VITAL SIGNS

ARE BODY TEMPERATURE, PULSE, RESPIRATIONS AND

BLOOD PRESSURE.

BODY TEMPERATURE
REFLECTS THE BALANCE BETWEEN THE HEAT PRODUCED AND THE HEAT
LOST FROM THE BODY AND IS MEASURED IN HEAT UNITS CALLED DEGREES.

2 KINDS OF BODY TEMPERATURE

CORE TEMPERATURE
THE TEMPERATURE OF THE DEEP
TISSUES OF THE BODY SUCH AS
ABDOMINAL CAVITY AND PELVIC
CAVITY
IT IS RELATIVELY CONSTANT

SURFACE TEMPERATURE
THE TEMPERATURE OF THE SKIN,
THE SUBCUTANEOUS TISSUE AND
FAT.
IT RISES AND FALLS IN RESPONSE
TO THE ENVIRONMENT.

FACTORS THAT AFFECT BODYS HEAT

PRODUCTION

1.

BASAL METABOLIC RATE IS THE RATE OF ENERGY UTILIZATION IN THE

BODY REQUIRED TO MAINTAIN ESSENTIAL ACTIVITIES SUCH AS BREATHING.
METABOLIC RATE DECREASES WITH AGE.

2.

MUSCLE ACTIVITY MUSCLE ACTIVITY INCLUDING SHIVERING INCREASES

THE METABOLIC RATE.

3.

THYROXINE OUTPUT INCREASED THYROXINE OUTPUT INCREASES THE

RATE OF CELLULAR METABOLISM THROUGHOUT THE BODY. THIS EFFECT IS
CALLED CHEMICAL THERMOGENESIS.

4.

EPINEPHRINE, NOREPINEPHRINE, AND SYMPATHETIC STIMULATION/ STRESS

RESPONSE THESE HORMONES IMMEDIATELY INCREASE THE RATE OF
CELLULAR METABOLISM IN MANY BODY TISSUES.

5.

FEVER INCREASE THE CELLULAR METABOLIC RATE THUS INCREASES THE

BODYS TEMPERATURE FURTHER.

HEAT IS LOST THROUGH:

1.

RADIATION - THE TRANSFER OF HEAT FROM THE SURFACE OF ONE OBJECT

TO THE SURFACE OF ANOTHER WITHOUT CONTACT BETWEEN THE TWO
OBJECTS, MOSTLY IN THE FORM OF INFRARED

2.

CONDUCTION THE TRANSFER OF HEAT FROM ONE MOLECULE TO A

MOLECULE OF LOWER TEMPERATURE.

3.

CONVECTION THE DISPERSION OF HEAT BY AIR CURRENTS.

4.

VAPORIZATION CONTINUOUS EVAPORATION OF MOISTURE FROM THE

RESPIRATORY TRACT AND FROM THE MUCOSA OF THE MOUTH AND FROM
THE SKIN.

REGULATION OF BODY TEMPERATURE

FACTORS AFFECTING BODY TEMPERATURE

1.

AGE THE INFANT IS GREATLY INFLUENCED BY THE TEMPERATURE OF THE

ENVIRONMENT. CHILDRENS TEMPERATURES CONTINUE TO BE MORE
VARIABLE THAN THOSE OF ADULTS UNTIL PUBERTY. OLDER ADULT OVER 75
Y.O ARE AT RISK OF HYPOTHERMIA (TEMP BELOW 36 DEG. CELCIUS).

2.

DIURNAL VARIATION (CIRCARDIAN RHYTHMS) BODY TEMPERATURES

NORMALLY CHANGE THROUGHOUT THE DAY. HIGHIEST TEMP IS REACHED
AT 4:00PM 6:00PM AND LOWEST TEMP IS DURING SLEEP AT 4:00 AM
6:00 AM

3.

