1. Chapter 24 Vital Signs

2. Vital Signs
Temperature
Pulse
Respiration
Blood pressure

3. When to Assess Vital Signs
Upon admission to any healthcare agency
Based on agency institutional policy and procedures
Any time there is a change in the patient’s condition
Before and after surgical or invasive diagnostic procedures
Before and after activity that may increase risk
Before administering medications that affect cardiovascular or respiratory functioning

4. Maintenance of Body Temperature
Thermoregulatory center in the hypothalamus regulates temperature
Center receives messages from cold and warm thermal receptors in the body
Center initiates responses to produce or conserve body heat or increase heat loss

5. Heat Production Primary source is metabolism
Hormones, muscle movements, and exercise increase metabolism
Epinephrine and norepinephrine are released and alter metabolism
Energy production decreases and heat production increases

6. Sources of Heat Loss Skin (primary source) Evaporation of sweat
Warming and humidifying inspired air
Eliminating urine and feces

7. Transfer of Body Heat to External Environment
Radiation
Convection (بواسطة الحمل)
Evaporation
Conduction

8. Pulse Physiology
Regulated by the autonomic nervous system through cardiac sinoatrial node
Parasympathetic stimulation — decrease heart rate
Sympathetic stimulation — increases heart rate
Pulse rate = number of contractions over a peripheral artery in 1 minute

9. Respirations
Pulmonary ventilation — movement of air in and out of lungs
Inhalation: breathing in
Exhalation: breathing out

10. Rate and Depth of Breathing
Changes in response to body demands
Controlled by respiratory centers in the medulla and pons
Activated by impulses from chemoreceptors
Increase in carbon dioxide is the most powerful respiratory stimulant

11. Physiology of Blood Pressure
Force of the blood against arterial walls
Controlled by a variety of mechanism to maintain adequate tissue perfusion
Pressure rises as ventricle contracts and falls as heart relaxes
Highest pressure is systolic
Lowest pressure is diastolic

12. Factors Affecting Body Temperature
Circadian rhythms
Age and gender
Environmental temperatures

13. Pulse Variations Increased or decreased pulse rate
Pulse amplitude and quality
Regular or irregular pulse rhythm

14. Factors Affecting Respirations
Exercise
Respiratory and cardiovascular disease
Alterations in fluid, electrolyte, and acid balances
Medications
Trauma
Infection
Pain
Anxiety

15. Factors Affecting Blood Pressure
Age, gender, race
Circadian rhythm
Food intake
Exercise
Weight
Emotional state
Body position
Drugs/medications

16. Equipment for Assessing Temperature
Electronic and digital thermometer
Tympanic membrane thermometer
Glass thermometer
Disposable single-use thermometer
Temporal artery thermometer
Automated monitoring devices

17. Equipment for Assessing Blood Pressure
Stethoscope and sphygmomanometer
Doppler ultrasound
Electronic or automated devices

18. Sites for Assessing Temperature
Tympanic membrane
Oral
Rectal
Axillary

19. Sites for Assessing Pulse
Palpating peripheral arteries
Auscultating apical pulse with stethoscope
Assessing apical-radial pulse

20. Assessing Respirations
Inspection
Listening with stethoscope
Monitoring arterial blood gas results
Using a pulse oximeter

21. Assessing Blood Pressure
Listening for Korotkoff sounds with stethoscope
First sound is systolic pressure
Change or cessation of sounds occurs - diastolic pressure
The brachial artery and popliteal artery are commonly used

22. Normal Temperatures for Healthy Adults
Oral – 37.0ºC, 98.6ºF
Rectal – 37.5ºC, 99.5ºF
Axillary – 36.5ºC, 97.6ºF
Tympanic – 37.5ºC, 99.5ºF
Forehead – 34.4ºC, 94.0ºF

23. Normal ranges for Vital Signs for Healthy Adults
Oral temperature — 37.0ºC, 98.6ºF
Pulse rate — 60 to 100 (80 average)
Respirations — 12 to 20 breaths/minute
Blood pressure — 130/85