1. Vital Signs Adapted from: Health and Physical Assessment in Nursing D’amico & Barbarito

2. Objectives By the end of this lesson, the student will:
Compare methods used to measure body temperature.
Describe the purpose of and methods for measuring heart rate.
Discuss techniques used for measurement of respiratory rate.
Describe the purpose of and methods for measuring blood pressure.
Recall the normal ranges of vital signs across age groups.
Discuss variables that affect the measurement of vital signs.

3. Vital Signs
Vital signs include temperature, pulse, respiratory rate, blood pressure and pain
TTUHSC EMS Program

4. Vital Signs
Vital signs are an outward clue to what is going on in the patient’s body
TTUHSC EMS Program

5. Vital Signs
Baseline vital signs provide a basis for comparison of later sets of vital signs.
This allows the nurse to identify any changes in the patient’s status.
TTUHSC EMS Program

6. Vital Signs
It is important to monitor “trends” in vital signs rather than individual sets of vital signs
While one set of vital signs will give the nurse a snap shot of the patient’s status, viewing trends over time will allow the nurse to identify any problems. For example, the patient’s temperature might be spiking at particular time of day, so an adjustment in medication might be necessary.
This is information which should be reported to the physician for him or her to act upon.
TTUHSC EMS Program

7. Temperature Temperature is the measure of body heat.
Heat is lost from the body by respiration, perspiration and excretion.
Heat is generated by shivering, vasoconstriction and inhibition of sweating.
The balance between the heat produced and the heat lost is the body temperature.
Temperature is regulated by sensors in the hypothalamus gland. These sensors decrease or increase the body’s core temperature based on information they receive.
TTUHSC EMS Program

8. Factors Influencing Body Temp
Exercise
Age
Diurnal variations
Illness
Stress
Hormones
*Exercise – Can increase T by 0.35 C to 0.5F
*The body’s sensitivity to alterations in evironmental temperature chages thoughout a person’s lifespan. Infants are much more susceptible to temperature changes than older children and adolescents. Older adults are more sensitive than middle aged adults.
This can be due to severl factors such as decreased subcutaneous tissue, decreased thermoregulatory control , decreased physical activity, inadequate diet or lack of central heating.
*Core body temperature flucuates throughout the day. It is higher between 8:00 p.m. and midnight and lower between 4:00 and 6:00 a.m. It can vary as much as 1.0 degrees C or 1.8 degrees F.
*Any illness or central nervous system disorder can impact the thermostatic function of the hypothalamus.
Hyperthermia (fever) might be a response to a viral or bacterial infection, tissue breakdown from a myocardial infarction, malignancy, surgery or trauma.
Hypothermia most often occurs due to prolonged exposure to cold external temperatures.
*Epinephrine and norepinephrine released during stress increases metabolic activity and heat productions which can in turn increase body temperature.
*Hormones can affect body temperature. A woman’s body temperature can be raised by about 0.35 degrees C or 0.5 degrees F due to progesterone secretion during ovulation.
TTUHSC EMS Program

9. Types of Thermometers
Glass (Mercury) – a hollow glass tube with calibration lines on it.
Aural (Tympanic) – Sensor measures body temp.
Chemically Treated Paper or Plastic – read by noting color it changes to.
Electronic/Digital Thermometers – Temp is registered on a screen.

10. TYPES OF THERMOMETERS GLASS THERMOMETER
A SMALL HOLLOW GLASS TUBE THAT CONTAINS MERCURY OR A MERCURY-FREE SUBSTANCE IN A BULB AT ONE END.WHEN HEATED THE MERCURY RISES IN THE TUBE.
Pear – shaped tip

11. ELECTRONIC THERMOMETER
BATTERY OPERATED
HAVE AN ORAL PROBE AND A RECTAL PROBE
DISPOSABLE PROBE COVER IS PLACED ON THE PROBE
THE TEMPERATURE REGISTERS IN ABOUT 30 SECONDS

