1. 1
VITAL SIGNS
Maria Teresita B. Dalusong, PTRP, MHPEd
Vital Signs
 Cardinal signs
 Important
indicators of the
body’s physiologic
Include
 Temperature
 Pulse
status
 Reflect the
function of the
internal organs
 Respiration
 Blood pressure
Vital Signs
 Factors that affect the vital signs:
 time of day
 exercise
 age
 sex
 weight
 metabolic conditions
 general health status
 pain
 drug intake
Why take the Vital Signs?
 Establish database of values for an
individual patient
 Assist in goal setting and treatment
l iplanning
 Assist with assessment of patient
response to treatment
 Contribute to assessment of
effectiveness of treatment activities
VITAL SIGNS
 Body Temperature
 Pulse rate
 Respiration
 Blood Pressure
1. Body Temperature
A. Definition
B. Thermoregulatory System
C. Abnormalities in BodyTemperature
F t I fl i T tD. Factors InfluencingTemperature
E. Types ofThermometer

2. 2
1. Body Temperature
 Represents a balance between the
heat produced or acquired by the
body, and the amount lost.
Thermoregulatory System
 Maintains a relatively constant internal
body temperature
 Monitors and acts to maintain
temperatures that are optimal forp p
normal cellular and vital organ function
 Components:
 Thermoreceptors
 Regulating center
 Effector organs
Thermoregulatory System
 Thermoreceptors
 Provide input to the temperature-
regulating center located in theregulating center located in the
hypothalamus
 Can be peripheral or central
Thermoregulatory System
 Regulating Center
 Hypothalamus
 Coordinate the heat
production and loss processes
 In healthy individuals, normal
temperature is set at 37° C ±
1 °C (98.6 ° F ± 1.8 °F )
 Sends input to the effector
organs via nervous pathways
of both somatic and
autonomic nervous system
Thermoregulatory System
 Effector Organs
 Respond to both increase and
decrease in temperaturedecrease in temperature
 Include vascular, metabolic,
skeletal muscle responses
(shivering), sweating
Thermoregulatory System
 Conservation of Body Heat
 Vasoconstriction of blood
vessels
H th l ti t Hypothalamus activates
sympathetic nerves which results
into vasoconstriction of cutaneous
vessels

3. 3
Thermoregulatory System
 Conservation of Body Heat
 Decrease in sweat gland activity
 To reduce or prevent heat loss by
evaporation, sweat gland activity is
diminished
 Sweating is abolished if body
temperature falls below 37° C
(98.6°F)
Thermoregulatory System
 Conservation of Body Heat
 Cutis anserina (piloerection)
“H i di d”“Hair standing on end”
Can trap a layer of insulating
air near the skin and decrease
heat loss
Thermoregulatory System
 Production of Body Heat
 Shivering
Primary motor center:y
posterior hypothalamus
Increased tone of muscles up
to a certain threshold level
Thermoregulatory System
 Production of Body Heat
 Hormonal Regulation
Increase in norepinephrinep p
and epinephrine
Increase in thyroxine
Thermoregulatory System
 Loss of Body Heat
 Radiation
 Transfer of heat by electromagnetic
waves from one object to another
 Occurs through air between objects
that are not in direct contact
Thermoregulatory System
 Loss of Body Heat
 Conduction
Transfer of heat from one objectTransfer of heat from one object
to another through a liquid, solid
or gas
Requires direct molecular
contact between the two objects

