VITAL SIGNS

Vital signs are measurement of the body’s most basic functions. It is also known as cardinal
signs. These signs should be looked at in total to monitor the vital function of the body. Vital
sign can be measured in a medical setting, at home, at the site of a medical emergency.It
includes:-
 Temperature
 Pulse
 Respiration
 Blood pressure

Purposes
 To assess the health status of an individual.
 To plan and implement the care.
 To understand the effectiveness of treatment.
 To modify or change the mode of treatment.
 To understand the present problems.

Strategies for Careful Vital Signs Assessment

 Equipment should be functional and appropriate for all size and the age of the client.
 Know the client’s usual range of vital signs.
 Know the client’s medical history, therapies and prescribed medicine.
 Control or minimize environmental factors that may affect vital signs.
 Use an organized, systematic approach when measuring vital signs.
 The health worker often on the best position to assess all clinical findings about client.
 Recheck the vital signs on newly admitted person at least twice during the first 8 hrs of
admission.
 Verify and communicate significant changes in vital signs. Baseline measurement will
allow you to identify changes in vital signs.

Conditions of Measurement of Vital Signs

 On patient’s admission to a health care facility.
 In hospital on routine schedule according to doctor’s order or hospital policy.
 Before and after any surgical procedure.
  Before and after any invasive diagnostic procedure.
 Before and after the administration of medications that affects cardiovascular, respiration
and temperature control functions.
 When the client general physical condition changes.
 Before and after any interventions influencing a vital signs.
 During post operative period.
 When the client reports nonspecific symptoms of physical distress.
 During the patient’s visit to clinic or physician’s office.
 During a basic screening physical examination.

Temperature
Temperature is the measurement of heat expressed in degree.Body temperature may be defined
as the degree of heat maintained by the body. It means the degree of warmth or a balance
maintained between the heat produced and heat lost in the body. Normal body temperature can
range from 97.8° F to 99°F for a healthy adult.

Regulation of Body Temperature

The balance between heat loss and heat produced thermoregulation is precisely regulated by
physiological and behavioral mechanisms. The relationship between heat loss and production is
regulated by neurological and cardiovascular mechanisms. The anterior hypothalamus control
heat loss and posterior hypothalamus control heat production.

Heat production
 Metabolism: Basal metabolism accounts for the heat produced by the body at absolute.
The average basal metabolic rate depends on the body surface area.
 Muscles activity ( Exercise): Muscular activities during exercise require additional
energy. The metabolic rate increased up to 2000 times during activity and heat production
can increase up to 50 times then normal.
 Strong emotions: Due to nervousness, anxiety, excitement autonomic nervous system is
stimulated. It causes stimulation of different organs in the body and activity is increased
so, heat is produced in the body.
 Change in atmospheric temperature: Change in external condition e.g. high room
temperature.
 Disease condition: Bacterial invasion produce heat in body.
Heat Loss
 Through skin
 Conduction: It is the transfer of heat from one object to another through direct contact.
Heat conducts through contact with solids, liquids and gases. In the body, heat is
conducted from the warm internal tissues to the skin surface. It is then lost to the
environment.
 Convection: It is the transfer of heat from warmer to a cooler object by means of
circulating fluid or gas. For example, the body losses excess heat as surrounding air
currents carry the heat to the cooler environment.
 Radiation: It is the transfer of heat from the surface of one object to the surface of another
without direct contact between the two. E.g. heat loss through radiation by removing
blankets and excess clothes.
 Evaporation: It is the transfer of heat through the conversion of water to vapor or transfer
of heat when liquid is changed to a gas.
 Through the lungs: When the individual breaths out, warm air is exhaled out and heat is
loss.
 Through the kidneys: The kidney secrets urine which is warmed by the heat taken from
the body. When the urine is excreted the heat is also lost from the body.
 Through the bowel: The faeces absorb heat from body. So, during defeacation the heat is
also lost from the body.
 Sleep: Body temperature is low.
 Fasting: Leads to decreased heat production.
 Prolonged exposure to cold: Change in external condition which hastens the evaporation
process.

