VITAL SIGN

OLEH:
Ns. Lilik Supriati, M.Kep
Learning objective
1. Explain physiologic process involved in
hemeostatic regulation of temperature,
pulse, respiration and blood pressure
2. Compare and contrast factor that increase
or decrease temperature, pulse, respiration
and blood pressure
3. Identify sites for assessing temperature,
pulse, respiration and blood pressure
Learning objective
5. Know the normal ranges for body
temperature, pulse, respiration and blood
pressure
6. Provide information to patients abaout taking
temperature, pulse, respiration and blood
pressure
Definition vital sign
• Vital sign is a person’s temperature, pulse,
respiration and blood pressure.
• TPR and BP are called vital signs (VS) or
cardinal symptoms because these
measurements are indicators of functions
necessary to sustain life.
• body temperature, pulse, respiration (TPR),
and blood pressure (BP) are basic client
assessments.
• Taken and documented over time, these
data demonstrate the course of a client’s
condition.
Vital signs
• Measures :
- Body temperature
- Pulse
- Respirations
- Blood pressure
temperature
• Body temperature is the measure of heat
inside a person’s body (core temperature)
• it is the balance between heat produced and
heat lost
• Two kinds of body temperature:
- Core temperature (deep tissues, eg.
Cranium, thorax, abdominal + pelvic cavity)
- Surface temperature (skin, subcutaneous
tissues, fat
Physiology of body temperature
• The hypothalamus is the brain’s heat-
regulating center, controls body temperature
by controlling blood temperature
Hipotalamus receives
message from cold and
warm thermal receptor

Compare that
information with its
temperature set point

Initiates responses to
either produce or
conserve body heat or
to reduce heat loss
Heat production
• Heat is a product of metabolism
• Various mechanism increase body
metabolism including hormone and exercise
Heat loss
• The skin is the primary site of heat loss
• Other through evaporation of sweat,
warming, elimination of urine and feses
• By radiation, convection, evaporation and
conduction
Elevated Body Temperature
• Temperature rises when the body’s heat
production increases or heat loss decreases
- If the temperature is elevated, fever (pyrexia)
is present
• Fever is a sign of some disorder within the
body : infection
• Oral temperatures in fever can range from
37.5ºC to 39.4ºC (100ºF–103ºF) or greater.
• A very high temperature can be life
threatening.
Lowered Body Temperature
• A temperature significantly below normal is
called hypothermia.
• The lowered body temperature slows
metabolism and thus decreases the body’s
need for oxygen.
• Clinical hypothermia is used to perform
some surgical procedures; accidental
hypothermia is life threatening and requires
immediate treatment.
WHAT PARTS OF THE BODY ARE USED IN
DETERMINING TEMPERATURE?
Factors affecting body temperature
• Age
• Diurnal variation (highest temp 8pm-
midnight, lowest temp 4-6am)
• Exercise
• Hormones
• Stress
• Environment
Variation in body temperatures
by age
Age Average temperature
Newborn Axillary 36.1-37.7 C 97.0-100F
1 year Oral 37.7C 99.7F
3 years Oral 37.2C 99.0F
5 years Oral 37.0C 98.6F
Adult Oral 37.0C 98.6F
Axillary 36.4C 97.6F
Rectal 37.6C 99.6F
Forehead 34.4C 94.0F
Tympanic 37.7C 99.9F
Elderly (over 70yr) Oral 36.0C 96.8F
PULSE
Pulse
• A wave of blood created by contraction of the
left ventricle of the heart.
• The pulse wave represents the stroke
volume output and the compliance of the
arteries
 Phisiology of the pulse
• The pulse is regulated by the autonomic
nervous system through the cardiac sinoartrial
node (SA) node.

