Fahmida Javed

Objectives
By the completion of this lecture students will be able to:
 Define Vital Signs.
 Define terms related to Vital sign.
 Describe the physiological concept of temperature, respiration and blood pressure.
 Describe the principles and mechanisms for normal thermoregulation in the body.
 Identify ways that affect heat production and heat loss in the body.
 Define types of body temperature according to its characteristics.
 Identify the sign and symptoms of fever.
 Discuss the normal ranges for temperature, pulse, respiration and blood pressure.
 List the factors affecting temperature, pulse, respiration.
 Describe the characteristics of pulse and respiration.
 List factors responsible for maintaining normal blood pressure.
 Describe various methods and sites used to measure T.P & B.P.
 Recognize the signs of alert while taking TPR and B.P.
Vital Signs
Vital signs also called “sign of life” or “cardinal sign”.
Vital signs are measurements of the body's most basic functions.
All of these vital signs can be observed, measured, and monitored. This
will enable the assessment of the level at which an individual
functioning. Normal ranges of measurements of vital signs change with
age and medical condition.
Vital signs are useful in detecting or monitoring medical problems.
Vital Signs
These includes:
 Temperature (T)
 Pulse (P)
 Respirations (R)
 Blood pressure (BP)
 Pain is our 5th Vital sign
 Physiological Basis of Body
Temperature
Body temperature regulation requires
the coordination of many body
systems. For the core temperature to
remain steady, heat production must
equal heat loss. The hypothalamus,
located in the pituitary gland in the
brain, is the body’s built-in thermostat.

It can sense small changes in body

temperature and stimulates the
necessary responses in the nervous
system, circulatory system, skin, and
sweat glands to maintain homeostasis
(state of dynamic equilibrium).
Temperature
(T)
The normal body temperature of a person varies person to person
depending on gender, recent activity, food and fluid consumption etc.
Normal body temperature can range from 97.8° F (36.5°C) to 99°F
(37.2°C) for a healthy person.
How to monitor
Temperature
A person's body temperature can be taken in any of the following ways:
 Orally
• The oral cavity temperature is considered to be reliable, accessible and
convenient.
Temperature can be taken by mouth using either the glass thermometer, or
digital thermometers that use an electronic probe to measure body
temperature.
Note:
If client has ingested hot or cold food or fluid or smoked, (the nurse should
wait 30 minutes before taking orally temperature to ensure that the mouth is
not affected by temperature of food, fluid, or smoke).
Contraindications of oral
thermometer
1. The child under 5-6 years
2. Unconscious patients
3. Patient who cannot breath from his nose.
4. Mouth surgery or infection
5. Patient on oxygen mask
6. Psychiatric patients or any disease condition
 Armpit (axillary)
Temperature is measured at the axilla by placing the thermometer in
the central position and adducting the arm close to the chest wall.
Axillary is the preferred site for measuring temperature in children.
 Rectally
Temperatures taken rectally (using a glass or digital thermometer) tend
to be 0.5°F to 0.7°F higher than when taken by mouth. This is more
common in babies because their body doesn't regulate temperature
the way an older child or adult's body does.
Skin site: (Forehead , abdomen skin
temperature):
A special thermometer can quickly measure the
temperature of the skin.
 Ear site: (Tympanic membrane):
A special thermometer can quickly measure the
temperature of the eardrum.
The tympanic membrane thermometer is a portable,
hand-held device resembling an otoscope.
Factors Affecting
Temperature
Basal metabolic rate ( BMR): The basal metabolic rate is the rate of energy
utilization in the body to maintain essential activities such as breathing.
 Muscle activity: It including shivering, can greatly increase metabolic rate.
Thyroxin output: Increased thyroxin output increases the rate of cellular
metabolism throughout the body.
Epinephrine and sympathetic stimulation, these immediately increase the
rate of cellular metabolism in many body tissues.
 Age & Gender
 Diurnal variation
 Exercise: Hard work or strenuous exercise can increase body temperature
Temperature
scales:
Centigrade or Fahrenheit scale are used to
measured and record body temperature. A
centigrade calibrated scale ranges from (34°C-
42°C), and a Fahrenheit calibrated scale ranges
from ( 94°F- 108°F).
Feve
r1. Pyrexia, hyperthermia, fever: a core body temperature above the usual range { >
There are two primary alteration in body temperature:

38 °C or 100.4 °F}.
• Hyperpyrexia: a very high fever above 41°C or 105.8 °F.
• Febrile: a client who has a fever.
• A febrile: a client who does not have a fever.