Factors Affecting Body Temperature

Many factors affect body temperature. Changes in body temperature within an acceptable range
occur when the relationship between heat production and heat loss is altered by physiological
and behavioral variables.
 Age
Body temperature is generally lower in older adults than in other age groups.
 Exercise
Body temperature increases with exercise. Muscles activity requires an increased blood supply
and increased carbohydrate and fat breakdown. This increased metabolism causes an increased
heat production.
  Environment
If body temperature is measured in a very warm room, the body temperature will be elevated.
Infants and older adults are most likely to affected by environmental temperature because their
temperature regulating mechanism is less effective.
 Hormone level
Women generally experience greater fluctuations in body temperature than men. Hormonal
variations during the menstrual cycle cause body temperature fluctuation. Body temperature
changes occurs in women during ovulation and also in menopause.
 Stress
Physical and emotional stress increases the body temperature through the hormonal and
neural stimulation. When stress stimulates the sympathetic nervous system, circulating levels of
epinephrine and non epinephrine increases.
 Circadian Rhythm (Time of day)
Body temperature normally fluctuates ( 0.5- 1°C) throughout the day . Temperature is usually
lowest around 3 am and highest from 5-7 pm.

Common Sites for Taking Temperature

 Orally
 Axillary
 Rectally

Variation of Normal Temperature at Different Sites

Conversion of Temperature
 C= (F-32) x 5/9
 F= (9/5 x C) + 32

Contraindications
Oral Method
 The patient who may bite the thermometer.
 Patients who are not able to hold thermometer in their mouth.
 Surgery infections in oral cavity.
 Patient who have severe cough.
 Patient who breath through mouth.
  Patient with continue convulsion.
 Patient with continue vomiting.
Axillary Method
 Any surgery/ lesion in axilla.
Rectal Method
 Patient after rectal surgery.
 Rectal injury/ infections.
 Patient having difficulty in assuming position.
 Patient having diarrhea/ dysentery.
 Any rectal pathology(piles/ tumor)
 Impact fecal matter.
 Reduced platelet count.

Pyrexia
When the body temperature is elevated above normal, the patient said to have pyrexia.

Causes
 Infections
 Systemic disease eg. Disease of nervous system, muscular system.
 Certain malignant neoplasm.
 Dehydration.
 Surgical operation /trauma/ Accidents.
 Skin diseases eg. Measles, chicken pox.

Physiological Changes
 Central nervous system: Headache, restlessness,s insomnia, may develop convulsion and
delirium.
 Circulatory system: Increase pulse, palpitation.
 Respiratory system: Shallow and rapid breathing.
 Digestive system: Dry mouth, coated tongue, loss of appetite, indigestion, nausea,
vomiting.
 Urinary system: Decrease in urinary output, burning micturition.
  Musculoskeletal system: Malaise, fatigue and body ache.

Types of Fever
 Constant or continuous fever
This type of fever remains at same level for a period of time with a variation of not more
than 1 to 2°F between morning and evening but the temperature does not come to normal e.g.
typhoid fever.
 Remittent fever
In remittent fever, the elevated temperature fluctuates widely between morning and evening
but does not reach normal level between fluctuations e.g. septicemia.
 Intermittent fever
High fever with a wide range between morning and evening temperature usually
accompanied by rigor and touches the normal or subnormal during the 24 hours as in malaria.
 Relapsing fever
Recurrent episode of fever lasting after a few days. Usually fever tends to be higher in the
evening then in the morning or febrile periods followed by one or more days of normal
temperature. E.g. syphilis.
 Inverse fever
In this type, the high temperature is recorded in the morning and lowest temperature is
recorded in the evening.
 Lysis
Temperature falls step by step; temperature comes to normal within 3-4 days or within
1week e.g. typhoid.
 Crisis
In this, the temperature falls suddenly from high fever to normal e.g. respiratory tract
infection.
 Irregular fever
Fever not corresponding to any of the above but manifesting the characteristics at some or
all of them at one time or another.