4. 4
Thermoregulatory System
 Loss of Body Heat
 Convection
T f f h t b tTransfer of heat by movement
of air or liquid (water)
Accomplished secondary to
conduction
Thermoregulatory System
 Loss of Body Heat
 Evaporation
 Conversion of liquid to a vaporq p
 Through the respiratory tract &
through perspiration
 Major mechanism of heat loss
during exercise
Abnormalities in Body Temperature
 Increased BodyTemperature
 Pyrexia
 Elevation of normal body temperature
 Caused by pyrogens Caused by pyrogens
 100 degrees °F or 38°C
 Signs and symptoms: general malaise, headache,
increased pulse and respiratory rate, chills, piloerection,
shivering, loss of appetite, flushed skin which is hot to
touch, nausea, irritability, restlessness, weakness, etc.
Abnormalities in Body Temperature
 Increased BodyTemperature
 Hyperpyrexia/ hyperthermia
 Extremely high fever (above 41.1°Cy g (
or 106°F)
 Patient may experience the following:
Disorientation, confusion, convulsion, or
comatose
Abnormalities in Body Temperature
 Increased BodyTemperature
 Stages of fever
 Invasion (onset)
 Fastigium or stadium (course)
 Difervescence (termination)
Crisis
Lysis
Abnormalities in Body Temperature
 Types of Fever
 Intermittent – Alternates between periods of
fever and periods of normal bodyT°
 Remittent – Elevated bodyT° that fluctuates >2°C
(3 6°F) within a 24-hour period but remain above(3.6 F) within a 24-hour period but remain above
normal.
 Relapsing – A.k.a. recurrent fever; periods of fever
are interspersed with normal temperatures that last
at least one day
 Constant – bodyT° is constantly elevated with
fluctuations <2°C (3.6°F)

5. 5
Abnormalities in Body Temperature
 Lowered BodyTemperature
 Hypothermia
 Lowered body temperature
 Signs and symptoms: decreased Signs and symptoms: decreased
pulse rate and respiratory rate, cold
and pale skin, cyanosis, decreased
cutaneous sensation, depression of
mental and muscular responses and
drowsiness
Abnormalities in Body Temperature
 Lowered BodyTemperature
 Hypothermia
Thermoregulatory center
Impaired at 34.4° C (94°F)
Completely lost at 29.4°C
(85°F)
Factors Influencing Body Temperature
 time of day
 lowest at 4-6 AM, highest at 4-8 PM
 circadian rhythm : 24 hour cycle of normal
variations in body temperature
 age age
 emotions
 exercise
 menstrual cycle
 Increased levels of progesterone during ovulation
can cause elevation of body temperature by 0.3 to
0.5 °C (0.9° F)
Factors Influencing Body Temperature
 Pregnancy
 Body temperature remains elevated by
0.5 °C
 external environment
l i f location of measurement
 Rectal & tympanic > oral > axillary
 Rectal/tympanic = 0.3 – 0.5° C higher
than oral
 axillary = 0.6° C lower than oral
 ingestion of warm or cold food
Types of Thermometers
 Electronic
thermometer
 Provides a rapidp
measure of body
temperature
 Low chance of
cross- infections
Types of Thermometers
 Glass Mercury
Thermometers
 Filled with mercury
 Calibrated in either (or
both) Celcius or Farenheit)
scales
 Range is from 34° C
(93.1°F) to 42.2° C (108°F)
 Shapes:
 Blunt, rounded
 Elongated, slender

6. 6
Types of Thermometers
 Disposable Single-use
Thermometers
 Consists of calibrated dots
impregnated with temperatureimpregnated with temperature
sensitive chemical
 Temperature- Sensitive Strips
 Change in color
 Readings are non- specific
Practical things to know in taking Body
Temp.
 Sites where body temperature are obtained
 Most common & convenient location: ORAL
 Most accurate measurement: RECTAL
 Least desirable sites:AXILLARY OR INGUINAL
 Very young patients & unconscious pt who cannot hold Very young patients & unconscious pt who cannot hold
the thermometer in the mouth: RECTAL OR EAR
CANAL
 When there is high temp, pt should not be allowed to
exercise or engage in strenuous activity
 One should determine the cause of a temperature that is
dropping than N.
2. Pulse
A. Definition
B. Parameters for pulse
C. Factors Affecting Pulse
D. Pulse point/ sites
Pulse
 Wave of blood in the artery created by
the contraction of the left ventricle
during the cardiac cycle
 Systole- highest point of pressure
 Diastole- lowest point of pressure
Parameters for Pulse Assessment
 Rate
 Number of beats per minute
 Normal rate: 60 to 80 beats per minute
 Rhythm
 Intervals between beats Intervals between beats
 Volume
 Amount of blood pushed through the
artery
Bounding/full
Weak/thready
 Quality or feel of arterial wall
Parameters for Pulse Assessment
Grade Pulse Description
0 Absent No perceptible pulse even with
maximum pressure
1 + Thready Barely perceptible; easily
obliterated with slight pressure;
fades in and out
2 + Weak Difficult to palpate; slightly
stronger than thready; can be
obliterated with light pressure
3 + Normal Easy to palpate; requires
moderate pressure to obliterate
4 + Bounding Very strong; hyperactive; is not
obliterated with moderate
pressure