EXERCISE HARD WORK OR STREANUOUS EXERCISE CAN INCREASE BODY

TEMPERATURE TO AS HIGH AS 38.3 TO 40 DEG. CELCIUS.

FACTORS AFFECTING BODY TEMPERATURE

4. HORMONES WOMEN USUALLY EXPERIENCE MORE HORMONE FLUCTUATIONS
THAN MEN. IN WOMEN, PROGESTERONE SECRETION AT THE TIME OF OVULATION
RAISES BODY TEMPERATURE BY ABOUT 0.3 TO 0.6 DEG. CELCIUS.
5. STRESS STIMULATION OF THE SYMPATHETIC NERVOUS SYSTEM CAN
INCREASE THE PRODUCTION OF EPINEPHRINE AND NOREPINEPHRINE, THEREBY
INCREASING METABOLIC ACTIVITY AND HEAT PRODUCTION.
6. ENVIRONMENT IF THE TEMPERATURE IS ASSESSED IN A VERY WARM ROOM
AND THE BODY TEMPERATURE CANNOT BE MODIFIED BY CONVECTION,
CONDUCTION OR RADIATION, THE TEMPERATURE WILL BE ELEVATED. IF IN A
COLD WEATHER, THE BODY TEMPERATURE MAY BE LOW.

ALTERATIONS IN BODY TEMPERATURE

1.
.

PYREXIA, HYPERTHERMIA OR FEVER A BODY TEMPERATURE ABOVE THE

USUAL RANGE.
HYPERPYREXIA A VERY HIGH FEVER SUCH AS 41 DEG. CELCIUS.

. THE CLIENT WHO HAS A FEVER IS REFERRED TO AS FEBRILE.

FOUR COMMON TYPES OF FEVER

INTERMITTENT THE BODY TEMPERATURE ALTERNATES AT REGULAR INTERVALS BETWEEN
PERIODS OF FEVER AND PERIODS OF NORMAL OR SUBNORMAL TEMPERATURES.
REMITTENT FEVER A WIDE RANGE OF TEMPERATURE FLUCTUATIONS (MORE THAN 2 DEG.
CELCIUS) OCCURS OVER THE 24-HOUR PERIOD, ALL OF WHICH ARE ABOVE NORMAL.
RELAPSING FEVER SHORT FEBRILE PERIODS OF A FEW DAYS ARE INTERSPERSED WITH
PERIODS OF 1 0R 2 DAYS OF NORMAL TEMPERATURE.
CONSTANT FEVER THE BODY TEMPERATURE FLUCTUATES MINIMALLY BUT ALWAYS
REMAINS ABOVE NORMAL.

ELEVATED TEMPERATURE BUT NOT FEVER

HEAT EXHAUSTION IS A RESULT OF EXCESSIVE HEAT AND DEHYDRATION.
SIGNS ARE PALENESS, DIZZINESS, NAUSEA, VOMITING, FAINTING, AND
MODERATELY INCREASE TEMPERATURE (101-102F).
HEAT STROKE GENERALLY HAVE BEEN EXERCISING IN HOT WEATHER, HAVE
WARM, FLUSHED SKIN, AND OFTEN DO NOT SWEAT. THEY USUALLY HAVE A
TEMP OF 106F OR HIGHER AND MAY BE DELIRIOUS, UNCONSCIOUS, OR
HAVING SEIZURES.

ALTERATIONS IN BODY TEMPERATURE

2. HYPOTHERMIA - A CORE BODY TEMPERATURE BELOW LOWER LIMIT OF
NORMAL.

3 MECHANISMS OF HYPOTHERMIA ARE:

A. EXCESSIVE HEAT LOSS
B. INADEQUATE HEAT PRODUCTION TO COUNTERACT HEAT LOSS
C. IMPAIRED HYPOTHALAMIC THERMOREGULATION.

CLINICAL MANIFESTATIONS OF
HYPOTHERMIA
DECREASED BODY TEMPERATURE, PULSE, AND RESPIRATIONS
SEVERE SHIVERING
PALE, COOL, WAXY SKIN
FROSTBITE
HYPOTENSION
DECREASED URINARY OUTPUT
DISORIENTATION
DROWSINESS PROGRESSING TO COMA

