHANGE in TEMPERATURE: FEVER

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  An elevation in body temperature above the normal circadian range because of an increase in the body’s
core temperature
Temperature above 37.2 °C (98.9°F) in the morning
37.7 °C (99.9°F) in the evening
 Known medically as:
Pyrexia

*Hyperthermia – refers to a group of heat-related conditions characterized by an abnormally high body

temperature. The condition occurs when the body’s heat-regulation system becomes overwhelmed by
outside factors, causing a person’s internal temperature to rise.

Difference between Fever (pyrexia) and Hyperthermia

Fever or Pyrexia Hyperthermia

 Elevation of body temperature above the normal
variation usually induced by cytokine activation.
 Caused by an increase in the hypothalamic set point
 A natural, adaptive response of the body to
physiological stress
 Controlled increase of the overall body temperature
 Responds well to anti-pyretic medications.
 Slight fluctuations in temperature within the day
 Natural, protective response of the body
 Elevation of core body temperature due to
thermoregulation failure
 No involvement of the hypothalamus and the
hypothalamic set-point remains untouched
 The body has impaired ability to lose heat; can be
caused either by excessive amounts of heat from the
surroundings or due to an increase in the body’s
internal heat production
 Sharp spike in temperature
 Does not respond to anti-pyretic drugs
 No variation or fluctuation observe within the day
 Considered as serious medical emergency and requires
intensive care

CAUSES
 Disturbance in normal immune response (caused by either a virus, bacteria)
 Injury to body tissues
 Metabolic disorders (gout)
 Injuries to the brain
 Some medications (such as antibiotics and drugs used to treat high blood pressure or seizures)
 Some immunizations (such as diphtheria, tetanus or pneumococcal vaccine)
 No apparent cause (Fever of Unknown Origin)

SIGNS & SYMPTOMS

Common signs and symptoms associated with fever occurs in three stages:
 Stage 1: Onset – gradual or abrupt
• Increased HR & RR
• Shivering, cessation of sweating
• Pallid, cold skin
• Complaints of feeling cold
• Cyanotic nail beds
• “gooseflesh” appearance of the skin
 Stage 2: Course – also called stadium or fastigium; last for a few days up to 3 weeks
• Absence of chills
• Skin feels warm (hyperemia)
• Photosensitivity & glassy-eyed appearance
• Increase PR & RR
• Increased thirst, or mild to severe dehydration
• Drowsiness, restlessness
• Loss of appetite
• Malaise, weakness & aching muscles
 Stage 3: Defervescence

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 • Skin appears flushed & feels warm
• Sweating, decreased shivering
• Possible dehydration

TYPES OF FEVER

 INTERMITTENT

 Body temperature alternates at regular interval between periods of fever and periods of normal or
subnormal temperature

 REMITTENT

 A wide range of temperature fluctuations (more than 2°C [3.6°F]) occurs over the 24-hour period all of
which are above normal

 RELAPSING

 Short febrile periods of a few days interspersed with periods of 1 to 2 days of normal temperature

 CONSTANT

 Body temperature fluctuates minimally but always remains above normal

When to refer patients with fever?

Contact a health care provider if the patient experiences any of the following:
 Temperature is higher than 39°C (103°F)
 Any of these symptoms accompanies fever:
- Severe headache
- Unusual skin rash, especially if the rash rapidly worsens
- Unusual sensitivity to bright light
- Stiff neck and pain when the head is bent forward
- Mental confusion
- Persistent vomiting
- Difficulty breathing or chest pain
- Abdominal pain or pain when urinating
- Convulsions or seizures

B. CHANGE in BOWEL FUNCTIONS: DIARRHEA & CONSTIPATION

CONSTIPATION
 Common condition that affects people of all ages.
 It means there is infrequent passage of stools.
 May be defined as fewer than 3 bowel movements per week
 Passage of dry, hard stools or the passage of no stool
 Occurs when the movement of feces through the large intestine is slow

CAUSES
It is often difficult to identify the exact cause of constipation, but several things can contribute to the
condition such as the following:
 Insufficient fiber in the diet (such as fruits, vegetables, and cereals) & not enough fluid intake
 Insufficient activity or immobility
 Irregular defecation habit or ignoring the urge to pass stools
 Change in daily routine
 Lack of privacy
 Emotional disturbances (depression)

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  Chronic use of laxatives or enemas
 Medications (ferrous sulfate; loperamide)

WHO is affected?
Anyone can be affected with this condition. It can occur on babies, children, and adults. It affects twice as
many women as men and more common in older adults and during pregnancy.

SIGNS & SYMPTOMS

 Decreased frequency of defecation
 Hard, dry, formed stools
 Straining at stool/painful defecation
 Reports of rectal fullness
 Abdominal pain, cramps, distension
 Decreased appetite
 Headache

COMPLICATIONS of constipation:

For most people, constipation rarely causes complications, but if the constipation is chronic, the following
may develop:
 Hemorrhoids
 Fecal impaction
 Bowel incontinence (leakage of liquid stools)

WHEN to refer a patient?