Parasimpatic stimulation of Sympathic stimulation of the SA

SA Node via vagus nerve node increases the heart rate
decreases the heart rate and force the contraction

• The pulse rate = the number of pulsation felt

over a peripheral artery or heard over the apex
of the heart in 1 minute
Increased pulse rate
- Called as tachycardia
- Tachycardia = pulse rate 100- 180
beats/minute…adult
Factor contributing to
tachycardia
• A decreases in blood pressure such as blood
loss
• Elevated temperature
• Poor oxygenation in blood
• Exercise
• Pain
• Strong emotion
• Some medication
Factors affecting pulse rate
• Age
• Sex
• Exercise
• Fever
• Medications
• Hemorrhage
• Stress
• Position changes
Pulse sites
Assessing of pulse
1. Pulse Rate
• The pulse rate tells how often a person’s
heart beats per minute (heart rate)
2. Pulse Volume
• Pulse volume varies with the blood volume in the
arteries, the strength of the heart contractions, and
the elasticity of blood vessels. When every beat is
full and strong, a normal pulse can be felt with
moderate finger pressure
Continue….
3. Pulse rhythm
Pulse rhythm is the spacing of the beats. With
normal or regular rhythm, intervals between
beats are the same
 Variations in pulse rate by
age
Age Average
(x/ minute)
Range
(x/ minute)

Newborn to 1 month 130 80-180

1 year 120 80-140

2 years 110 80-110

6 years 100 75-120

10 years 70 50-90

Adult 80 60-100
Method and equipment
• Palpation
• Auscultation With a Stethoscope (apical
pulse)
RESPIRATION
 DEFINITION RESPIRATION
• Respiration is the process that brings oxygen
into the body and removes carbon dioxide.

External respiration: Internal respiration;

the exchange of oxigen and CO2 the exchange of O2 and CO2
between the alveoli of the lungs between circulating blood and
and the circulating blood tissue cell
 Physiology of respiration
the rate and depth of breathing can change in
response to body demand

These change by inhibition or stimulation of the respiratory muscle

by respiratory center in medulla and pons

Respiratory center are activated by impulses from chemoreceptor , from

stretch and iritant receptor in the lungs and from receptor in muscle and joint

Increase CO2 is the most powerfull respiratory stimulant

The cerebral cortex of the bran allows voluntary control of breathing
 Variations in respiratory rate
by age
Age Average
(x/ minute)
Range
(x/ minute)

Newborn 35 30-80

1 year 30 20-40

2 years 25 20-30

8 years 20 15-25

16 years 18 15-20

Adult 16 12-20
Factor affecting respiration
1. Exercise
2. Respiratory and cardiovascular diseases
3. Alteration in fluid
4. Electrolite and acid-base balances
5. Medication
6. Trauma
7. Infection
8. Pain
9. emotion
Respiratory rate
• Normal respiration is called eupnea
• Increased respiratory rate is called
tachypnea …. Often as respons to the
increased metabolic rate such as fever
• Bradypnea : decreased respiratory rate
Assessing respiration
1. Respiratory rate (breath per minute)
2. Depth
3. Rhythm

-By :
-Inspection (observing and listening)
-By listening with the stetoscope
BLOOD PRESSURE
Blood pressure
• Arterial blood pressure is a measure of the
pressure exerted by the blood as it flows
through the arteries
• Systolic pressure (peak level when ventricle
giving contraction)
• Diastolic pressure (lowest level when
ventricle rest)
• Normal range (adult) 100/60 sampai 140/90.
regulation of the blood pressure
• Blood pressure is determined by two major
factors:
1. cardiac output
2. peripheral resistance.
- Cardiac output is a combination of the heart
rate and the amount of blood pumped out of
the heart with each contraction (stroke
volume). These are measured over 1 minute.
- Peripheral resistance is the resistance of
blood vessels to the flow of blood. Peripheral
resistance affects both blood pressure and the
work required of the heart to pump the Blood
 Factors affecting blood pressure
• Age
• Exercise
• Stress
• Race
• Obesity
• Sex
• Medications and body position
• Diurnal variations
• Disease process
 Variations in blood pressure
by age
Age Mean blood pressure
(mmHg)
Newborn 73/55

1 year 90/55

6 years 95/57

10 years 102/62

14 years 120/80

Adult 120/80

Elderly (over 70 years) Diastolic pressure may increase

Asseing blood pressure
Systole and Diastole
• The blood pressure is the highest during
heart contraction = systolic blood pressure
(SBP).
• Pressure diminishes as the heart relaxes.
Pressure is lowest when the heart relaxes
before it begins to contract again =
diastolic blood pressure (DBP)
• The difference between the systolic and
diastolic readings is called = pulse pressure.
Equipment