Grading of Fever
 Hypothermia: below 95° F.
 Hypo pyrexia/subnormal: When the body temperature below the average normal is
called subnormal temperature. (95°- 97° F).
  Low pyrexia: If the temperature range from 99° F to 101° F it is called as low pyrexia.
 Moderate pyrexia: The body temperature range between 101°F to 103° F is called as
moderate pyrexia.
 High pyrexia: The temperature remains between 103°- 105° F is called as high pyrexia.
 Hyper pyrexia/ hyperthermia: The temperature goes above 105° F.

Rigor
Rigor is the severe shivering attack of the body which is caused when the heat regulatory
mechanism of the body is disturbed.
Shivering occurs due to vigorous contraction of the body muscles to produce heat and usually
starts with a rise in temperature. Once the temperature reaches high the patient start sweating and
the temperature falls.

Causes
 Infections e.g. malaria, respiratory tract infection.
 Allergic reaction e.g. after IV infusion or blood transfusion, due to certain drugs.

Stage of Rigor
Cold Stage
Cold stage remains for 15- 20 minutes.
Sign and Symptoms
 Patient becomes restless
 Skin is cold and pale face
 Patient feels chills
 Extreme uncontrollable shivering
 Increase pulse
 Temperature rises rapidly to 103°F or above.
Hot Stage
This is the stage when the temperature reaches high. This stage last for few minutes to few hours.
Sign and symptoms
 Patient stops shivering and starts feeling hot.
 Patients feels thirsty.
  Patient may become restless.
 Temperature may continue to rise.
Sweating Stage
 The patient sweats profusely.
 As the sweat evaporates the patient’s temperature drops.
 Patient may go into a stage of shock and collapse, if not cared properly.

Care of patient with fever

 Reducing Temperature
 Assess the general condition of patient and take temperature.
 Keep the room well ventilated.
 Remove blankets and excess clothing but prevent from getting draughts.
 Give cold drinks.
 Apply cold compresses, cold sponging and cold packs.
 Provide cool air by electric fan.
 Record temperature after 15-20 minutes.
 Nutritional Management
 The diet should be early digestable and patable.
 Encourage plenty of fluid intake.(3000ml in 24 hour)
 A diet containing fruits and pulses.
 Care of sleep and rest
 Environment should be calm and quite.
 Help the patient to change the position regularly.
 Care of personal hygiene
 Provide sponge bath daily to keep patient clean.
 If profuse sweating is present frequent sponging is essential.
 Back care should be given sore to prevent pressure.
  Care of safety factors
 Never leave a patient with high fever alone.
 Put side rails up.

Pulse
Pulse is the wave of expansion and recoil occurring in an artery in response to the pumping
action of the heart. The pulse rate is a measurement of the heart rate or the number of times the
heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and
contract with the flow of the blood.

Characteristics of pulse
 Pulse rate: It is the number of pulse beats per minute.
 Tachycardia: greater than 100b/min.
 Bradycardia: less than 60b/min.
 Rhythm or regularity: pulse rhythm is the time interval between pulse beats. Normally
the time intervals between pulse beats are equal or regular. If not equal or regular, the
pulse is said to be irregular or arrhythmia. Pulse should be counted for one full minute to
detect any arrhythmias.
 Tension: It is degree of compressibility and it depends upon the resistance of wall of the
artery. When artery is difficult to compress, it is said to be high tension and easy to
compress, it is said to be low tension.
 Strength/volume: It is fullness of artery. It is force of blood felt at each beat. It can be
either full or weak. If the amount of the blood in artery is decreased , the pulse becomes
feeble or weak as in hemorrhage or dehydration.

