Prepared byPrepared by

Dr. Hoda Abed El-Azim Dr. Hoda Abed El-Azim

What are vital signs?What are vital signs?

Are four objective assessment data Are four objective assessment data that indicate how well or poorly the that indicate how well or poorly the body is functioning.body is functioning.

Body temperature Body temperature Pulse rate Pulse rate Respiration rate (rate of breathing) Respiration rate (rate of breathing) Blood pressureBlood pressure

Definition:Definition: Refers to warmth of the human bodyRefers to warmth of the human body

It is the degree of heat maintained by the It is the degree of heat maintained by the body body

It is balance between heat produced in the It is balance between heat produced in the tissues and heat lost to the environment tissues and heat lost to the environment

Kinds of body temperatureKinds of body temperature Shell (surface) temperatureShell (surface) temperature (warmth at the skin surface ) it rises and falls (warmth at the skin surface ) it rises and falls

in response to the environmentin response to the environment

Core (internal) temperatureCore (internal) temperature (warmth in deeper sites within the body like (warmth in deeper sites within the body like the brain and heart) it remains relatively the brain and heart) it remains relatively constantconstant

Shell tempShell temp. is usually lower than core temp. . is usually lower than core temp. Core tempCore temp. is much more significant than . is much more significant than

shell temp. shell temp.

Temperature ScalesTemperature Scales

The most commonly used scales include the: The most commonly used scales include the: Fahrenheit, (FFahrenheit, (F ̊ ̊ ))

Centigrade, (CCentigrade, (C ̊ ̊ ))The Fahrenheit (·FThe Fahrenheit (·F ̊ ̊ ) and Centigrade (·C) and Centigrade (·C ̊ ̊ ) scales ) scales are based on the freezing point and boiling point are based on the freezing point and boiling point of water.of water.

The freezing pointThe freezing point of a substance is the temperature at which it of a substance is the temperature at which it changes its physical state from a liquid to a solid. changes its physical state from a liquid to a solid.

The boiling pointThe boiling point is the temperature at which a substance changes is the temperature at which a substance changes from a liquid state to a gaseous state.from a liquid state to a gaseous state.

Fahrenheit scale :Fahrenheit scale :

Scale that uses Scale that uses 3232 ̊ ̊ F F as the as the temperature at which water freezes and temperature at which water freezes and 212212 ̊ ̊ F F as the point at which it boils. as the point at which it boils.

Centigrade scale:Centigrade scale:

Scale that uses Scale that uses 0 0 ̊ ̊ CC as the temperature as the temperature at which water freezes and at which water freezes and 100100 ̊ ̊ CC as as the point at which it boils.the point at which it boils.

To ConvertTo Convert : :

A Fahrenheit reading to its equivalent A Fahrenheit reading to its equivalent Centigrade reading, the following Centigrade reading, the following

equation is used.equation is used.

C = 5/9 (·F - 32C = 5/9 (·F - 32 ̊ ̊ ))

Centigrade to Fahrenheit, the following Centigrade to Fahrenheit, the following equation is used.equation is used.

F = 9/5 (·C) + 32F = 9/5 (·C) + 32 ̊ ̊

Normal body temperature Normal body temperature

In normal health adults, core body In normal health adults, core body temp. temp.

Ranges from Ranges from

97.5 to 100. 4 97.5 to 100. 4 ̊ ̊ F F

36.4 to 37.3 36.4 to 37.3 ̊ ̊ C C

Heat ProductionHeat Production Factors that affect the body’s heat production Factors that affect the body’s heat production

are:are:

1. Basal metabolic rate “RMR”:1. Basal metabolic rate “RMR”:

BMR is the rate of energy utilization in the BMR is the rate of energy utilization in the body required to maintain essential body required to maintain essential activities such as breathing. activities such as breathing.

Metabolic rate decrease with age.Metabolic rate decrease with age.

2. Muscular activity (2. Muscular activity (shivering) shivering)

Factors that affect the body’s heat production Factors that affect the body’s heat production are:are:

cont. cont.

3. Epinephrine, Norepinephrine, and 3. Epinephrine, Norepinephrine, and sympathetic stimulationsympathetic stimulation

These hormones immediately increase the These hormones immediately increase the rate of cellular metabolism. rate of cellular metabolism.

4. Thyroxin output:4. Thyroxin output:

Increased thyroxin output increases the Increased thyroxin output increases the rate of cellular metabolism throughout the rate of cellular metabolism throughout the body.body.

