Overview

Vital
Signs ANDRE BRIAN D.
AZARCON, RN, MAED
What are vital signs?
Vital signs are measurements of the body's most basic
functions. The four main vital signs routinely monitored
by medical professionals and health care providers
include the following:
• Body temperature
• Pulse rate
• Respiration rate (rate of breathing)
• Blood pressure (Blood pressure is not considered a
vital sign but is often measured along with the vital
signs.)
 Vital signs are useful in detecting or monitoring medical
problems. Vital signs can be measured in a medical
setting, at home, at the site of a medical emergency, or
elsewhere.

Why is it essential that vital signs are

measured accurately?

John Hopkins Medicine

Other Assessments
• Pain – patients asked to rate on scale of 1 to 10 (1 is minimal and
10 is severe)
• Color of skin
• Size of pupils and reaction to light
• Level of consciousness
• Response to stimuli
Measuring Temperature

Measures balance between heat lost and heat produced in

the body. A high or low reading can indicate disease.

The normal body temperature of a person varies depending

on gender, recent activity, food and fluid consumption,
time of day, and, in women, the stage of the menstrual
cycle. Normal body temperature can range from
97.8 degrees F (or Fahrenheit, equivalent to 36.5
degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for
a healthy adult.
A person's body temperature can be taken in any of the
following ways:
• Orally. Temperature can be taken by mouth using either the classic
glass thermometer, or the more modern digital thermometers that use
an electronic probe to measure body temperature.
• Rectally. Temperatures taken rectally (using a glass or digital
thermometer) tend to be 0.5 to 0.7 degrees F higher than when taken
by mouth.
• Axillary. Temperatures can be taken under the arm using a glass or
digital thermometer. Temperatures taken by this route tend to be 0.3
to 0.4 degrees F lower than those temperatures taken by mouth.
• By ear. A special thermometer can quickly measure the temperature of
the ear drum, which reflects the body's core temperature (the
temperature of the internal organs).
• By skin. A special thermometer can quickly measure the temperature
of the skin on the forehead.
Body temperature may be
abnormal due to
hyperthermia/fever (high
temperature) or hypothermia
(low temperature). A fever is
indicated when body
temperature rises about one
degree or more over the
normal temperature of 98.6
degrees Fahrenheit, according
to the American Academy of
Family Physicians.
Hypothermia is defined as a
drop in body temperature
below 95 degrees Fahrenheit.
Measuring Pulse
•Pulse is the pressure of the blood
felt against the wall of an artery as
the heart contracts and relaxes, or
beats. Pulse is usually taken over
the radial artery. Any abnormality
can indicate disease.
•The rate, rhythm, and volume are
recorded
• Rate – number of beats per
minute
• Rhythm – the regularity
• Volume – refers to the strength
Pulse can be taken on several places
• Temporal – side of forehead
• Carotid – at the neck
• Brachial–inner aspect of the
forearm at the crease of the
elbow
• Radial- at the inner aspect of
the wrist, above the thumb
• Femoral-inner aspect of the
upper thigh
• Popliteal-behind the knee
• Dorsalis pedis-at the top of the
foot arch
Measuring Pulse – Rate
Adults have a range of 60 – 90 beats per minute
Children over 7 - a range of 70 – 90 beats per
minute
Children age 1 – 7 have a range of 80 – 110
Infants 100 – 160 beats per minute
Any variation or extremes in pulse rate should be
reported immediately
Bradycardia is a pulse rate under 60 beats per
minute
Tachycardia is a pulse rate over 100 beats per
minute (except in children)
Measuring Pulse – Rhythm and Volume

• Rhythm refers to the regularity of the pulse or

spacing of the beats.
• An arrhythmia is an irregular or abnormal
rhythm, usually caused by a defect in the
electrical conduction pattern of the heart. (prefix
a- means without)
• Volume is the strength or intensity of the pulse.
It is described as strong, weak, thready, or
bounding
Factors that can change pulse rate

Pulse will be increased Pulse will be decreased

by: by:
• Exercise • Sleep
• Stimulant • Depressant
drugs drugs
• Excitement • Heart disease
• Fever • Coma
• Shock • Physical
• Nervous training
tension
Apical Pulse
•An apical pulse is
the heartbeat at
the apex of the
heart and is heard
with a
stethoscope.
Apical Pulse
• When listening to the heart two
sounds will be heard:
lubb – dupp. Each lubb –
dupp counts as one heart beat.