ASSESSING BODY TEMPERATURE

ORAL IF PATIENT HAS BEEN DRINKING COLD OR HOT DRINKS OF SMOKING, WAIT
FOR 30 MINUTES BEFORE TAKING THE TEMPERATURE.
RECTAL CONSIDERED TO BE VERY ACCURATE. CONTRAINDICATED TO PATIENTS WITH
MYOCARDIAL INFARCTION, RECTAL SURGERY, DIARRHEA, DISEASE OF THE RECTUM,
IMMUNOSUPPRESSED, HAVE CLOTTING DISORDER OR HAVE HEMORRHOIDS.
AXILLA THE PREFERRED SITE FOR MEASURING TEMPERATURE IN NEWBORNS.
TYMPANIC MEMBRANE OR NEARBY TISSUE IN THE EAR CANAL- A FREQUENT SITE FOR
ESTIMATING CORE BODY TEMPERATURE USING NONINVASIVE INFRARED
THERMOMETERS.

ASSESSING BODY TEMPERATURE

FOREHEAD TEMPERATURE IS MEASURED USING CHEMICAL THERMOMETER.

BODY TEMPERATURES
HYPERPYREXIA - 41C AND ABOVE
PYREXIA 37.6 TO 40C
AVERAGE OR NORMAL 36 TO 37.5C
HYPOTHERMIA - 36C AND BELOW

PULSE
A WAVE OF BLOOD CREATED BY CONTRACTION OF THE LEFT VENTRICLE OF
THE HEART.

FACTORS AFFECTING THE PULSE

AGE AS AGE INCREASE, THE PULSE RATE GRADUALLY DECREASES OVER ALL
GENDER AFTER PUBERTY, THE AVERAGE MALES PULSE RATE IS SLIGHTLY LOWER
THAN THE FEMALES.
EXERCISE PULSE RATE NORMALLY INCREASE WITH ACTIVITY. THE RATE IN THE
PROFESSIONAL ATHLETE IS OFTEN LESS THAN IN THE AVERAGE PERSON BECAUSE
OF GREATER CARDIAC SIZE, STRENGTH, AND EFFICIENCY.
FEVER PULSE RATE INCREASES IN RESPONSE TO THE LOWERED BLOOD PRESSURE
THAT RESULTS FROM PERIPHERAL VASODILATATION ASSOCIATED WITH ELEVATED
BODY TEMPERATURE AND BECAUSE OF THE INCREASE METABOLIC RATE.

FACTORS AFFECTING THE PULSE

MEDICATIONS SOME MEDICATIONS DECREASES THE PULSE RATE, AND
OTHERS INCREASE IT.
HYPOVOLEMIA LOSS OF BLOOD FROM THE VASCULAR SYSTEM NORMALLY
INCREASES PULSE RATE. IN ADULTS THE LOSS OF CIRCULATING VOLUME
RESULTS IN AN ADJUSTMENT OF THE HEART RATE TO INCREASE BLOOD
PRESSURE AS THE BODY COMPENSATES FOR THE LOST VOLUME.
STRESS IN RESPONSE TO STRESS, SYMPATHETIC NERVOUS STIMULATION
INCREASES THE OVERALL ACTIVITY OF THE HEART.

FACTORS AFFECTING THE PULSE

POSITION CHANGES WHEN A PERSON IS SITTING OR STANDING, BLOOD
USUALLY POOLS IN DEPENDENT VESSELS OF THE NERVOUS 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 DISEASE SUCH AS SOME HEART CONDITIONS OR
THOSE THAT IMPAIR OXYGENATION CAN ALTER THE RESTING PULSE RATE.

