1. Vital Signs
Signs of Life

2. Vital Signs (VS) Learning Objectives: Overview of Vital Signs
5 main VS
Definition of Pulse
How to obtain & accurately measure each pulse
Identify sites for assessing pulse
Practice accurate measuring of pulse and recording results
Medical Terminology

3. Vital Signs Assignments: Discussion Articles Reading Textbook
Note taking
Handouts
Pulse Points
Graphic Chart
Review

4. Vital Signs (VS) Discussion
Vital = Life
Why do we need to know information about and how to take vital signs (VS)?
Why is it important to obtain all patient’s VS?
How often should we take a patient’s VS?
What can VS tell us about our patients?
Is it important to know what a patient’s normal set of VS is? Why?
What do we do when VS are abnormal or out of normal range?

5. Vital Signs
Defintion: Important information about the condition of a patient’s body
Detect Changes in normal body function
May signal life-threatening condition
Provide responses to treatment
Usually taken at rest with person sitting or lying down

6. Types of Vitals Five Main Vital Signs: Documented as:
Temperature (T)
Pulse(P) = heart rate
Respirations(R)
Blood Pressure(BP)
Pain Score
Documented as:
TPR, BP and Pain Score

7. Vitals are Measured Upon admission
As often as required by the person’s condition
Before and after surgery
After a fall or accident
When given a drug that can affect a person’s respiratory or circulatory system
When patient complains of pain, dizziness, shortness of breath (SOB) or chest pain

8. Vital Facts about Assessing Vitals
Any extreme variations must be reported immediately
Extreme abnormal high or low rates must be reported immediately
If unable to obtain report immediately
Certain factors will change readings of vitals especially pulse, respirations and BP.
Increased rate can be affected by
Exercise
Stimulant drugs
Excitement
Fever
Shock
Anxiety

9. Decreased rates can be affected by:
Sleep
Depressant drugs
Heart Disease
Coma
Physical Training

10. Pulse

11. Pulse (P)
Definition: pressure of the blood felt against the wall of an artery as the heart beats
Pulse Characteristics:
Rate = # of beats per minute
Rhythm = regularity / irregularity
Volume - = strength – described as strong, weak or bounding

12. Pulse (P)
Obtained:
by palpation (to feel) of an artery and count the number of beats. If regular can count 15 sec. X 4 or 30 sec. X2. If irregular count full 60 seconds
or auscultation (to hear) of an artery
Normal:
-rate = varies by age, sex and body size
- rhythm = regular
- volume = strong, not bounding

13. Measuring Radial Pulse Procedure
1. Assemble equipment
2. Wash Hands
3. Introduce self
4. Place patient in comfortable position with arm supported
5. With tips of first two or three fingers (prefer middle finger and ring finger) , locate the pulse on the thumb side of patient’s wrist. Never use thumb. WHY??
6.When pulse is felt, exert slight pressure and start counting. Use the second hand of watch and count for full minute or 30 seconds X 2 or 15 sec. X 4 unless irregular then must count for full minute.
7. When counting pulse, note the volume (character or strength) and the rhythm (regular or irregular) . NOTE MAKE SURE ALL PULSES ARE BILATERAL and SYMETRICAL…
8.Record the following information: date, time, rate, rhythm and volume using agency policy for recording

14. 9. Check the patient before leaving
9. Check the patient before leaving. Observe all safety precautions to protect the patient
10. Replace all equipment used.
11. Wash hands
12. Record all required information on the patient’s chart for example.
8/22/ P82 strong and regular R. Davenport, RN

15. Bradycardia – less than 60 bpm Tachycardia – greater than 100bpm
Pulse (P) Terminology
Bradycardia – less than 60 bpm
Tachycardia – greater than 100bpm
Arrythmia – irregular heart beat -

16. Pulse Points Temporal – side of the forehead
Carotid – neck (used during child/adult CPR)
Brachial – inner aspects of forearm at the antecubital (crease of the elbow). Used for BP and infant CPR
Apical – below left breast. Most accurate pulse point. Use stethoscope and count for a full minute.
Radial – at the inner aspects of the wrist, above the thumb (thumb-side). Most common site to assess pulse.
Femoral – at the groin (inner side) Used for assessment and procedures
Popliteal – behind the knee. Used for assessment
Dorsalis pedis – top of the foot arch (between Big Toe and 2nd toe)