Temperature RegulationTemperature Regulation

A.A. Nervous system controlNervous system control (physiological control)(physiological control)

Temperature is regulated by the Temperature is regulated by the thermoregulatory center of the thermoregulatory center of the hypothalamus in the central hypothalamus in the central nervous system , located of the nervous system , located of the brain brain

Heat lossHeat loss

The anterior part of hypothalamus The anterior part of hypothalamus promotes heat loss throughpromotes heat loss through

Vasodilatation Vasodilatation SweatingSweating

It stimulates the sweat glands to increase It stimulates the sweat glands to increase their rate of secretion and vasodilatation their rate of secretion and vasodilatation of the skin surface blood vessels (of the skin surface blood vessels (the heat the heat is lost by radiation from large quantity of is lost by radiation from large quantity of blood circulating near the surface in the blood circulating near the surface in the dilated skin vessels) dilated skin vessels)

Four mechanism heat loss takes Four mechanism heat loss takes placeplace

Radiation:Radiation: the heat transferred the heat transferred

from one object to another without from one object to another without

direct contact between the twodirect contact between the two

ConvectionConvection : heat is lost through: heat is lost through

convection when air currents pass convection when air currents pass

over a warm object, carrying its over a warm object, carrying its

heat away with them heat away with them

ConductionConduction : : the heat transferred the heat transferred

from one object to another by direct from one object to another by direct

contact between the two objects contact between the two objects

Evaporation :Evaporation : process whereby process whereby

a substance in liquid state is a substance in liquid state is

change to a vapor state change to a vapor state

Heat GainingHeat GainingIn a cold environment, the posterior part of In a cold environment, the posterior part of hypothalamus promotes heat production hypothalamus promotes heat production throughthrough

Heat conservation by:Heat conservation by:causes constriction of skin surface blood vessels causes constriction of skin surface blood vessels which decreases the volume of blood circulating which decreases the volume of blood circulating near the surface and so decreases the heat loss by near the surface and so decreases the heat loss by radiationradiation

Heat productionHeat productionIncrease metabolism Increase metabolism Increase secretion of thyroid hormones as Increase secretion of thyroid hormones as

well as epinephrine and non epinephrine well as epinephrine and non epinephrine Increase muscular activity Increase muscular activity ShiveringShivering

As long as heat production and heat loss are As long as heat production and heat loss are

properly balancedproperly balanced

==

Heat production

Heat loss

B. Behavioral ControlB. Behavioral Control

1. Behavioral actions that increase 1. Behavioral actions that increase body temperature:body temperature:

Exposure to hot extremes.Exposure to hot extremes.Adding more cloths. Adding more cloths. Move to a warm place. Move to a warm place. Increase the muscular activity. Increase the muscular activity. Take a warm shower. Take a warm shower. Decrease the surface area exposed to air Decrease the surface area exposed to air

currents sit with arms and legs are tightly currents sit with arms and legs are tightly wrapped together.wrapped together.

2. Behavioral actions that decrease 2. Behavioral actions that decrease body temperaturebody temperature

Exposure to cool extremes. Exposure to cool extremes.

Decrease the clothing. Decrease the clothing.

Moving to a cool place. Moving to a cool place.

Decrease muscular activity. Decrease muscular activity.

Take a cool shower. Take a cool shower.

Increase the surface area exposed Increase the surface area exposed

to air currentsto air currents

Factors affecting body temperatureFactors affecting body temperature

AgeAgeGender Gender Women generally have greater Women generally have greater

variations in body temperature than variations in body temperature than men due to hormonal changes during men due to hormonal changes during ovulation and menstruationovulation and menstruation..

Physical or emotional stress, such as Physical or emotional stress, such as anxiety, may rise body temperature. anxiety, may rise body temperature.

Exercise and activity Exercise and activity Hormonal influences Hormonal influences

Factors affecting body temperature Factors affecting body temperature cont.cont.

EnvironmentEnvironment

Ingestion or drinking of hot/cold Ingestion or drinking of hot/cold

liquidsliquids

Smoking cigarettes may increase Smoking cigarettes may increase

body temperature measurements. body temperature measurements.

Illness or injury Illness or injury

MedicationsMedications

Electronic vital signs monitor.

Equivalent mercury thermometer Equivalent mercury thermometer measurements according to sitemeasurements according to site

AssessmenAssessmentt

FahrenheiFahrenheit t

CentigradCentigrade e

OralOral 98.698.6 3737

Rectal Rectal equivalent equivalent 99.699.6 37.537.5

Axillary Axillary equivalent equivalent 97.6 97.6 36.536.5

Types of thermometersTypes of thermometers

Electronic thermometerElectronic thermometer

Mercury glass thermometerMercury glass thermometer

Tympanic membrane thermometerTympanic membrane thermometer

Chemical thermometerChemical thermometer

Definition :Definition : Waves of blood forced through Waves of blood forced through

arteries by contraction of the left arteries by contraction of the left ventricle. ventricle.