2. Hypothermia: a core body temperature below the lower limit of normal {< 36°C
or 96.8 °F}. There are three physiological mechanics of hypothermia include:
a. Excessive heat loss.
b. Inadequate heat production to counteract heat loss.
c. Impaired hypothalamic thermoregulation.
 Signs &
Symptoms
Clinical Manifestation of fever:
1. Onset (cold or chill phase):
 Increased heart rate.
 Increased respiratory rate.
 Shivering.
 Pallid, cold skin.
 Complaints of feeling cold.
 Cyanotic nail beds.
 Cessation of sweating.
Signs &
Symptoms
2. Course (plateau phase):
 Absence of chills.
 Skin that feels warm.
 Photosensitivity.
 Glassy- eyed appearance.
 Increased pulse and respiratory rate.
 Increase thirst.
 Mild to severe dehydration.
Signs &
Symptoms
Clinical manifestation of hypothermia:
 Decrease body temperature, pulse, and respirations.
 Severe shivering (initially).
 Feelings of cold and chills.
 Pale, cool, waxy skin.
 Frostbite (discolored, blistered nose, fingers, toes).
 Hypotension.
 Decrease urinary output.
 Lack of muscle coordination.
 Disorientation, Drowsiness progressing to coma.
 Pulse
(P)is a wave of blood created by contraction
“Pulse
of the left ventricle of the heart”.
Pulse provides valuable data about
person’s cardiovascular status.
The normal pulse for healthy adults ranges from 60
to 100 beats per minute.
The pulse rate is a measurement of the heart rate.
This is the number of times the heart beats per
minute. As the heart pushes blood through the
arteries, the arteries expand and contract with the
flow of the blood.
Term
s
Bradycardia is a heart rate less than 60 beats per minute in an adult.
Tachycardia is a heart rate in excess of 100 beats per minute in an
adult.
Pulse rhythm is the regularity of the heartbeat. It describes how evenly
the heart is beating.
Regular (the beats are evenly spaced).
Irregular (the beats are not evenly spaced).
Dysrhythmia (arrhythmia) is an irregular rhythm caused by an early,
late, or missed heartbeat.
Pulse
locations
Factor
s
Factors Contribute to Increase Pulse Rate
1. Pain. 2. Fever. 3. Stress, exercise . 4. Bleeding. 5. Decrease in blood
pressure . 6. Some medications as (adrenalin, aminophylline).
Factors May Slow The Pulse
1. Rest . 2. Increasing age. 3. People with thin body size . 4. Some
Medications. 5. Thyroid gland disturbances .
Respiration
(R)
Pulmonary ventilation (breathing ):
movement of air in and out of the lungs.
Inspiration (inhalation) is the act of
breathing in.
Expiration (exhalation ) is the act of
breathing out .
Respiration
Rate
Normal breathing is automatic and involuntary. At rest, the normal
adult respiratory rate is 12 to 20 breaths per minute and respiratory
rate for an infant is 30 to 60 breaths per minute.
Tachypnea is an abnormally fast respiratory rate (usually above 20
breaths per minute in the adult).
Bradypnea is an abnormally slow respiratory rate (usually less than 12
breaths per minute in the adult).
Apnea, the absence of respirations, is often described by the length of
time in which no respirations occur (e.g., a 10-second period of apnea).
Factors Affecting
Respiration
 Pain, anxiety, exercise
 Medications
 Trauma
 Infection
 Respiratory and cardiovascular disease
 Alteration in fluids, electrolytes, acid- base balances
 Blood Pressure
(BP)pressure is the force that blood exerts against the
Blood
walls of the blood vessels. The pressure in the systemic
arteries is most commonly measured in the clinical
setting. Blood pressure is stated in millimeters of
mercury (mm Hg).
The normal BP is 120/ 80 mmHg.
Hypertension: refers to a systolic blood pressure more
than 120 mm Hg or 20 to 30 mm Hg more the
client’s normal systolic pressure. Hypotension, refers
to a systolic blood pressure less than 90 mm Hg or 20
to 30 mm Hg below the client’s normal systolic
pressure.
Ways to measure
BP
Direct:
Blood pressure may be measured directly with a
catheter placed into an artery. Direct measurement
provides a continuous reading of blood pressure
and is used in critical care settings.
Indirect:
Indirect methods, using an inflatable cuff to
temporarily occlude arterial blood flow through one
of the limbs. As the cuff is deflated and flow returns,
the blood pressure is determined by pal-pation,
auscultation, or oscillations.