Unit V

Nursing Skills (Vital Signs)

Misbah Khan
Lecturer DIONAM,DUHS
Objectives
At the completion of this unit learners will be able to:

 Define Vital Signs.

 Define terms related to Vital sign.
 Describe the physiological concept of temperature, respiration and blood
pressure.
 Describe the principles and mechanisms for normal thermoregulation in the body
 Identify ways that affect heat production and heat loss in the body.
 Define types of body temperature according to its characteristics.
 Identify the sign and symptoms of fever.
 Discuss the normal ranges for temperature, pulse, respiration and blood pressure.
 List the factors affecting temperature, pulse, respiration.
 Describe the characteristics of pulse and respiration.
 List factors responsible for maintaining normal blood pressure.
 Describe various methods and sites used to measure T.P & B.P.
 Recognize the signs of alert while taking TPR and B.P.
 Vital Sign
• Vital signs are the “signs of life,” providing a way of connecting
the external inspection with the internal functioning of the client’s
organs.

• This is also known as cardinal signs

Vital Signs or Cardinal Signs
are:
• Body temperature
• Pulse
• Respiration
• Blood pressure
• Pain
Body Temperature
 Body Temperature
• Body temperature is the balance between heat produced in the
body and heat loss from the body.

• Body temperature is measured in heat units called degrees.

Mechanisms For Normal
Thermoregulation
 Mechanisms For Normal
Thermoregulation (Heat
Loss)
• Heat is lost from the body through:
– Conduction
– Convection
– Radiation
– Evaporation

Conduction: Conduction is the process of losing heat through

physical contact with another object or body. For example, if you
were to sit on a metal chair, the heat from your body would transfer
to the cold metal chair.
• Convection: the process of losing heat through the
movement of air or water molecules across the skin. The use
of a fan to cool off the body is one example of convection.

• Radiation: This involves the transfer of heat from one object

to another, with no physical contact involved. For example,
infrared rays, the sun transfers heat to the earth through
radiation.
• Evaporation: the process of losing heat through the
conversion of water to gas (evaporation of sweat).

The primary heat loss process for aqua enthusiasts is convection,

however, in an outdoor pool on hot day evaporation will also play
a primary role in heat loss.
 Types of Temperature
• Core Temperature
Temperature of the deep tissues of the body such as abdominal or
pelvic cavities. It is relatively constant

• Surface Temperature
Temperature of the skin and subcutaneous tissue. It fluctuates
depending on the blood supply to the skin and the amount of
heat loss to the external environment.
 Regulation of Body Temperature
• The system that regulates body temperature has three main parts:
 Sensors in the periphery and in the core
 An integrator in the hypothalamus
 An effector system that adjusts the production and loss of heat.

Most sensors or sensory receptors are in the skin. The skin has
more receptors for cold than warmth. Therefore, skin sensors detect
cold more efficiently than warmth. When the skin becomes chilled
over the entire body, three physiological processes to increase the
body temperature take place:
1. Shivering increases heat production.
2. Sweating is inhibited to decrease heat loss.
3. Vasoconstriction decreases heat loss.
 Behavioral
• When an individual perceives he is hot or cold, he
changes his behavior such as:
– Moves to the shade or sun

– regulates the thermostat

– removes extra clothes or puts on sweater.

• The normal range for adults is
considered to be between 36°C
and 37.5°C (96.8°F to
99.5°F).
• A body temperature above the usual range is called
pyrexia, hyperthermia, or fever.

• A very high fever, such as 41°C (105.8°F), is called

hyperpyrexia

• The client who has a fever is referred to as febrile

• the one who does not have fever is referred as afebrile

• Hypothermia is a core body temperature below the lower

limit of normal
 Types of Fever Pattern
• Intermittent Fever: Temperature returns to acceptable value at
least once in 24 hours. The temperature curve returns to normal
during the day and reaches its peak in the evening. E.g.-
malaria.