Waves of blood created by Waves of blood created by alternating expansion and recoil of alternating expansion and recoil of arteries during each cardiac cyclearteries during each cardiac cycle

What is the pulse rate?What is the pulse rate?

The pulse rate is a measurement of the The pulse rate is a measurement of the heart rate, or the number of times the heart rate, or the number of times the heart beats per minute.heart beats per minute.

Taking a pulse not only Taking a pulse not only

measures the heart rate, measures the heart rate,

but also can indicate:but also can indicate:Strength of the pulseStrength of the pulse (Volume) (Volume)

Pulse rhythmPulse rhythm

PULSEPULSE Assessment Assessment

Pulse ratePulse rate : Describes how often the heart beats. : Describes how often the heart beats.

. .

Abnormality ofAbnormality of pulse ratepulse rate

Tachycardia(pulse rate more

than 100 beat Per / M)

Bradycardia(pulse rate less

than 60 beat Per / M)

N0N0 DefinitioDefinition n

Description Description

00 Absent pulseAbsent pulse No pulsation is felt despite extreme No pulsation is felt despite extreme pressure pressure

+1+1 Thready Thready Pulsation is not easily felt, slight pressure Pulsation is not easily felt, slight pressure causes it to disappearcauses it to disappear

+2+2 Weak pulseWeak pulse Pulse is stronger than thready, light Pulse is stronger than thready, light pressure causes it to disappearpressure causes it to disappear

+3+3 Normal pulseNormal pulse Pulsation is easily felt, moderate Pulsation is easily felt, moderate pressure causes it to disappearpressure causes it to disappear

+4+4 Bounding Bounding pulse pulse

Pulsation is strong and does not Pulsation is strong and does not disappear with moderate pressure disappear with moderate pressure

•Pulse volumePulse volume:: Describes the force with which the heart Describes the force with which the heart beats.beats.

Pulse rhythmPulse rhythm is the spacing of the is the spacing of the heartbeats heartbeats

Type of Rhythm

Regular Intermittent or

irregular

NOTE: A pulse may be regular in rhythm but irregular in force

Common arterial pulse sitesCommon arterial pulse sites

Radial. Radial. Temporal. Temporal. Carotid. Carotid. ApicalApical Brachial. Brachial. Femoral. Femoral. Popliteal. Popliteal. Pedal Pedal

(dorsalis (dorsalis pedis) pedis)

Apical heart rateApical heart rate

Number of ventricular Number of ventricular

contraction per minute contraction per minute A more accurate estimate A more accurate estimate

of the heart beat of the heart beat Its obtained by listening Its obtained by listening

with a stethoscope over the apex of with a stethoscope over the apex of the heartthe heart

Apical radial rateApical radial rate Number of sounds Number of sounds heard at the heart’s apex and the heard at the heart’s apex and the rate of the radial pulse during the rate of the radial pulse during the same period same period

Pulse DeficitPulse Deficit the difference between the difference between redial and apical pulse redial and apical pulse

NOTE:NOTE: An apical pulse will never be An apical pulse will never be lower than the radial pulse. lower than the radial pulse.

Normal pulse rate per minute at Normal pulse rate per minute at various agevarious age

Age Age Range Range Average Average

New born New born 120-160120-160 140140

1-12 months 1-12 months 80-14080-140 120120

1-2 years1-2 years 80-13080-130 110110

3-6 years 3-6 years 75-12075-120 100100

7-12 years7-12 years 75-11075-110 9595

Adolescence Adolescence 60-10060-100 8080

Adulthood Adulthood 60-10060-100 8080

Factors, which affect the pulse Factors, which affect the pulse

raterate Age.Age. A normal pulse for infants range from 90 to A normal pulse for infants range from 90 to

170 and the rate gradually decreases up to age 14 170 and the rate gradually decreases up to age 14 when it is equal to the normal adult pulse rate of when it is equal to the normal adult pulse rate of 60 to 100. 60 to 100.

Body Build and Size.Body Build and Size. A short, fat person may A short, fat person may have a higher rate than a tall, slender person.have a higher rate than a tall, slender person.

Blood PressureBlood Pressure. As the blood pressure decreases, . As the blood pressure decreases,

the pulse will frequently increase. the pulse will frequently increase.

Medications.Medications. Stimulants will increase the pulse Stimulants will increase the pulse rate; depressants will decrease the pulse rate. rate; depressants will decrease the pulse rate.