7. 7
Pulse
 Other variations in pulse
 Pulsus alterans
 Bigeminal pulse
 Paradoxical pulse
Factors affecting the Pulse
 age
 New born = 100 – 130/180 bpm
 Child (1 – 7yr old) = 80 – 120 bpm
d lt 60 100 b adults = 60 – 100 bpm
 gender
 emotional status
 In response to grief, fear, anxiety
and pain
Factors affecting the Pulse
 exercise
 pulse can be a basis for exercise
prescription
 Important method of assessing response
t ito exercise
 pulse proportional to intensity of
workload
 Maximal heart rate: 220 minus age
 systemic or local heat
 body size
Pulse Points
 Superficial arteries located
over a bony surface
 Temporal
 Superior and lateral to the outer
canthus of the eyey
 Carotid
 On either side of the anterior
neck below earlobe and between
the SCM and trachea
 Brachial
 Medial aspect of the antecubital
fossa
Pulse Points
 Radial
 Radial aspect of the wrist
at the base of the thumb
 Femoral
 Inguinal region
 Popliteal
 Behind the knee
 Pedal
 Dorsal, medial aspect of
the foot
Practical things in taking the pulse
 Auscultation is used to determine the heart rate (over
the apex of the heart with the use of stethoscope).
 Most common site: radial & carotid
 When measuring one’s own pulse; Carotid
 PeripheralVascular disease: lower extremities pulsep p

8. 8
3. Respiration
A. Definition
B. Respiratory System
C. Regulatory Mechanism
D Factors influencing RespirationD. Factors influencing Respiration
E. Parameters of Respiration
F. Breath Sounds
G. Patterns of Respiration
Respiration
 Supply the body with oxygen for
metabolic activity and to remove
carbon dioxide
The Respiratory System
 Inspiration
 contraction of the
diaphragm and
intercostal muscles
 increases the
intrathoracic space
to give space for the
lungs to expand
The Respiratory System
Expiration
passive during relaxed
accessory muscleaccessory muscle
recoil of the lungs
Regulatory Mechanisms
 Respiratory center
 Lies in the pons and
medulla
 Provides control of
both the rate and the
depth of breathing in
response to the
metabolic needs of
the body
Regulatory Mechanisms
 Afferent inputs :
 Central Chemoreceptors
 located in the respiratory center
sensitive to carbon dioxide and hydrogeny g
ion levels
 Peripheral Chemoreceptors
 in the carotid bifurcation and arch of
aorta
 sensitive to partial pressure of oxygen

9. 9
Factors Influencing Respiration
 Age
 Newborn: 30 to 50
breaths per minute
 Adults: 12 to 18/20
breaths per minute
 body position
 environment
 emotion and
stressbreaths per minute
 body size
 stature
 exercise
stress
 drug intake
Parameters of Respiratory Assessment
 rate
 number of breaths per minute
 depth
 volume of air exchanged with each breath
 rhythm
 regularity of inspirations and expirations
 character
 deviation from normal quiet effortless
breathing
Breath Sounds
 wheezing
 whistling sound produced by air
passing through a narrowed bronchi
 stridor stridor
 harsh high pitched sound due to
narrowing of glottis or trachea
 rales
 rattling, crackling due to secretions
in air passage
Breath Sounds
 sigh
 deep inspiration followed by
prolonged audible expirationprolonged audible expiration
 stertorous
 snoring due to secretions on
trachea and large bronchi
Patterns of Respiration
 Dyspnea
 difficult or labored
breathing
 Tachypnea Tachypnea
 increase in RR (>
24 bpm)
 Bradypnea
 decreased RR (<
10 bpm)
Patterns of Respiration
 Apnea
 Absence of
respirationp
 Hyperventilation
 Increased rate
and depth of
respiration