17. Pulse Normal Ranges Age Infant Child 1-7 years old Child 7-12
12 years and older
Pulse Per Minute
80-110 90
60-90

18. Charting Vital Signs
See graphing handout

19. Temperature

20. Temperature (T)
Definition: the measurement of the balance between heat loss and heat produced by the body
Obtained:
Oral – mouth – 98.6 (Most common) 3-5 min.
Wait 15 minutes after eat, drink or smoke.
Rectal and/or temporal – (most accurate)3-5 min. Used on infants and small children
tympanic/aural – 98.6 (less than 2-5 seconds)
axillary – armpit or groin (10 minutes)

21. Temperature (T) Measured: Degrees Fahrenheit / Celsius
Normal Body Temp – 98.6 F / 37
Temp affected by:
Body processes- some people have accelerated body processes which produce a higher body temp
Time of day – Body temp is lower in morning after body has rested and higher after muscular activity and daily food intake

22. Body Sites: The various sites of taking temp will affect the reading.
Causes of increased body temp: illness, infection, exercise, excitement and incr. environment temperature
Causes of Decreased body temp: Starvation or fasting, sleep, decreased muscle activity, mouth breathing.

23. Hypothermia- body temp below 95F ®
Hypothermia- body temp below 95F ®. Death occurs if body temp drops below 93F for a period of time.
Hyperthermia – temp exceeds 104F ®. Caused by prolonged exposure to high temp, brain damage and serious infections. Temp above 106F can lead to convulsions, brain damage and death.

24. Inhale & Exhale
Respirations

25. Respirations(R)
Definition: reflection of breathing rate of patient . Process of taking in O2 and release CO2
Obtained:
look, listen, feel
Measured by :
Rate = # of breaths per minute
Rhythm = regular / irregular
Character = labored, non-labored, shallow,

26. Respiratory Terminology
Dyspnea- difficult or labored breathing
Apnea- absence of respirations
Tachypnea- fast, shallow resp. above 25bpm
Bradypnea- slow resp rate below 10bpm
Orthopnea- severe dyspnea when laying down
Cheyne-Stokes- period of dyspnea and apnea
Rales- bubbling noises caused by fluid
Wheezing- high pitched whistling (expiration)
Cyanosis- condition of bluish discoloration

27. Blood Pressure

28. Blood Pressure (BP)
Definition: the force exerted by the blood against arterial walls when the heart contracts or relaxes
Obtained:
Sphygmomanometer & stethoscope
Dynamap (automatic, no stethoscope)
Measured:
Systolic – ventricle is contracting
Diastolic – rest

29. Blood Pressure (BP) Normal Range: varies by age Hypertension:
Definition – High blood pressure; Systolic > 140 and/or Diastolic >90
Causes- Stress, anxiety, obesity, Incr. sodium, aging, kidney disease, decr thyroid function and vascular conditions

30. Hypotension:
Definition – Low blood pressure; Systolic < 90 and/or Diastolic < 60
Causes- Heart failure, dehydration, depression, burns, hemorrhage and shock
Orthostatic hypotension – Occurs when a drop in either systolic or diastolic when moving from lying to sitting or standing position. (inability of blood vessels to compensate quickly)

31. -algia
Pain

32. Pain 5th VS Is a subjective symptom Measured:
By severity on a scale of 0 – 10
According to location
By description – sharp, stabbing, dull, etc.
By occurrence: constant vs. intermittent
Obtained:
From patient via verbal or non-verbal communication

33. Review
Abbreviations: VS BP R
TPR Sx F C
bpm

34. Review
Name the 5 VS
2. What is the most common site for taking a pulse?
3. What is the heart rate less than 60 bpm called?
4. Give one reason that an apical pulse should be taken.
5.What is an irregular heart rate called?
6. Why is it important to obtain a person’s VS?
7. Give three instances when vitals should be obtained.