Chapter 3:

VITAL SIGNS
ASSESSMENT

Daven Kayte S. Cocson, PTRP

Lakshmi Joanna C. Doco, PTRP
 LEARNING OUTCOMES
At the end of the session, the student will be able to:

1. Demonstrate ability to correctly monitor and document

vital signs.
2. Define vital signs including pulse, blood pressure and
respiratory rate.
3. Identify the signs and symptoms of abnormal vital signs and
its precautions to be taken when measuring vital signs.
4. Measure vital signs including pulse, blood pressure and
respiratory rate utilizing proper technique and considering
precautions.
 TOPIC OUTLINE
1. Assessment and recording of vital signs
a. Body temperature
b. Pulse
c. Blood pressure
d. Respiration

2. Importance of checking vital signs

3. Different signs and symptoms of abnormal vital signs

 Vital signs

● A.K.A CARDINAL SIGNS

● Indicators of the body’s physiological status
and response to physical activity,
environmental conditions, and emotional
stressors (Schmitz et al ,6ed.)
● Measurement of a person’s body
temperature, heart and respiration rates, and
blood pressure (Fairchild & Pierson)
 Vital signs

Guide to Physical Therapist Practice:

Includes examination of vital signs (HR, RR, and

BP) in the cardiovascular/pulmonary systems
review
 Vital signs

Vital sign measures assist the physical therapist in

making clinical judgment to:

1. Assign a diagnostic label and classify patient

2. Determine the prognosis and plan of care
3. Evaluate patient progress
4. Evaluate effectiveness of selected interventions
5. Determine if a referral to another practitioner is
warranted

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 Vital signs
A baseline measurement of the VS at rest, particularly to
the ff:

● Elderly patients
● Very young patients
● Debilitated patients
● Limited aerobic activities for several weeks or months
● Previous or current history of cardiovascular problems
● Recovering from recent trauma, those with a condition
or disease that affects the cardiopulmonary system or
those recovering from recent major surgery
 Vital signs
General factors that frequently cause an increase or
decrease in a person’s vital signs:

● Level or amount of physical activity

● Environmental temperature
● Age
● Emotional status
● Physiologic status
Measuring Body
Temperature
 Body Temperature

● Represents a balance between the heat produced or

acquired by the body and the amount lost

Fahrenheit Celcius
Oral 96.8° F to 99.3° F 36° C to 37.3° C
core (98.6° F ) (37° C)
Rectal 97.8° F to 100.3° F 36.6° C to 38.1°C
 Factors influencing Body
Temperature
● Time of Day (CIRCADIAN RHYTHM)
● Age
● Emotions/Stress
● Exercise
● Menstrual cycle
● Pregnancy
● External Environment
● Measurement site
● Ingestion of warm or cold foods
Body Temperature Assessment

● Established a baseline

- 2 or 3 serial measurement should be taken infants

younger than 3 months
- Toddlers younger than 3 years when absence or
presence of fever is a critical finding
- When operator unfamiliar with the device used.

● Sites : oral cavity, rectum, axilla, ear canal, forehead or

temporal lobe, and the inguinal fold.
Ear Thermometer
● Measures body temperature on
the basis of heat generated by the
ear canal and its surrounding tissue
● For infant, toddlers and older persons where oral
thermometer is difficult to use.
● Ear should not be used for measurement until has
been exposed to the air 2 to 3 minutes when lying on
his ear
● Same ear should be used for all measurement
Oral Thermometer
Points to consider when monitoring
body temperature
● Normal body temp before treatment can be
monitored during or at the end of treatment
-

● Lower than Normal before treatment, monitor to

certain treatment is tolerated

● Body temperature becomes lower than normal

during treatment, demonstrate abnormal response
to exercises
 Abnormalities in Body
Temperature

Increased Body Temperature

● Generally believed to assist the body in fighting

disease or infection
● Hyperpyrexia / Hyperthermia (106°F/ 41.1°C)
● Influenced by the release of PYROGENS
 Stages of fever

1. Prodromal phase
● Period just prior to fever elevation
● Slight headache, muscles aches, general malaise, or
loss of appetite

2. Invasion or onset
● Period from either gradual or sudden rise until the
maximum temperature is reached
● Chills, shivering, and pale appearance of skin
 Stages of fever

3. Stationary phase (fastigium/stadium)

● Point of highest elevation of the fever
● Fever is sustained
● Skin may be warm and appear flushed

4. Defervescence (termination, resolution)

● Period during which the fever subsides and
temperatures move toward normal
 Types of Fever

1. Intermittent
● Temperature alternates at regular intervals between
periods of fever and periods of normal temperatures

