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VITAL SIGNS King Saud University Nursing College Vital Signs V/S also termed cardinal signs, reflect the body’s physiologic status and provide information critical to evaluating homeostatic balance . They include: – – – – – Temperature Pulse Respiration Blood pressure Pain (considered the 5th vital sign) 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 functions. Maintenance of Body Temperature Thermoregulatory center in the hypothalamus regulates body temperature. The center receives messages from cold and warm thermal receptors in the body. The center initiates responses to produce or conserve body heat or increase heat loss. Heat Production Primary source is metabolism. Hormones, muscle movements, and exercise increase metabolism. Epinephrine and nor-epinephrine are released and alter metabolism Fever: increases the cellular metabolic rate & thus increases the body temperature. Heat loss occur through: Conduction - heat escapes from or enters into your body e.g. when lying on a cold or hot surface. Convection - cooler air currents remove heat from the surface of your skin, warmer air currents make the skin hotter. Evaporation - evaporative cooling occurs when water (from perspiration or swimming) leaves the skin surface as a vapour, lowering the body temperature by taking the heat from the body. Radiation - e.g. acquisition of heat from solar radiation or losing heat from the skin. Factors affecting body temp Age: new born have unstable body temp Related to immature thermoregulatory mechanism. Elderly body temp drops as a person age going up as they are more sensitive to temp changes. Environment: environment temp not affecting core temp. if the core temp 25C or 77F death may happen. Time of the day. Exercise Stress Hormones such as progesterone. Circadian rhythm (Lowest 1-4 Am, Max at 4-6 Pm) Factor affecting body temp measurement Site: Oral( most common, easy & convenient, wait 15-30 min if the patient has hot or cold drinks). Rectal:( most reliable) Axillary: safe, non-invasive but least accurate Tympanic: non-invasive, safe & accurate. Type of the thermometer: Electronic versus traditional ones. Commonly used Terms: Pyrexia or fever. Hyperthermia. Hypothermia. Febrile. Afebrile. Temperature Conversion The body temp. is measured in degrees on two scales: Celsius (Centigrade) & Fahrenheit. C=(Fahrenheit temp-32) x 5/9 F= (Celsius temp x 9/5)+32 Convert: Celsius (C) Fahrenheit (F) 36 ? ? 97.7 Pulse Pulse is a wave of blood created by the contraction of left ventricle of the heart through the arteries. It is an index of the heart’s rate and rhythm The pulse rate is the number of heartbeats per min. Closure of the heart valves creates the sound heart A normal adult heart rate= 60-100 beats per min. Rates are slight faster in women, and more rapid in children and infants. Tachycardia = HR over 100/m Bradycardia= HR below 60/m Cont. Pulse Heart rhythm( the pattern of beats, regular or irregular) is the time interval between each heart beat. Normal HR is regular. Irregular heart rhythm = arrhythmia or dysarrhythmia Cardiac out put= HR/min multiplied by stroke volume( the amount of blood ejected with one contraction). C.O.P.=HRXSV Pulse Physiology Regulated by the autonomic nervous system through cardiac sinoatrial node (SA node) Parasympathetic stimulation — decreases the heart rate Sympathetic stimulation — increases the heart rate Pulse rate = number of contractions over a peripheral artery in 1 minute Factor affecting pulse Age: as age increases, the pulse rate decreases. Autonomic nervous system ( parasympathetic decrease HR, sympathetic increase HR) Medication Exercise Fever Stress Hypovolemia Postural changes. Pulse Sites Temporal Apical Carotid Brachial Radial Popliteal Femoral Posterior tibial Dorsalis Pedis (Pedal) Assessing the Pulse Equipment: Stethoscope for apical pulse. Methods: palpation( fingers), auscultation The nurse should be aware of : - any medication that could affect HR. - if the patient has been physically active, wait for 10-15 min before taking the pulse. Respiration Is the process of bringing oxygen to body tissues and removing carbon dioxide through the lungs Resp. functions: to maintain arterial blood homeostasis by maintaining the PH of the blood.( lungs accomplish this by breathing) Breathing= inspiration + expiration. Inspiration= is an active process in which the diaphragm descends, the intercostal muscles contract, and the chest expands to allow air to move into the tracheobronchial tree. Expiration= is a passive process in which air flows out of the respiratory tree. Normal breathing is almost invisible, effortless, quiet, automatic, and regular. Cont. Respiration Resp. center in the medulla of the brain and the level of CO2 in the blood both control the rate and depth of breathing. The diaphragm and the intercostal muscles are the main muscles used for breathing. The chest normally expands symmetrically without rib flaring or retraction. Tidal volume( depth of breathing)= the amount of air moving in and out with each breath.= 500 ml in health adult. Tachypnea= is an abnormally fast respiratory rate (usually above 20-24/min in adult). Bradypnea= is an abnormally slow respiratory rate (usually less than 10-12/min in adult). Apnea= the absence of respiration. Dyspnea= respirations that require excessive effort. Can be painful and labored Factors affecting respiration Age 12-20= adult, 20-25= children, up to 40/min = infant Medication Stress Exercise Altitude Gender Body temp. Rate and Depth of Breathing Changes in response to body demands. Controlled by respiratory centers in the medulla oblongata and pons of the brain Activated by impulses from chemoreceptors Increase in carbon dioxide is the most powerful respiratory stimulant Blood pressure( BP) Is the force that blood exerts against the walls of the vessels. The heart generates pressure during the cardiac cycle to perfuse the organs of the body with blood. Blood flow from the heart to the arteries, into the capillaries, and veins, and then back to the heart. Blood pressure in the arterial system varies with the cardiac cycle, reaching the highest level at the peak of systole and the lowest level at the end of diastole. The difference between the systolic and diastolic pressure is the pulse pressure, which is normally 30-50mmHg 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 Physiologic factors determining BP The contraction of the heart result in a pulsating flow of blood into the arteries The pressure is the highest when the ventricles of the heart contract and eject blood into the aorta and pulmonary arteries. BP during ventricular contraction= cardiac systole/systolic BP BP during ventricular relaxation= cardiac diastole/diastolic BP BP is a function of the flow of blood produced by the contraction of the heart & the resistance to blood flow in the vessels Blood flow= blood flow is essentially equal to cardiac out put (COP) COP is the produce of stroke volume ((SV) = the amount of blood each ventricle pumps with each heart beat )& heart rate . COP= SV X HR Cont. factors determining BP Resistance= friction among the cells & other blood components & between the blood & the vessels wall caused resistance to blood flow. The friction within the blood components reflects the blood’s viscosity & is largely due to the number & shape of the blood cells. Hormones Enzymes Method of measuring BP Factors Affecting Blood Pressure Age, gender, race Circadian rhythm Food intake Exercise Weight Emotional state Body position Drugs/medications 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 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 — 110/70 - 130/85