12. TYMPANIC THERMOMETER
MEASURES THE TEMPERATURE IN THE TYMPANIC MEMBRANE (EARDRUM)
FAST AND ACCURATE - 1 TO 3 SECONDS
INFANTS – PULL THE EAR STRAIGHT BACK
ADULTS AND CHILDREN OVER ONE YEAR –
PULL THE EAR UP AND BACK

13. Temporal Thermometer Digital, takes temperature on forehead
Press button down and sweep probe across forehead; This is fairly new technology, but seems to be relatively accurate and very quick and easy to use

14. Temperature Sites Oral – 98.6 or 37 Rectal – 99.6 or 38
Tympanic – 98.6 or 37
Axillary – 97.6 or 36.4
Temporal – 99.6 or 38

15. Terms Afebrile – temperature is within normal range.
Febrile – temperature is elevated
Hypothermia – temperature is below normal.
Pyrexia – above normal temperature
Pyrogenic – any substance that produces fever.

16. Pulse rate The number of time your heart beats per minute.
Also called the heart rate.
Usually counted for 30 seconds and multiplied x 2, unless it is irregular.
TTUHSC EMS Program

17. Pulse
Carotid
Brachial
Radial
Femoral
Popliteal
Pulse Points

18. Pulse Pulse Points Dorsal Pedal Posterior Tibial
(Posterior and slightly inferior to medial Malleolus)
Pulse Points

19. Pulse
Rate
bpm
Less than 60 bpm is considered a slow pulse rate – bradycardia
Over 100 bpm is considered fast – tachycardia.
Bradycardia can be normal in athletes and tachycardia is a normal finding for someone who is undergoing stress, is anxious or has just finished exercising.
TTUHSC EMS Program

20. Pulse Rhythm Regular Irregular
The nurse must also assess whether or not the pulse is regular or irregular. Pulses should come at regular intervals, without skips or extra beats.
TTUHSC EMS Program

21. Pulse Quality Full (bounding) Weak (Thready) Elasticity
The nurse must also assess the quality or stroke volume. This is determined by the amount of pressure that has to be exerted before the pulse is felt.
A full pulse is easy to palpate and is not easy to obliterate. This can be due to fear, anxiety or exercise, as well as many other factors.
A weak, thready pulse is easy to obliterate. This can be an indication of hemorrhage.
The nurse should palpate along an artery in a proximal-to-distal direction to to assess the elasticity of the artery. Normal arteries feel smooth, straight and resilient.
TTUHSC EMS Program

22. Factors Affecting Pulse Rate
Age
Gender
Exercise
Stress
Fever
Hemorrhage
Medications
Position changes
Pulse rates can be affected by a number of factors.
Pulse rates decrease as a person ages. Pulse rates begin stabilize around after the age of 16 with the average pulse rate being around 70 bpm in males and 75 bpm in females.
Pulse rate increases with exercise, stress and fever. When a persons body temperature increases, you will have peripheral vasodilation. This lowers blood pressure which in turn increases pulse rate.
Loss of blood from hemorrhage cause an increase in pulse rate at the body attempts to circulate blood throughout the body.
Medications and either increase or decrease pulse rates.
When a person sits or stands for long periods of time, the pulse rates lowers
TTUHSC EMS Program

23. Terms Arrythmia – any deviation from the normal heart rate.
Bradycardia – abnormally slow heartbeat.
Pulsation – rhythmic beat.
Tachycardia – abnormally fast heartbeat.