VARIATIONS IN PULSE & RESPIRATION BY

AGE
AGE

PULSE AVERAGE &

RANGES

RESPIRATIONS AVERAGE
& RANGES

Newborn

130 (80-180)

35 (30-80)

1 year

120 (80-140)

30 (20-40)

5-8 years old

100 ( 75 120)

20 (15-25)

10 years

70 ( 50-90)

19 (15-25)

Teen

75 ( 50-90)

18 (15-20)

Adult

80 ( 60-100)

16 (12-20)

Older Adult

70 (60-100)

16 (15-20)

PULSE SITES
TEMPORAL
CAROTID
APICAL
BRACHIAL
RADIAL
FEMORAL
POPLITEAL
POSTERIOR TIBIAL
PEDAL

ASSESSING THE PULSE

TACHYCARDIA AN EXCESSIVELY FAST HEART RATE ( OVER 100 BPM IN ADULT).
BRADYCARDIA A HEART RATE IN AN ADULT OF LESS THAN 60 BPM (IN ADULT).
PULSE RHYTHM THE PATTERN OF BEATS AND THE INTERVALS BETWEEN THE
BEATS. EQUAL TIME ELAPSES BETWEEN BEATS OF A NORMAL PULSE.
DYSRHYTHMIA OR ARRHYTHMIA A PULSE WITH AN IRREGULAR RHYTHM.
PULSE VOLUME, PULSE STRENGTH, AMPLITUDE THE FORCE OF BLOOD WITH
EACH BEAT. I CAN RANGE FROM ABSENT TO BOUNDING ( ABSENT, WEAK,
FEEBLE, OR THREADY, BOUNDING).

RESPIRATIONS
IS THE ACT OF BREATHING
INHALATION OR INSPIRATION REFERS TO THE INTAKE OF AIR INTO THE
LUNGS.
EXHALATION OR EXPIRATION REFERS TO BREATHING OUT OF THE
MOVEMENT OF GASES FROM THE LUNGS TO THE ATMOSPHERE
VENTILATION- IS ALSO USED TO REFER TO THE MOVEMENT OF AIR IN AND
OUT OF LUNGS.

TWO TYPES OF BREATHING

COSTAL ( THORACIC) BREATHING INVOLVES THE EXTERNAL INTERCOSTAL
MUSCLES AND OTHER ACCESSORY MUSCLES, SUCH AS THE
STERNOCLEIDOMASTOID MUSCLES. IT CAN BE OBSERVED BY THE MOVEMENT
OF THE CHEST UPWARD AND OUTWARD.
DIAPHRAGMATIC BREATHING INVOLVES THE CONTRACTION AND
RELAXATION OF THE DIAPHRAGM, AND IT IS OBSERVED BY THE MOVEMENT
OF THE ABDOMEN, WHICH OCCURS AS A RESULT OF THE DIAPHRAGMS
CONTRACTION AND DOWNWARD MOVEMENT.

MECHANICS AND REGULATION OF

BREATHING
DURING INHALATION, THE DIAPHRAGM CONTRACT ( FLATTENS), THE RIBS
MOVE UPWARD AND DOWNWARD AND THE STERNUM OUTWARD, THUS
ENLARGING THE THORAX AND PERMITTING THE LUNGS TO EXPAND.
DURING EXHALATION, THE DIAPHRAGM RELAXES, THE RIBS MOVE
DOWNWARD AND INWARD AND THE STERNUM MOVES INWARD, THUS
DECREASING THE SIZE OF THE THORAX AS THE LUNGS ARE COMPRESSED.
A NORMAL ADULT INSPIRATION LAST 1 TO 1.5 SEC. AND AN EXPIRATION
LASTS 2 TO 3 SECONDS.