2. Remittent
● Elevated body temperature that fluctuates more
than 3.6 °F (2°C) within a 24-hour period but remain
above normal
 Types of Fever

3. Relapsing
● Periods of fever are interspersed with normal
temperatures that last at least once a day; also called
recurrent fever

4. Constant
● Body temperature is constantly elevated with
fluctuations less than 3.6°F ( 2°C)
 Lowered body temperature
Hypothermia

• Depression of the thermoregulatory center

• Thermoregulatory center seriously impaired

94°F ( 34.4 °C)

• Thermoregulatory center completely lost

Below 85 °F ( 29.4°C)
 Types of Thermometers

1. Glass Mercury
Thermometers
2. Electronic
Thermometers
3. Disposable
Single-Use
Thermometers
4. Temperature-sen
sitive strips
Monitoring Pulse
 Pulse
● Wave of blood in the artery created by contraction of
the left ventricle during a cardiac cycle

● Peripheral pulse
- Located in the periphery of the body that can be felt
by palpating an artery over a bony prominence or
other firm surface

● Apical pulse
- Central pulse located at the apex of the heart that is
typically monitored using a stethoscope
 Normal Value

Resting pulse rate

• Adult: 60-100 beats/min

• Newborns: 100 to 130 beats/min
• Children aged 1 to 7 years: 80 to 120 beats/min
 Factors Affecting Pulse
● Age - Older than 65 y/o ; Adolescents & younger
● Gender
● Environmental temperature
● Infection
● Physical Activity
● Emotional Status
● Medications
● Cardiopulmonary disease
● Physical conditioning
Pulse sites

Posterior tibial
Rate/Pulse frequency

● Number of pulsations (peripheral pulse waves) per

minute

● Bradycardia - slow pulse rate; ＜ 60 beats per minute

● Tachycardia - high pulse rate: ＞100 beats per minute

● Palpitation - Sensation of a rapid or irregular pulse rate

perceived by the patient without actually palpating a
peripheral pulse
Rhythm

● Pattern of pulsations and the intervals between

● Arrhythmia/dysrhythmia - Irregular rhythm in which

pulses are not evenly spaced

● Irregular - both strong and weak beats occurs during

the period of measurement

● Thready - indicates a weak force to each beat and

irregular beats.
Quality (amplitude or volume)

● Amount of force created by the ejected blood against

the arterial wall during each ventricular contraction

● Strong and regular - even beats with a good force to

each beat.

● Weak and regular - even beats with a poor force to

each beat.
 Measuring apical-radial pulse
Involves two examiners simultaneously measuring to
pulse locations separately

● Apical pulse at the apex of the heart

● Radial pulse at the wrist

Pulse DEFICIT
• Difference between the rate of radial and apical
pulses
• Provides important information about the
cardiovascular system’s ability to perfuse the
body

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Pulse oximetry

Provides a measure of arterial

blood oxygenation

• Arterial plasma
• Transports only about 3% of oxygen in the blood
• Measured by partial pressure of oxygen

• Arterial hemoglobin
• Transports 97%
• Measured as SaO2( arterial hemoglobin oxygen
saturation)
 RHR vs MHR vs THR

● Resting Heart Rate - heart rate of an individual during

rest

● Maximal Heart Rate - highest heart rate a person

should achieve upon exertion with respect to age and
medical condition

● Target Heart Rate - heart rate that an individual should

achieve during exercise for cardiovascular conditioning
with respect to age and medical condition
Blood Pressure
 Monitoring Arterial Blood
Pressure
Blood pressure

● Refers to the force the blood exerts against a vessel

wall
● Measured in millimeters of mercury (mmHg)
● The pressure is highest in the arteries, lower in the
capillaries, and lowest in veins
• Systolic pressure: time of contraction
• Diastolic pressure: at rest
• Pulse pressure - difference between the systolic
and diastolic pressures
 Blood pressure regulation

Vasomotor center

● Located bilaterally in the lower pons and upper

medulla

● Transmits impulses through sympathetic nerves to all

vessels of the body
 Factors Affecting Blood
Pressure
● Age
● Physical Activity
● Emotional Status
● Medications
● Size and condition of arteries
● Arm position
● Muscle contraction
● Blood volume
● Dehydration
● Cardiac output
● Site of measurement
Assessment of Blood Pressure
● Brachial artery: most common site

● Femoral artery: used occasionally especially with

known suspected lower extremity PVD
 Materials
•Stethoscope
•Sphygmomanometer
•Chair
•alcohol wipes
•Recording materials
 Mean arterial Pressure:
● average pressure that occurs during a single cardiac
cycle (contraction/relaxation)