• Remittent Fever: fever spikes & falls without a return to the

normal temperature levels. The temperature fluctuates but does
not return to normal. E.g.- TB, viral diseases, bacterial infections

• Constant Fever: the temperature remains continuously

elevated above 38 degree Celsius & demonstrates little
fluctuation.

• Relapsing Fever: short febrile periods of a few days are

CLINICAL MANIFESTATIONS OF FEVER

1. ONSET (COLD OR CHILL 2. COURSE (PLATEAU PHASE)

PHASE) • Absence of chills
• Increased heart rate & respiratory rate • Skin that feels warm
• Shivering • Photosensitivity
• Complaints of feeling cold • Increased pulse and respiratory
• Cyanotic nail beds rates
• “Gooseflesh” appearance of the skin • Increased thirst
• Cessation of sweating • Drowsiness, restlessness, delirium,
or convulsions
• Loss of appetite
3. DEFERVESCENCE (FEVER • Malaise, weakness, and
ABATEMENT/FLUSH PHASE) aching muscles
• Skin that appears flushed
and feels
warm
• Sweating
• Decreased shivering
Sites for checking Temperature
• Oral
• Rectal
• Axillary
• Tympanic membrane
• Temporal artery.
Pulse
 Puls
• e
The pulse is a wave of blood
left ventricle of the heart.
created by contraction of the

• The pulse wave represents the stroke volume output or the

amount of blood that enters the arteries with each
ventricular contraction.

• Compliance of the arteries is their ability to contract and

expand. When a person’s arteries lose their dispensability, as
can happen with age, greater pressure is required to pump the
blood into the arteries
 Pulse
• The pulse is a wave of blood created by contraction of the
left
ventricle of the heart

• The rate of the pulse is expressed in beats per

minute
(beats/min)
 Pulse Sites
A pulse may be measured in nine
sites
 Pulse site
 Temporal – forehead
 Carotid – neck
 Apical -above the apex of heart
 Brachial – inner, upper arm
 Radial – wrist
 Femoral – groin
 Popliteal – behind knee
 Posterior tibialis – behind inner
ankle
 Dorsalis pedis – top of foot
 Characteristics of
pulse
• Rate
• Rhyth
m
• Volume
 Rate
Number of beats per minute

• Tachycardia : An excessively fast heart rate i.e., over

100
beats/min in an adult

• Bradycardia: A heart rate in an adult of less than 60

beats/min.
 Rhythm
Rhythm refers to the regularity of beats.
• the pattern of the beats and the intervals between the
beats.

 Regular rhythm - interval between heartbeats same.

 Irregular rhythm - interval between heartbeats different.

• If an irregularity is present, the pulse should be counted

for
one full minute.
 Volum
e
The force of blood with each beat
3+ Full, bounding
2+ Normal/strong
• Volume refers to the fullness of the artery.
1+ Weak, thready
• also called the pulse strength or
0 Absent/non-
amplitude
palpable

Volume depends upon the amount of blood in the arteries.

• If the arteries contain a large volume of blood---- full or
Bounding in volume.
• If the arteries contain a norm volume of blood ----
satisfactory/ Normal/Strong.
• If the volume of the blood is decreased (as by shock, or loss of
fluid from the body, e.g., diarrhea and vomiting) ---- small weak
pulse or thready.
 Factors that Influence Pulse Rate
• Age.
• Exercise.
• Fever.
• Medications.
• Hypovolemia /dehydration..
• Stress
• Position
• Pathology.
Normal range of Pulse and Respiration
Respiration
 Respiration
• Respiration is the act of breathing.

• The mechanical act of breathing in air (inspiration)

and expelling air (expiration) from the body
• Ventilation is also used to refer to the movement of air in
and out of the lungs.

 Inhalation or inspiration---- intake of air into the lungs.

Exhalation or expiration ---- breathing out or the movement of

gases from the lungs to the atmosphere.
 Types of Breathing
• There are basically two types of breathing:

1. Costal (thoracic) breathing: involves the external

intercostal muscles and other accessory muscles. It can be
observed by the movement of the chest upward and
outward.