Common sites for taking pulse

 Radial: Inner aspect of the wrist on thumb site.
 Temporal: Over the temporal bone or superior and lateral eyes.
 Carotid: At the side of the trachea where carotid artery runs between the trachea and
sternocleidomastoid muscles.
 Apical: Left side of the chest in the 4 th 5th or 6th intercostal space in the midclavicular
line.
 Brachial: Medially in the antecubital space, above the elbow.
 Femoral: Below inguinal ligament, midway between symphysis pubis and anterosuperior
iliac spine of illium.
 Popliteal: Medial or lateral to the popliteal fossa with knees slightly flexed.
 Tibial: On the medial surface of the ankle behind the medial malleolus.
 Dorsalis pedis: Along dorsum of foot between extensor tendons of great and first toe.
 Facial: At the outer angle of the lower jaw.
Factors affecting the pulse
 Age: very old person have slow pulse rate and children will have faster beat.
 Sex: Females have a slightly higher pulse rate than males.
 Exercise/activity: It is much faster during exercise.
 Stature: The short and thin persons have a more rapid pulse than tall and heavy.
 Emotions: Anger or excitement increases the pulserate temporally.
 Fever: When body temperature is elevated, the pulse rate usually increases as well. Pulse
increases at a rate of about 10 beats/min each degree rise of body temperature (10:1).
 Blood pressure: When the blood pressure decreases, pulse rate may increase to increase
the blood flow. If blood pressure increase, the pulse may decrease to correct the blood
flow.
 Drug: Stimulates drugs increase pulse rate , depressant drugs decrease pulse rate.
 Disease condition: Heart disease, thyroid disease and other infectious disease effect on
pulse.
 Acute pain & anxiety: increase pulse.
 Hemorrhage: Loss of blood increases pulse rate because of demand of oxygen.
 Position: slow while lying down and rapid while standing.

Scientific Principal for Taking Pulse

 Exercise, emotions and anxiety will cause increases pulse rate so take pulse when the
patient is in rest.
 Finger tips sensitive to touch will feel the pulsation.
 There is pulsation in the thumb, which may be mistaken for patient’s pulse so thumb is
not used to count pulse.
 Count the pulse for one full minute, especially if there is irregularity.
 Choose suitable site for taking pulse.
 Be aware if patient is on any medication that can interfere with heart rate.

Respiration
Respiration is the act of breathing in and out. It means the exchange of gases that take place
between the lungs and the blood. The respiration rate is the number of breaths a person takes per
minute. It is an automatic action of the body controlled by the respiratory centre of the brain i.e.
medulla oblangata. When the amount of carbondioxide in the blood increases to a certain level,
the respiratory center stimulates the diaphragm and intercostals muscles to contract. This allows
the lungs to expand and to breath in oxygenated air. This activity is called inspiration. In the
lungs, exchange of gases takes place; oxygen from air sac passes into blood and carbondioxide
from blood passes into air sacs. This carbondioxide is by breathing out, which is known as
expiration.

Types of Respiration
 External Respiration: The exchange of gases between the blood and air in the lungs is
called external or pulmonary respiration.
 Internal Respiration: The exchange of gases between the blood and cells is called as
internal or tissue respiration.

Characteristics of Normal Respiration

 Effortless
 Painless, quite and automatic.
 Rhythmical rising and falling of the chest wall.
 The normal respiration in resting adult is 16-18 breaths/min. The usual ratio of respiration
to pulse rate is 1:4. If pulse rate increases, the respiratory rate also increases.
 Expansion of chest wall on both sides is uniform.

Factors Affecting Respiration

 Sex: Females have slightly higher respiration than males.
 Age: A person’s respiration rate becomes slower as he/she get older.
 Exercise: Exertion of any type increases the metabolic rate and stimulates respiration.
 Emotion: Sudden stressful condition such as fear and anxiety influences the respiratory
rate.
 Changes in atmospheric pressure: In high altitudes the content of oxygen in the
atmosphere is very low. So rate of respiration is increased to fulfill the demand of
oxygen.
 Disease condition: Severity of disease condition may affect the respiration rate.
 Rest and sleep: During rest and sleep metabolism is decreased so respiration rate is
normal or decreased.
 Hemorrhage: A decreased volume of blood in the body causes an increase in the
respiration rate.
  Environment: Expose to cold stimulate the respiratory center reflect and causes the
person to breathe deeper.