ASSESSING RESPIRATION ( ASSESS FOR

RATE, DEPTH, RHYTHM AND QUALITY)
BRADYPNEA ABNORMALLY SLOW RESPIRATIONS.
TACHYPNEA OY POLYPNEA ABNORMALLY FAST RESPIRATIONS
APNEA THE ABSENCE OF BREATHING
THE DEPTH OF A PERSONS RESPIRATIONS CAN BE ESTABLISHED BY WATCHING THE
MOVEMENT OF THE CHEST. IT IS DESCRIBED AS NORMAL, DEEP, OR SHALLOW.
HYPERVENTILATION REFERS TO VERY DEEP, RAPID RESPIRATIONS
HYPOVENTILATION REFERS TO VERY SHALLOW RESPIRATIONS.
RESPIRATORY RHYTHM REFERS TO THE REGULARITY OF THE EXPIRATIONS AND THE
INSPIRATIONS. IT IS DESCRIBED AS REGULAR AND IRREGULAR.

ASSESSING RESPIRATION ( ASSESS FOR

RATE, DEPTH, RHYTHM AND QUALITY)
RESPIRATORY QUALITY NORMAL BREATHING AND LABORED BREATHING

BLOOD PRESSURE
IS A MEASURE OF THE PRESSURE EXERTED BY THE BLOOD AS IT FLOWS THROUGH
THE ARTERIES.
SYSTOLIC PRESSURE THE PRESSURE OF THE BLOOD AS A RESULT OF CONTRACTION
OF THE VENTRICLES, THAT IS, THE PRESSURE OF THE HEIGHT OF THE BLOOD WAVE.
DIASTOLIC PRESSURE THE PRESSURE WHEN THE VENTRICLES ARE AT REST.
PULSE PRESSURE THE DIFFERENCE BETWEEN THE DIASTOLIC AND THE SYSTOLIC
PRESSURE. NORMAL IS 40 MM HG BUT CAN BE AS HIGH AS 100 MM HG.
120/80 MM HG NORMAL BLOOD PRESSURE

FACTORS AFFECTING BP
AGE NEWBORNS HAVE MEAN SYSTOLIC PRESSURE OF ABOUT 75MM HG. PRESSURE RISES WITH
AGE, REACHING A PEAK AT THE ONSET OF PUBERTY.
EXERCISE PHYSICAL ACTIVITY INCREASES THE CARDIAC OUTPUT. REST OF 20 TO 30 MINUTES
IS REQUIRED BEFORE TAKING BP.
STRESS STIMULATION OF THE SYMPATHETIC NERVOUS SYSTEM INCREASES CARDIAC OUTPUT
AND VASOCONSTRICTION OF THE ARTERIOLES INCREASING BP.
SEVERE PAIN DECREASES BP BY INHIBITING THE VASOMOTOR CENTER AND PRODUCING
VASODILATION.
GENDER AFTER PUBERTY, FEMALE HAVE LOWER BP THAN MALES OF THE SAME AGE. AFTER
MENOPAUSE, WOMEN HAVE HIGHER BP THAN BEFORE.

FACTORS AFFECTING BP
MEDICATION MANY MEDICATION INCLUDING CAFFEINE MAY INCREASE OR
DECREASE BP.
OBESITY PREDISPOSE TO HYPERTENSION
DIURNAL VARIATION BP IS LOWEST EARLY IN THE MORNING AND PEAKS IN
THE LATE AFTERNOON OR EARLY EVENING.
DISEASE PROCESS ANY CONDITION THAT AFFECTS THE CARDIAC OUTPUT,
BLOOD VOLUME, BLOOD VISCOSITY, AND OR COMPLIANCE OF THE ARTERIES
HAS A DIRECT EFFECT ON THE BLOOD PRESSURE.

HYPERTENSION
A BLOOD PRESSURE ABOVE NORMAL

HYPOTENSION
A BLOOD PRESSURE THAT IS BELOW NORMAL
SYSTOLIC IS 85-100 MM HG IN AN ADULT WHOSE NORMAL PRESSURE IS
HIGHER THAN THIS.