Constipation can be managed simply by looking into what probably has caused them, how long, and/or how
severe the symptoms are. It is a common condition that is generally not serious and typically does not last long,
however, the following are instances that you may use as parameters for referral:
 Blood in the stool
 Intense or constant abdominal pain
 Vomiting
 Painful stomach bloating
 Unexplained weight loss
 Persistent tiredness

DIARRHEA
 According to the WHO, it is defined as the passage of three or more loose liquid stools per day (more
frequent passage than is normal for the individual)
 It is the second leading cause of death among children under five years old
 It can last for several days and can leave the body without the water and salts necessary for survival
(dehydration)
 It is usually a symptom of an infection of the intestinal tract
 Physiologically it results from the rapid movement of fecal contents through the large intestine
 There are three clinical types of diarrhea:
o Acute watery (short-term) diarrhea – lasts several hours or days and includes cholera
o Acute bloody diarrhea – also called dysentery
o Persistent diarrhea (long-term diarrhea) – lasts 14 days or longer

CAUSES
 Infection caused by bacteria, virus, parasite – which is commonly spread by feces contaminated water,
when there is shortage of adequate sanitation and hygiene and safe water for drinking, cooking, and
cleaning.
 Malnutrition – especially among children, underlying malnutrition makes them more vulnerable to
diarrhea
Other Causes of Diarrhea:
 Physiologic stress (anxiety)
 Medications (antibiotics, iron)

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  Allergy to food, fluid, or drugs
 Diseases of the colon (malabsorption syndrome, Crohn’s disease)

SIGNS & SYMPTOMS

 Increased frequency of defecation
 Passage of relatively unformed & excessively liquid stools
 Difficulty in controlling the urge to defecate
 Spasmodic cramps & increased bowel sounds
 Fatigue, weakness, malaise, & emaciation (prolonged)

If diarrhea is not managed properly and immediately, it can lead to dehydration which can pose a serious
threat to any individual with diarrhea. What are then the signs of dehydration?

Signs of dehydration in children:

 Irritability or drowsiness
 Passing urine infrequently
 Pale or mottled skin
 Cold hands and feet
 Look or feel increasingly unwell

Signs of dehydration in adults:

 Tiredness and lack of energy
 Loss of appetite
 Nausea
 Feeling lightheaded
 Dizziness
 Dry tongue
 Sunken eyes
 Muscle cramps
 Rapid heartbeat

When to refer a patient with diarrhea?

For children:
 Symptoms of dehydration
 Blood in the stools
 Diarrhea and vomiting at the same time
 Severe or continuous stomachache
For Adults:
 Blood in the stool
 Vomiting persistently
 Weight loss
 Diarrhea occurs at night and is disturbing sleep
 Symptoms of dehydration
 Black or dark stools suggestive of bleeding

C. CHANGES in URINATION

 The process of emptying the urinary bladder

Micturition or voiding or urination
 Capacity of adult bladder:
250 – 450 mL of urine
 Normal average daily urine output in adults:
2,500 mL of urine or
700 mL to 2,000 mL per day
 Normal characteristics of urine:
 Clear, straw-colored, slightly acid
 Has the odor of urea
 Specific gravity: 1.003 – 1.035

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  Constituents: water, urea, NaCl, potassium chloride, phosphates, uric acid, organic salts, pigment
urobilin

Factors that affect voiding

 Growth & development
 Fluid intake
 Stress
 Activity
 Medications
 Various diseases

ALTERATIONS in URINE PRODUCTION

 POLYURIA (diuresis)
• Refers to the production of abnormally large amount of urine by the kidneys
• Can follow excessive fluid intake – polydipsia or can be associated with diseases such as diabetes
mellitus, diabetes insipidus or chronic nephritis
• Can cause excessive fluid loss – intense thirst, dehydration & weight loss.

 OLIGURIA
• Low urine output, lesser than 500 mL/day or 30 mL/hour
• Causes:
a. Abnormal fluid losses
b. Lack of fluid intake
c. Impairment of blood flow to the kidneys
d. Impending renal failure

 ANURIA
• Lack of urine production

ALTERATION in URINE ELIMINATION

 URINARY FREQUENCY
• Voiding at frequent intervals, more than the usual
• Causes:
 Increased intake of fluid
 Urinary Tract Infection
 Stress
 Pregnancy

 NOCTURIA (NYCTURIA)
• Voiding 2 or more times at night

 URGENCY
• The feeling that the person must void
• There may or may not be a great deal of urine in the bladder, but the person may feel a need to void
immediately
• Causes: stress; irritation of the urethra