24. Respiration Respiratory rate is the number of respirations per minute.
A respiration is one inhalation in and one exhalation out.
The nurse counts the number of respirations for 30 seconds and then multiplies x 2, unless the respirations are irregular or difficult to assess. In either of these situations, the nurse should count the respirations for 60 seconds.
TTUHSC EMS Program

25. Respirations Rate Adult Child 12-20 Resp/min 20-30 Resp/min
As in the pulse rate, the respiratory rate decreases with age.
TTUHSC EMS Program

26. Respirations Rate Newborn - 30-80 resp/min 3-9 y.o. – 20-30 resp/min
16-adult – resp/min

27. Respirations
Rhythm
Regular
Irregular

28. Respiration
Quality
Full
Deep
Shallow
Labored
Noisy

29. Factors Increasing Respiration
Exercise
Anxiety
Respiratory Disease
Medication
Pain
Heart disease (CHF)

30. Factors Decreasing Respiration
Relaxation
Depression
Head injury
Medication

31. Terms Dyspnea – Difficulty breathing. Apnea – Absence of respirations.
Cheynes-Stokes – Periods of labored respirations followed by apnea.
Rales – Bubbling or rattling sounds caused by mucus in the air passages.

32. Blood Pressure
Systolic - Pressure on the arterial wall when the heart contracts
Diastolic - Pressure on the arterial wall when the heart is at rest

33. BLOOD PRESSURE
The measurement of the amount of force blood exerts against the arterial walls.
Systolic:
Pressure exerted when the heart muscle contracts
Diastolic:
Pressure exerted when the heart muscle relaxes between beats.
SYSTOLIC /DIASTOLIC
120/80
BP is measured in mm of Hg
Blood pressure is recorded as a fraction with the systolic pressure on top and the diastolic pressure on the bottom.
TTUHSC EMS Program

34. ABNORMAL BLOOD PRESSURE
Average adult systolic range is 100 to 140
Average adult diastolic range is 60 to 90
ABNORMAL BLOOD PRESSURE
Hypertension
Hypotension
High blood pressure – measurements above the normal range.
Low blood pressure – below normal blood pressure readings
TTUHSC EMS Program

35. GUIDELINES FOR MEASURING
BLOOD PRESSURE
Do not take blood pressure on an arm with an IV, cast or shunt.
Do not take a blood pressure on the side of a mastectomy.
Blood pressure should be taken with the person sitting or lying.
Cuff should be applied to bare upper arm, should be the correct size and should be snug.
The room should be quiet

36. Blood Pressure
Auscultated BP - Listening for both the systolic and diastolic values
Palpated BP - Feeling for the systolic pressure

37. FACTORS THAT AFFECT BLOOD PRESSURE AGE GENDER BLOOD VOLUME STRESS PAIN
EXERCISE
WEIGHT
RACE
DIET
MEDICATIONS
POSITION
BLOOD PRESSURE INCREASES AS A PERSON GROWS OLDER
WOMEN USUALLY HAVE LOWER BLOOD PRESSURE THAN MEN
BLOOD VOLUME – SEVERE BLEEDING LOWERS THE BLOOD PRESSURE
STRESS – HEART RATE AND BLOOD PRESSURE INCREASE AS PART OF THE BODY’S RESPONSE TO STRESS
PAIN – INCREASES BLOOD PRESSURE
EXERCISE – INCREASES HEART RATE AND BLOOD PRESSURE
WEIGHT – BLOOD PRESSURE IS HIGHER IN OVERWEIGHT PERSONS
RACE – BLACK PERSONS GENERALLY HAVE HIGHER BLOOD PRESSURE THAN WHITE PERSONS DO
DIET – A HIGH-SODIUM DIET INCREASES THE FLUID VOLUME IN THE BODY WHICH INCREASES BLOOD PRESSURE
MEDICATIONS – CAN BE TAKEN TO RAISE OR LOWER BLOOD PRESSURE
POSITION – lower when lying down
TTUHSC EMS Program

38. Terms
Diastolic – least force of pressure exerted against the walls of arteries.
Hypertension – high BP
Hypotension – low BP
Stethoscope –instrument used to amplify sound
Systolic – greatest force of pressure exerted against the walls of the arteries

39. Sphygmomanometer Instrument used to measure BP
Sphygmo – refers to pulse
Mano – refers to pressure
Meter – refers to measure