Abnormal Respiration
Rate
 Tachypneoa: respiration is more than 24breaths/min. It is commonly found in
pneumonia, fever and haemorrhage.
 Bradycardia: respiration is less than 10breaths/min. It is commonly found in coma,
cerebral conditions.
 Apneoa: Absence of breathing for short period of time usually 5-30 seconds.
Variation in volume(Depth)
 Shallow Breathing: The respiration is not deep due to pain while taking inspiration. It is
found in shock and lungs diseases.
 Deep Breathing: Respiration are long, deep and slow as in air hunger.

Others
 Dyspnoea: This is forced, difficult and laboured breathing in which patient struggles for
breath.It may be accompanied by pain, respiratory diseases.
 Wheezing: This is a characteristic hoarse whistling sound that occurs due to partial
obstruction of smaller bronchi and bronchioles, that is produced during expirations. E.g.
asthma, emphysema.
 Stridor: Inspiration is forced or vibrating and accompanied with crowing sounds due to
obstruction in larynx, foreign body in the respiratory tract.
 Orthopneoa: Difficulty in breathing in supine. E.g. ascities, pregnant women, cardiac
disease.
 Hyperapneoa: This is the state when rate and depth of respiration both increases. E.g.
acidosis.
 Anoxia: It means lack of oxygen in tissue.

Blood Pressure
Blood pressure may be defined as forced exerted by blood against the wall of vessels in which it
is contained. The term blood pressure usually refers to the pressure of blood on the arterial wall.

Types
 Systolic blood pressure: It is the highest degree of force exerted by blood on the arterial
wall. The normal range of systolic pressure is 100- 140 mm of hg.
  Diastolic blood pressure: It is the lowest degree of forced exerted by blood on the
arterial wall. The normal range of diastolic pressure is 60- 90 mm of hg.
 Pulse pressure: The difference between the systolic and diastolic blood pressure is
called pulse pressure. It indicates the volume output of the left ventricle. The normal
range of pulse pressure is 20- 50 mm of hg.

Factors affecting blood pressure

 Pumping action of the heart: Pascal’s law operates in the pumping action of the heart.
This law states that any pressure applied to any part of enclosed fluid at rest is transmitted
to all parts of the body. A strong pumping action of the left ventricle results in high blood
pressure whereas, a weak pumping action results in low blood pressure.
 The volume of the circulating blood: The volume of the blood circulating in the
vascular system affects the blood pressure. When the volume is less, blood pressure is
lowered. E.g. when blood and fluid are lost from the body, blood pressure is lowered.
When blood and intravenous infusion are given, the blood volume is increased thereby
increased blood pressure.
 Viscosity of blood: The more viscous the blood, the higher is the blood pressure.
 The condition of the arterial wall: The less the elasticity of the arterial wall, the greater
is the resistance of the arterial wall. Increased resistance of arterial wall causes increased
blood pressure.
 Peripheral resistance: When the peripheral blood vessels is constricted, the peripheral
resistance increases thereby increasing blood pressure. When the peripheral blood vessels
dilates, peripheral resistance decreases thereby decreasing blood pressure.
 Age: As age increases, blood pressure also increases.
 Stress: Anxiety, fear, pain and emotional stress increases blood pressure.
 Medication: Narcotic and analgesic lower down blood pressure.
 Exercise: Exercise will increase blood pressure.
 Sex: In male, it is higher than in female.
 Position: Blood pressure is lower in lying down than sitting or standing.
 Diet: High sodium containing diet increases blood pressure, low calcium containing diet
increases blood pressure.
 Time: Blood pressure is usually low in early morning and high in early evening.
Abnormal Blood Pressure
 Hypertension: When the blood pressure is above the normal level, it is called
hypertension. i.e. BP > 140/90 mm of hg.
 Hypotension: When the blood pressure is below the normal level, it is called
hypotension. i.e. BP < 100/60 mm of hg.