2. Diaphragmatic (abdominal) breathing: involves the

contraction and relaxation of the diaphragm, and it is
observed by the movement of the abdomen.
 Physiology of Breathing
• During inhalation
– The diaphragm contracts (flattens), the ribs
move upward and outward, and the sternum
moves outward, thus enlarging the thorax and
permitting the lungs to expand.
 Physiology of Breathing
• During exhalation
– the diaphragm relaxes, the ribs move downward and
inward, and the sternum moves inward, thus decreasing
the size of the thorax as the lungs are compressed.

• Normal breathing is automatic and effortless

 Terms related to Respiration
• Tachypnea—quick, shallow breaths
• Bradypnea—abnormally slow breathing
• Apnea—cessation of breathing
• Hyperventilation— overexpansion of the lungs characterized by
rapid and deep breaths
• Hypoventilation— underexpansion of the lungs, shallow
respirations
• Cheyne-Stokes breathing —rhythmic waxing and waning of
respirations, from very deep to very shallow breathing and
temporary apnea
• Dyspnea—difficult and labored breathing
• Orthopnea—ability to breathe only in upright sitting or
standing
positions
Blood Pressure
 BLOOD PRESSURE
• Arterial blood pressure is a measure of the pressure exerted by
the
blood as it flows through the arteries.

• Blood pressure is a measure of the force that your heart uses to

pump blood around your body.
• Blood pressure is measured in millimeters of mercury
(mmHg) and recorded as a fraction: systolic pressure over the
diastolic pressure.
 Blood Pressure Measurement

• The blood moves in waves, there are two blood pressure

measurements.
 Systolic Pressure: is the pressure of the blood as a result of
contraction of the ventricles, that is, the pressure of the
height of the blood wave.
 Diastolic Pressure: is the pressure when the ventricles are
at rest between beats .

For example, if your blood pressure is "140 over 90" or

140/90mmHg, it means you have a systolic pressure of
140mmHg and a diastolic pressure of 90mmHg.
Pulse Pressure :
• The difference between the diastolic and the systolic
pressures
is called the pulse pressure.

• A normal pulse pressure is about 40 mmHg but can be as

high as 100 mmHg during exercise.

• A typical blood pressure for a healthy adult is 120/80 mmHg

(pulse pressure of 40).

• Because blood pressure can vary considerably among

individuals, it is important for the nurse to know a specific
client’s baseline blood pressure.
 Terms Related to Blood Pressure

• Hypertension
A blood pressure that is persistently above normal is called
hypertension
• Hypotension
Hypotension is a blood pressure that is below normal

• Orthostatic
Hypotension is a blood pressure that decreases when the client
sits or stands.
 Factors Affecting Blood Pressure
• Age
• Exercise
• Stress
• Race
• Gender
• Medications
• Obesity
• diurnal variations
• medical conditions
• temperature.
 Blood Pressure Assessment Sites
• The blood pressure is usually assessed in the client’s upper
arm using the brachial artery and a standard stethoscope.

• Assessing the blood pressure on a client’s thigh is

indicated in
these situations:
– The blood pressure cannot be measured on either arm
(e.g.,
because of burns or other trauma).
– The blood pressure in one thigh is to be compared with
the
blood pressure in the other thigh.
 Contraindication for Blood Pressure
Assessment Sites
• Blood pressure is not measured on a particular client’s limb in
the following situations:
– The shoulder, arm, or hand (or the hip, knee, or ankle)
is injured or diseased.
– A cast or bulky bandage is on any part of the limb.
– The client has had surgical removal of breast or axillary
(or
inguinal) lymph nodes on that side.
– The client has an intravenous infusion or blood
transfusion
in that limb.
– The client has an arteriovenous fistula (e.g., for renal
dialysis) in that limb.
 References
• Berman, A., Snyder, S., Kozier, B., & Erb, G. L. (2020). Kozier
and Erb's fundamentals of nursing, volumes 1-3 (10th ed.).

• White, L., Duncan, G., & Baumle, W. (2010). Foundations of

adult health nursing (3rd ed.). Cengage Learning