40. TYPES OF BLOOD PRESSURE CUFFS
THE PROPER NAME FOR A BLOOD PRESSURE CUFF IS SPHYGMOMANOMETER
MERCURY
ANEROID

41. USING BLOOD PRESSURE
EQUIPMENT
TTUHSC EMS Program

42. Korotkoff Sounds First Phase Second Phase Third Phase
A clear tapping sound; onset of the sound for two consecutive beats is considered systolic
Second Phase
The tapping sound followed by a murmur
Third Phase
A loud crisp tapping sound
When measuring blood pressure we are listening for the Korotkoff sounds
First Phase
A clear tapping sound; onset of the sound for two consecutive beats is considered systolic
Second Phase
The tapping sound followed by a murmur
Third Phase
A loud crisp tapping sound
Fourth Phase
Abrupt, distinct muffling of sound, gradually decreasing in intensity
Fifth Phase
The disappearance of sound, is considered diastolic blood pressure- two points below the last sound heard

43. Korotkoff Sounds Cont. Fourth Phase Fifth Phase
Abrupt, distinct muffling of sound, gradually decreasing in intensity
Fifth Phase
The disappearance of sound, is considered diastolic blood pressure- two points below the last sound heard
Fourth Phase
Abrupt, distinct muffling of sound, gradually decreasing in intensity
Fifth Phase
The disappearance of sound, is considered diastolic blood pressure- two points below the last sound heard

44. Steps for Measuring Blood Pressure
Seated for 5 minutes
Patient Position
Expose Upper arm
Center of upper arm at heart level
Seated for 5 minutes
No smoking, caffeine or vigorous exercise for 30 minutes before
Patient Position
Sit straight, both feet flat on floor, arm at slightly more than 90 degree angle on table with crease in elbow level with heart
Expose Upper arm
Use the right arm- for accuracy and for consistency
Center of upper arm at heart level
Elbow slightly flexed, Forearm with the palm facing upwards and supported on flat surface

45. Steps for measuring cont.
Cuff applied 1 inch above crease at elbow
Locate brachial artery
Palpate radial pulse
Inflate cuff until pulse disappears
Cuff applied 1 inch above crease at elbow
Make sure cuff is correct size
Locate brachial artery
Palpate radial pulse
Inflate cuff until pulse disappears

46. Steps for measuring cont.
Let air out
Place stethoscope on brachial artery
Pump up cuff to above point of obliteration
Let air out at 2 mmHg per second
Let air out
Place stethoscope on brachial artery
Pump up cuff to above point of obliteration
20 for kids
30 for adults
Let air out at 2 mmHg per second

47. PAIN Pain means to ache, hurt, or be sore.
Pain is a warning from the body.
Pain is personal.
Types of pain
Acute pain – felt suddenly from an injury, disease, trauma, or surgery
Chronic pain – lasts longer than 6 months. Pain can be constant or occur on and off.
Radiating pain – felt at the site of tissue damage and in nearby areas.
Phantom pain – felt in a body part that is no longer there.
Pain is referred to as the “5th vital sign”.
TTUHSC EMS Program

48. Signs and symptoms Location – Where is the pain?
Pattern – When did the pain start?
Intensity – Rate the pain on a scale of 1 to 10, with 10 as the most severe
Description – Can you use words to describe the pain?
Precipitating factors– What were you doing when the pain started?
Vital signs – Take the person’s vital signs when they complain of pain.
Other signs and symptom
Body responses - ↑ vital signs, nausea, pale skin, sweating, vomiting
Behaviors – crying, groaning, holding affected body part, irritability, restlessness
Patients should be observed for signs of pain. If pain is present, a full pain assessment should be completed.
TTUHSC EMS Program

49. Pain Assessment Scales
Pain can be assessed using scales.
In adults, a 1-10 scale is usually sufficient to rate pain.
In children, the use of pictures often works best.
TTUHSC EMS Program