1. Name the four main vital signs
temperature
pulse
respirations
blood pressure

2. Unit 14 Vital Signs

3. Measuring and Recording Vital Signs
Why is it essential that vital signs are measured accurately?
They are important indicators of the health state of the body.
Main vital signs (VS)
Temperature
Pulse
Respiration
Blood pressure

4. 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

5. Measuring Temperature
Measures balance between heat lost and heat produced in the body. A high or low reading can indicate disease
Normal temperature is 97.0 – 100.0F
Five sites in the body where temperature can be measured are:
Axillary (armpit)
Oral
Aural (ear)
Rectal
Temporal

6. 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

7. Measuring Pulse 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

8. 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)

9. 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

10. Factors that can change pulse rate
Pulse will be increased by:
Exercise
Stimulant drugs
Excitement
Fever
Shock
Nervous tension
Pulse will be decreased by:
Sleep
Depressant drugs
Heart disease
Coma
Physical training

11. Apical Pulse
The apical pulse is taken with a stethoscope at the apex of the heart. The actual heartbeat is heard and counted.
An apical pulse is taken because of illness, hardening of the arteries, a weak and rapid pulse, or the patient is on heart medication.
Because infants and small children have a rapid pulse, an apical pulse is always done.

12. Apical Pulse
An apical pulse is the heartbeat at the apex of the heart and is heard with a stethoscope.

13. 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.

14. 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

15. Respirations - Rate
The normal rate for respirations in adults is breaths per minute
In children, respirations are a little faster than adults, breaths per minute
Infants the rate is between 30 – 50 breaths per minute

16. 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

17. 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

18. 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

19. 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)

21. Blood Pressure
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.

22. 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.

23. Factors that influence blood pressure
Factors that may increase BP are:
Excitement
Anxiety
Nervous tension
Stimulant drugs
Exercise
Eating
Smoking

24. Factors that can influence BP
Factors that may decrease blood pressure are
Rest or sleep
Depressant drugs
Shock
Excessive blood loss
Fasting
Changes in body position