• The sound is caused by the closing

of the heart valves as blood flows
through the chambers of heart.
• If an abnormal sound is heard
contact the provider.
 Measuring
Respirations
• Respiration is the process of taking in
oxygen and expelling carbon dioxide.
Abnormal respirations indicate a health
problem or disease.
• Three factors that are noted about
respirations are the count, rhythm, and
character.
• Count – the number of breaths
• Rhythm – the regularity of breaths
• Character – type of respirations
Respirations - Rate
• The normal rate for respirations in
adults is 14 - 18 breaths per minute
• In children, respirations are a little
faster than adults, 16 -25 breaths per
minute
• Infants the rate is between 30 – 50
breaths per minute
Respirations – Character and Rhythm
•Character is the depth and quality of
respirations. Character of respirations
are described as
• Deep
• Shallow
• Labored
• Difficult
• Stertorous (abnormal, like snoring)
• Moist
•Rhythm is the regularity of the
respirations. Rhythm is described as
• Regular
• irregular
Respirations – Abnormal
• Dyspnea – difficult or labored breathing
• Apnea – absence of respirations
• Tachypnea – respirations over the normal range
• Bradypnea – respirations below the normal range
• Orthopnea – severe dyspnea in which breathing is very difficult in any
position other that standing or sitting erect
• Cheyne - Stokes – periods of dyspnea followed by periods of apnea. Seen
in dying patients
• Rales – bubbling or noisy sound caused by fluids or mucus in the air
passages.
• Wheezing – Difficult breathing with high-pitched whistling or sighing
sounds during expiration. Seen in persons with asthma
• Cyanosis – a dusky, bluish discoloration of the skin, lips, and nailbeds
Measuring
Blood Pressure
• Blood pressure is the
force exerted by the
blood against the arterial
walls when the heart
contracts and relaxes.
• Two readings noted on a
blood pressure are
systolic and diastolic
Measuring Blood Pressure
Systolic pressure is noted when the pressure is at its
highest. Systolic pressure occurs in the walls of the
arteries when the left ventricle of the heart is contracting
and pushing blood through the arteries. Normal reading
is 120mmhg. (range is 100 – 140 mmHg)
Diastolic pressure is the noted when the pressure is at
its lowest. Diastolic pressure is the constant pressure in
the walls of the arteries when the left ventricle of the
heart is at rest, or between contractions. A normal
reading is 80mmHg (range of 60 – 90 mmHg)
 Systolic Blood
Pressure
• Pressure that occurs in the
walls of the arteries when the
LEFT VENTRICLE OF THE
HEART is contracting
• Normal systolic reading is
BELOW 120 mm or mercury
• Normal range is 100- 120
mm of mercury
• Systolic is the FIRST sound
heard
Diastolic Blood
Pressure
• The constant pressure in the
walls of the arteries when the
LEFT VENTRICLE is at rest
(between contractions)
• Normal diastolic reading is
below 80mm of mercury
• Normal range is 60-80 mm of
mercury
• It is noted as the reading on
the BP gauge when the sound
STOPS or becomes very
FAINT
 Pulse Pressure
• The difference between
the SYSTOLIC and the
DIASTOLIC pressure
• Important indicator of
the health & tone of
the arterial walls
• Normal pulse pressure
is: 30-50 mm of
mercury
• Example: what is the
pulse pressure of
110/80
• Blood pressure is read using an
stethoscope and a
sphygmomanometer.
• Stethoscope is placed in ears
and on the forearm in the
antecubital space. The
sphygmomanometer is placed
one to one and one half inches
above the elbow. Cuff is
inflated to about 160mmHg.
• Listen for heart tones. First
heart tone heard is the systolic
pressure. The diastolic
pressure is when the heart tone
can no longer be heard.
Factors to Follow When taking a BP
• American Heart Association recommends:
• Patient should be quite for at least 5 minutes
• Take 2 separate readings
• Wait at least 30-60 seconds between readings
• Correct size and placement of the cuff
• Patient should be sitting or lying down
• Arm should be freely extended and free of
constricting clothes
• BP cuff must be deflated and free of any air
• BP cuff should be placed over directly over the
brachial artery
• Edge of cuff should sit 1” above the antecubital
space
• Person should be comfortably seated or lying down