Exercise and Muscular Activity.Exercise and Muscular Activity. An increase An increase in pulse rate will occur with increased activity to in pulse rate will occur with increased activity to meet increased oxygen and nutrient demands. meet increased oxygen and nutrient demands.

Food IntakeFood Intake. Digestion increases the pulse . Digestion increases the pulse slightly. slightly.

Elevated Body TemperatureElevated Body Temperature. The pulse . The pulse increases approximately 10 beats per minute increases approximately 10 beats per minute for every 1 F for every 1 F (0.56 C) increase in body temperature. (0.56 C) increase in body temperature.

Emotional Status. Fear, anger, and anxietyEmotional Status. Fear, anger, and anxiety will all increase the pulse rate. will all increase the pulse rate.

PainPain. When the patient is in pain, the pulse rate . When the patient is in pain, the pulse rate will increasewill increase

Is the exchange of oxygen and carbon dioxide Is the exchange of oxygen and carbon dioxide between an organism and its environment between an organism and its environment i.e.i.e. intake of oxygen and output of carbon dioxide intake of oxygen and output of carbon dioxide

External RespirationExternal Respiration :this is the exchange of :this is the exchange of gases between the blood in the pulmonary gases between the blood in the pulmonary capillaries and the air in the lungs.capillaries and the air in the lungs.

Internal RespirationInternal Respiration :this is the exchange :this is the exchange between the blood and the tissue cells.between the blood and the tissue cells.

Respiratory cycle:Respiratory cycle:

Movement of air in and out of the Movement of air in and out of the chest chest

Involves inhalation or inspiration Involves inhalation or inspiration (breathing in)(breathing in)

andand

Exhalation or expiration (breathing out)Exhalation or expiration (breathing out)

Mechanism Respiratory Cycle:Mechanism Respiratory Cycle: Inspiration:Inspiration: The tips of the ribs are pulled upward and The tips of the ribs are pulled upward and

outwards by contracting of the intercostals outwards by contracting of the intercostals muscles.muscles.

The dome shaped diaphragm is flattened by The dome shaped diaphragm is flattened by contraction of its muscles, the chest cavity is contraction of its muscles, the chest cavity is enlarged ,the air pressure outside forces air into enlarged ,the air pressure outside forces air into the lungs through the glottis.the lungs through the glottis.

Expiration:Expiration: The tips of the ribs move backwards.The tips of the ribs move backwards. The muscles of the diaphragm relax and its The muscles of the diaphragm relax and its

bulges into the thorax, partly also the pressure of bulges into the thorax, partly also the pressure of the abdominal organs .The chest cavity is the abdominal organs .The chest cavity is reduced ,the pressure inside is increase (positive reduced ,the pressure inside is increase (positive pressure) and the air is driven out of the lungs.pressure) and the air is driven out of the lungs.

What is the respiration rate?What is the respiration rate?

The respiration rate is the number of The respiration rate is the number of breaths a person takes (at rest) per breaths a person takes (at rest) per minute, by counting how many times the minute, by counting how many times the chest rises. chest rises.

Normal respiration rates Normal respiration rates

for an adult person at rest for an adult person at rest

range from range from 15 15 toto 20 20 breaths breaths

per minuteper minute. .

Type of Breathing Patterns Type of Breathing Patterns TachypneaTachypnea : rapid respiratory rate : rapid respiratory rate

Bradypnea Bradypnea : slower respiratory rate : slower respiratory rate than normal at rest than normal at rest

DyspneaDyspnea : difficult breathing its : difficult breathing its always accompanied by a rapid always accompanied by a rapid respiratory rate respiratory rate

OrthopneaOrthopnea : breathing facilitated : breathing facilitated by sitting up or standing by sitting up or standing

Type of Breathing Patterns Type of Breathing Patterns cont. cont.

ApneaApnea : absence of breathing ( is life : absence of breathing ( is life threatening if it lasts more than 4 to 6 threatening if it lasts more than 4 to 6 minutes)minutes)

HyperpneaHyperpnea: increase respiration –both : increase respiration –both rate and depth may be increased.rate and depth may be increased.

CyanosisCyanosis: blueness or discoloration of the : blueness or discoloration of the skin and mucous membrane caused by skin and mucous membrane caused by lack of O2 in the blood lack of O2 in the blood

Stertorous breathingStertorous breathing: noise ventilation: noise ventilation

It is the force or the amount of pressure It is the force or the amount of pressure exerted by the blood against the wall of an exerted by the blood against the wall of an

arteryartery..””

Systole:Systole: It is the period of heart muscle contraction It is the period of heart muscle contraction..