Formula:
MAP = [SBP + (DBP × 2)] / 3
MAP = 1/3 (SBP - DBP) + DBP

● MAP of 60 mm Hg or higher is necessary to perfuse

the body’s major organs and vessels to maintain
them
 Abnormal Responses Exhibited by Blood Pressure
Systolic pressure rapidly
increases during active exercise.
• Systolic pressure does not
increase during active exercise.
• Systolic pressure continues to
increase or decreases as the
intensity of the exercise or
activity plateaus.
• Systolic pressure rapidly
declines as the intensity of the
exercise or activity declines and
terminates.
• Systolic pressure does not
decline as the intensity of the
exercise or activity declines.
• Systolic pressure declines
significantly below its resting
level at the termination of the
exercise or activity.
• Systolic pressure declines
during exercise before the
intensity of the exercise declines.
• The systolic pressure rate or
the amount of systolic pressure
increase is excessive during the
exercise or activity period.
• Diastolic pressure increases
more than 10 to 15 mm Hg
during the exercise or activity
period.
Monitoring respiration
 Respiration

● 1 respiration= 1 inhalation + 1 exhalation

External respiration
• Exchange of oxygen and carbon dioxide between the
alveoli of the lungs and blood

Internal respiration
• Exchange of oxygen and carbon dioxide between the
circulating blood and tissues
A person may be classified as either an upper chest
(thoracic) or abdominal breather:

1. Upper chest breather: thorax elevates and expands

during inspiration, abdomen remains relatively
motionless

2. Abdominal breather: expansion of abdominal during

inspiration and thorax remains motionless
 Parameters of respiration

1. Rate

● Number of cycle per minute

● 12-20 cpm (normal adult RR)

● Should be counted for 30 seconds and multiplied by

2, if any irregularities are noted, a full 60-second
count is indicated
 Parameters of respiration
2. Depth
• Refers to the amount (volume) of air exchanged with
each breath
• 500 ml - normal adult tidal volume
• Described as deep or shallow

3. Rhythm
• Regularity of inspiration and expirations
• Described as regular or irregular
 Breath Sounds
• Tracheal breath sounds - best heard in the neck region
- high pitched, harsh, hollow, and loud.
• Bronchial breath sounds - best heard over the
manubrium of the sternum.
- loud tubular, less-harsh sounds
• Bronchovesicular sounds - come from the mainstem
bronchi best heard between the scapulae
- high pitched and soft
• Vesicular breath sounds - heard over the periphery of
both lung fields
- are soft and low pitched
Sound
•Deviations from normal, quiet, effortless breathing
•Common abnormal (adventitious sound)

1. Wheezing - Continuous whistling sound produced by air

passing through a narrowed airway such as bronchi or
bronchiole
2. Stridor - Harsh, high-pitched crowing sound
3. Crackles (Rales) - Rattling or bubbling sound
4. Sigh - Deep inspiration followed by a prolonged, audible
expiration
5. Ronchi - Snoring or gurgling sound sound owing large
obstruction by secretions
6. Pleural rubs - sounds like brushing or creaking. Seen in
patients with pneumothorax or pleural effusion
 Patterns of Respiration
Normal 12-20 in adults and up to 50 per min in infants
Tachypnea Rapid shallow breathing
Hyperpnea/ Rapid deep breathing
Hyperventilation KUSSMAUL BREATHING- deep breathing associated with
metabolic acidosis
Bradypnea Slow breathing
Cheyne-stokes Respiration waxes and wanes cyclically so that periods of deep
breathing breathing alternate with periods of apnea
Biot’s breathing Ataxic breathing
Unpredictable irregularity
Breaths may be shallow or deep
Sighing Breathing punctuated by frequent sighs (HYPERVENTILATION
respiration SYNDROME)
Obstructive Expiration is prolonged because of increased airway resistance
Breathing Patient lacks sufficient time for full expiration
•Apnea: absence of
breathing
•Orthopnea: difficulty of
breathing in recumbent •Watch or Clock: used to
position measure the RR
 Pulmonary Auscultation
Considerations:
● The environment should be quiet
● The patient should be sitting up or standing and not be leaning
on anything (e.g., a wall nor bed rails)
● The patient should be asked to breathe in through his/her nose
and breathe out through his or her mouth; you should warm
the stethoscope with your hand
● Auscultation should only be performed over bare skin
● Care should be taken not to touch the stethoscope tube
against bed rails or the patient’s clothing
● Always auscultate one side and then the other, moving in a
systematic direction.
Path of systematic auscultation
 Pain Assessment
Pain

• unpleasant sensory and emotional experience

associated with actual or potential tissue damage or
described in terms of such damage
Pain Assessment Tools
Thank you for listening!
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