• Should have rested for 10-15 minutes prior to the
reading
• Arms that are paralyzed, injured, have an IV or
shunt should not be used**** never take BP the
same side as a mastectomy
• Infant blood pressures can be taken on the leg
• Cuff should be placed snugly on upper arm.
• Gauge should be easily visualized
• Valve should be closed, but easily able to be
opened
Abnormal Blood Pressure readings
Hypertension – is high blood pressure (greater than
140 systolic and 90 diastolic) and can be caused by stress,
anxiety, obesity, high salt intake, aging, kidney disease,
thyroid deficiency, and vascular conditions such as
arteriosclerosis.
Hypotension –low blood pressure, can be caused by
heart failure, depression, severe burns, hemorrhage, and
shock.
Orthostatic hypotension, occurs when there is a
sudden drop in both systolic and diastolic pressures when
a person moves from lying or sitting to a standing position.
Factors that influence blood pressure
Factors that may Factors that may
increase BP are: decrease blood
• Excitement pressure are
• Anxiety • Rest or sleep
• Nervous • Depressant drugs
tension • Shock
• Stimulant • Excessive blood
drugs loss
• Exercise • Fasting
• Eating • Changes in body
• Smoking position
 A pulse oximeter measures your blood
oxygen levels and pulse. A low level of
Pulse Oximetry: oxygen saturation may occur if you
Purpose, Uses, and
How to Take a Reading have certain health conditions. Your
skin tone may also affect your
reading.
Purpose and uses
The purpose of pulse oximetry is to see if your blood is well
oxygenated.
Medical professionals may use pulse oximeters to monitor the
health of people with conditions that affect blood oxygen levels,
especially while they’re in the hospital.
These can include:
1.chronic obstructive pulmonary disease (COPD)
2.asthma
3.pneumonia
4.lung cancer
5.anemia
6.heart attack or heart failure
7.congenital heart disease
Doctors use pulse oximetry for several different reasons,
including:
• to assess how well a new lung medication is working
• to evaluate whether someone needs help breathing
• to evaluate how helpful a ventilator is
• to monitor oxygen levels during or after surgical procedures that
require sedation
• to determine whether someone needs supplemental oxygen therapy
• to determine how effective supplemental oxygen therapy is, especially
when treatment is new
• to assess someone’s ability to tolerate increased physical activity
• to evaluate whether someone momentarily stops breathing while
sleeping — like in cases of sleep apnea — during a sleep study
To take a reading with a pulse oximeter, you will:
1.Remove any jewelry or fingernail polish on your finger if
measuring from this location.
2.Make sure your hand is warm, relaxed, and below heart level
if attaching the device here.
3.Place the device on your finger, earlobe, or toe.
4.Keep the device on for as long as needed to monitor your
pulse and oxygen saturation.
5.Remove the device once the test is over.
In pulse oximetry, small beams of light pass through the blood in
your finger, measuring the amount of oxygen. According to the
British Lung Foundation, pulse oximeters do this by measuring
changes in light absorption in oxygenated or deoxygenated blood.
This is a painless process.
Pulse oximetry tests are an estimation of blood oxygen levels,
but they’re typically precise. This is especially true when
using high quality equipment found in most medical offices
or hospital settings. With this equipment, medical
professionals can carry out the tests accurately.

The Food and Drug Administration (FDA)Trusted Source

requires that prescription oximeters must provide results
within an accuracy range of 4 to 6 percent.

The American Thoracic SocietyTrusted Source says that

typically, more than 89 percent of your blood should be
carrying oxygen. This is the oxygen saturation level needed to
keep your cells healthy.
Having an oxygen saturation temporarily below this
level may not cause damage. But repeated or
consistent instances of lowered oxygen saturation
levels may be damaging.

An oxygen saturation level of 95 percent is

considered typical for most healthy people. A level of
92 percent or lower can indicate potential
hypoxemia, which is a seriously low level of oxygen
in the blood.

Various factors can affect readings, including a

person’s skin tone.