Systolic PressureSystolic Pressure:: It is pressure within the arterial It is pressure within the arterial system when the heart contracts system when the heart contracts

Diastole:Diastole: It is the period of heart muscle relaxationIt is the period of heart muscle relaxation..

Diastolic Pressure:Diastolic Pressure: It is pressure within the arterial It is pressure within the arterial system when the heart relaxes and fills with bloodsystem when the heart relaxes and fills with blood

Normal range of Bp.Normal range of Bp.

SySystolestole 120120++ 20 20 ــــــــــــــــــــ ــــــــــــــــــــ ــــــــــــــــــــــ mmHgmmHg ــــــــــــــــــــــ

Diastole Diastole 8080++ 15 15

Pulse PressurePulse Pressure It is the difference between systolic and diastolic It is the difference between systolic and diastolic pressurepressure

e.g.e.g. 126 126 // 88 mmHg 88 mmHg

Pulse pressure = 126-88 = 38 Pulse pressure = 126-88 = 38

Normal average 30 to 50Normal average 30 to 50

Physiological factors create Physiological factors create blood pressureblood pressure

Blood volumeBlood volume Averages amount Averages amount

(4.5 to 5.5 L in adult women and 5.0 to 6.0 L in adult men)(4.5 to 5.5 L in adult women and 5.0 to 6.0 L in adult men)

Blood volume Blood volume decrease Bp decrease Bp

Blood viscosityBlood viscosity (thickness) (thickness) Circulating viscous blood also tires the heart Circulating viscous blood also tires the heart

and weakens its ability to contractand weakens its ability to contract

Blood viscosity Bp Blood viscosity Bp

Cardiac outputCardiac output : (volume of blood : (volume of blood ejected from the left ventricle per minute)ejected from the left ventricle per minute)

Stroke volume Stroke volume SVSV ( (amount of blood that amount of blood that

leave the heart with each contractionleave the heart with each contraction))

Cardiac output = HR Cardiac output = HR XX SV SV

Increase exercise Cardiac output Increase exercise Cardiac output

Cardiac outputCardiac output BP BP

Peripheral vascular resistancePeripheral vascular resistance (PVR)(PVR)

(force against which the heart pumps (force against which the heart pumps when ejecting blood)when ejecting blood)

It increases when the valves of the It increases when the valves of the heart and arterioles are narrowed heart and arterioles are narrowed and decreases when arteries dilateand decreases when arteries dilate

PVRPVR BpBp

Elasticity of blood vessels Elasticity of blood vessels

In health people the arterial walls are In health people the arterial walls are elastic and easily stretch and recoil elastic and easily stretch and recoil to accommodate the changing to accommodate the changing volume of circulating blood. volume of circulating blood.

Decrease elasticity increase in BpDecrease elasticity increase in Bp

e.g.e.g. old age, arteriosclerosisold age, arteriosclerosis

Relaxation of arteries decrease BpRelaxation of arteries decrease Bp

e.g.e.g. shockshock

Other factors affecting blood Other factors affecting blood pressurepressure

AgeAge GenderGender

Women tend to have lower Bp than men of Women tend to have lower Bp than men of the same age the same age

Exercise and activityExercise and activity Bp rise during exercise and activityBp rise during exercise and activityRegular exercise helps to maintain BpRegular exercise helps to maintain Bp

Emotions and painEmotions and pain Strong emotion and pain increase BpStrong emotion and pain increase Bp

Posture Posture Bp increases in standing or sitting than Bp increases in standing or sitting than when lying down when lying down

Abnormalities of blood pressureAbnormalities of blood pressure HypertensionHypertension It is the persistent blood pressure measurements It is the persistent blood pressure measurements

above the normalabove the normal MِMِabnormal elevation of blood pressureabnormal elevation of blood pressure

120 + 20 120 + 20 mmHgmmHgــــــــــــــــــــــــــــــــــــــــــــــــــــ 80 + 15 80 + 15

Hypotension :Hypotension : It is a condition in which blood pressure measurements It is a condition in which blood pressure measurements

below the normalbelow the normal abnormal decrease in blood pressureabnormal decrease in blood pressure

2020ــ ــ 120 120 mmHgmmHgــــــــــــــــــــــــــــــــــــــــــــــــــــ 1515ـــ ـــ 80 80 ..

Postural hypotensionPostural hypotension Sudden but temporary drop in Bp associated with Sudden but temporary drop in Bp associated with dizziness and fainting when rising to an erect dizziness and fainting when rising to an erect position.position.

Common in :Common in : Circulatory problem Circulatory problem Dehydrated patientDehydrated patientTake diuretics Take diuretics