10. 10
Patterns of Respiration
 Cheyne-Stokes
respiration
 Gradual increase
in rate and depth,p ,
followed by a
gradual decrease
 Biot’s respiration
 Alternating
periods of apnea
and hyperapnea
Patterns of Respiration
 Kussmaul’s respirations
 Gasping, labored
pattern
 Apneustic breathing
 Prolonged inspiration Prolonged inspiration
followed by short,
ineffective expiration
 Paradoxical respiration
 Lung inflation during
expiration, deflation
during inspiration
4. Blood Pressure
1. Definition
2. Classification of Blood Pressure
3. Regulatory Mechanism
4. Factors Affecting BPg
5. Equipment Used
6. Karotkoff’s Sound
Blood Pressure
 Refers to the force the blood exerts
against a vessel wall
 Measured at both the highest and lowest
points in the pulse
 Arteries > capillaries > veins
 Pulse pressure
Blood Pressure Blood Pressure
 Normal range of systole:
 90 – 135/140mmhg
 Normal range of diastolic:
 60 – 80mmhg 60 80mmhg
 Normal systolic/diastolic value:
 120/80mmHg
 Hypertensive range:
 90++mmHg/135 – 140mmHg

11. 11
FACTORS ASSOCIATED TO
HYPERTENSION:
 Obesity
 Physical inactivity
 Excessive use of nicotine, alcohol, salt
 Arteriosclerosis
 DM DM
 Oral contraceptives
 Advance age
 Kidney Disease
Regulatory Mechanisms
 Vasomotor center
 Located at the lower pons and upper
medulla
 Tonically active; produces a slow,
continuous firing in all vasoconstrictor
nerve fibers
 Provides a normal vasomotor tone
Regulatory Mechanisms
 Afferent inputs
 baroreceptors
(pressoreceptors)
i i h f sensitive to stretch of a
vessel wall
 highly concentrated at
the :
 internal carotid arteries
above the bifurcation
 walls of the arch of aorta
Regulatory Mechanisms
 Afferent Inputs
 chemoreceptors
 sensitive to decreased arterial oxygen
concentration, increase in carbon,
dioxide and increase in hydrogen ion
concentrations.
 lie close to the baroreceptors at the
carotid artery (carotid body) and the
aortic arch (aortic body)
 cranial nerves IX and X
Factors Affecting Blood Pressure
 blood volume
 diameter or elasticity of the arteries
 cardiac output
Factors Affecting Blood Pressure
 age
 Normal average adult BP:
120/80mmHg
 Exercise Exercise
 Valsalva maneuver
 Arm position

12. 12
Equipment
 Blood pressure cuff
 Airtight, flat rubber
bladder that can be
inflated with air
 Adult cuff:
 width- 4.5 to 5.5
inches
 length: 9 inches
Equipment
 Sphygmomanometer
 Aneroid
 Circular calibrated dial
 Mercurial
 Mercury- filled calibrated
cylinder
 View the meniscus at eye
level
Equipment
 Stethoscope
 Used to listen to
the soundsthe sounds
 Has a diaphragm
and 2 earpieces
Korotkoff’s Sounds
 series of sounds heard through the
stethoscope during BP assessment
 has 5 phases
Korotkoff’s Sounds
 Phases :
 Phase 1: 1st clear, rhythmic, tapping
sound, corresponds to systole
 Phase 2: murmur or swishing soundg
 Phase 3: sounds become crisp and
louder
 Phase 4: abrupt muffling, 1st diastole
 Phase 5: sounds disappear, 2nd diastole
For the Lab Session:
 Bring your materials forVital Signs
Assessment:
 Sphygmomanometer
 Stethoscope Stethoscope
 Thermometer
 Watch

13. 13
Practical Application
 Baseline values of pt – to takeVS at rest
 Type of patients whose base line are important to
determine.
 AbnormalValues at rest and its consequences