 DYSURIA
• Voiding that is either painful or difficult
• Causes:
 Stricture of the urethra
 UTI
 Injury to the bladder & urethra

 ENURESIS
• Involuntary urination in children beyond the age when voluntary bladder control is normally acquired
(4-5 years of age)

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 • Types:
a. Nocturnal
 Often irregular in occurrence; affect boys more than girls
b. Diurnal
 Maybe persistent & pathologic in origin; affects women & girls more

 URINARY INCONTINENCE
• Inability to control urination
• A symptom, not a disease; common among elders
• Forms:
 Functional
 Result of cerebral clouding and or physical factors that make it difficult to get to the bathroom
facilities in time
 Overflow
 Occurs when the urinary tract is obstructed or when the detrusor muscle fail to contract as
bladder capacity is reached
 Stress
 Occurs most often in women and is commonly related to anatomical change
 Precipitated by coughing, sneezing, straining
• Predisposing factors:
 History of UTI
 Surgery or trauma
 STD
 Multiple vaginal births
 Musculo-skeletal, endocrine & neurological disorders

 URINARY RETENTION
• Incomplete emptying of the bladder
• Characteristics:
 Bladder distension
 Small, frequent voiding/absence of urine output
 A sensation of bladder fullness
 Dribbling
 Residual urine
 Dysuria
• Causes:
 Prostatic hypertrophy
 Surgery
 Some medication

D. CHANGE IN RESPIRATION: RATE, RHYTHM, CHARACTER, & STRENGTH

Change in Rate & Rhythm of Respiration:

FAST BREATHING or TACHYPNEA

 Refers to rapid, shallow breathing
 Occurs when you take more breaths than normal in a given minute
 How does this differ with hyperventilation?
o Hyperventilation – refers to rapid, deep breaths

CAUSES:
 Anxiety
 Lung infection such as pneumonia
 Asthma
 Heart failure
When to refer patient?
It is important to always treat rapid, shallow breathing as a medical emergency. If the patient experience
any of the following, he/she should be referred immediately:

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  Bluish-gray tint to the skin, nails, lips, or gums
 Lightheadedness
 Chest pain
 Chest that caves in with each breath (chest indrawing)
 Rapid breathing that gets worse
 Fever

Changes in Respiratory Character

COUGH
 Also known as tussis. Is a voluntary or involuntary act or reflex action that clears the throat and airways of
mucus and irritants
 Coughs are classified according to (a) duration [acute or short-term and chronic or long-term] and (b)
according to whether they are accompanied with mucus or not [productive or “wet” and non-productive
or “dry”].
Duration:
o Acute or Short-term cough – the infection is in the upper respiratory tract and affects the throat
and is known as URTI or URI (upper respiratory tract infection). Examples include: flu, common
cold, laryngitis. If the infection affects the lungs and the airways lower down the windpipe it is
called a LRTI (lower respiratory tract infection). Examples include: bronchitis, pneumonia
o Chronic (long-term) cough – sometimes referred to as persistent cough usually last more than 3
weeks. It can be caused by smoking, mucus dripping down the throat from the back of the nose,
asthma, allergy, gastro-esophageal reflux disease (GERD), and some medications (ACE inhibitor).
Mucus Secretion:
o Productive – also referred to as “wet” cough because they produce mucus.
o Non-productive – a dry, hacking cough that do not produce any phlegm or mucus. It can be
caused by irritation, dry respiratory tissues, and inflammation.

When to refer the patient?

 Cough is getting worse
 Swelling or lumps in the neck region
 Weight loss
 Difficulty swallowing
 Permanent changes in the sound of voice
 Coughing up of blood
 Difficulty breathing
 Chest pain
 Fever

E. GENERAL SIGNS & SYMPTOMS

 HEADACHE
• Medically known as cephalalgia. Refers to pain in the head
• Causes:
 Migraine
 Alcohol/drugs
 Stress
 Hypertension
 Tumor of the brain
 Febrile conditions
 Sinusitis

 BODY MALAISE
• A vague general discomfort or feeling of illness
• Seen in various diseases characterized by body weakness & inability to do activities of daily living
• Causes:
 Poor appetite
 Infectious process
 Disturbance in food metabolism

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  ANOREXIA
• Lack or loss of appetite
• Refers to distaste for food or reduction in the desire for food
• Causes:
 Illness
 Food intake before a meal
 Immobility
 Psychological factors (pain, fear)
 Social isolation

 WEIGHT LOSS
• Reduction in body weight indicating loss of protein from body cell mass
• Causes:
 Inadequate total sleep time
 Inadequate food intake
 Infectious process
 Disturbance in food metabolism

 NAUSEA
• An unpleasant feeling suggesting a tendency to vomit
• Causes:
 Use anesthesia (surgery)
 Morning sickness (pregnancy)
 Side effects of medicine
 Food intake before peristalsis
 Ingestion of gastric irritants
 Motion sicknesS

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