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Vital signs
D.ALTAF ALKAMISH

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 Obtaining Vital Signs and Clinical Impression
 Frequency of Vital Signs Measurement
 Height and Weight
 General Clinical Presentation
 Temperature
 Pulse
 Respiratory Rate and Pattern
 Blood Pressure

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Vital signs are used for the following purposes:
 Help determine the relative status of vital organs, including
the heart, blood vessels, and lungs, which may be helpful in making many
clinical decisions such as when to admit the patient to the hospital.
 Establish a baseline (a record of initial measurements against which future
recordings are compared)
 Monitor response to therapy, such as surgery and medication
administration, as well as selected diagnostic tests.
 Observe for trends in the health status of the patient
 Determine the need for further evaluation, diagnostic testing, or intervention

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What is the vital signs?
Are excellent bedside clinical indicators of the
patient's physiologic and psychologic health. In
many patient care settings, the oxygen saturation
as measured by pulse oximetry (SpO2) is
considered to be the “fifth vital sign.”

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What is the vital signs?
 Vital signs
 Temperature
 Pulse
 Respirations
 Blood pressure
 Spo2
Vital signs and body measurements are used to evaluate health problems.
Accuracy is essential.

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Vital Signs: Temperature
 Febrile – body temperature above
 patient’s normal range
 Fever – sign of inflammation or infection
 Hyperpyrexia – extremely high temperature
 Afebrile – normal body temperature
 Body temperature varies with time of day

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Temperature
Axillary
Tympanic
rectal
Oral

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 Measurements
 Degrees Fahrenheit (°F)
 Degrees Celsius
 (centigrade; °C)
 Normal adult oral temperature
 98.6°F
 37°C

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Measured using either electronic or disposable
 Electronic digital
 Accurate, fast, easy to read
 Comfortable for the patient
 Tympanic
 Temporal
 Disposable
 Single use
 Less accurate

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 Tympanic temperatures
 Proper technique essential
 Adult – pull ear up and back
 Child – pull ear down and back
 Fast, easy to use, and preferred in pediatric offices

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 Rectal temperatures
 Standard precaution – gloves
 Patient is positioned on side (left side preferred)
 Lubricate tip of thermometer
 Slowly and gently insert tip into anus
 ½ inch for infants
 1 inch for adults
 Hold thermometer in place while temperature is taken

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 Temporal temperatures
 Temporal scanner
 Noninvasive, quick
 Stroke scanner across
forehead, crossing over the
temporal artery

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 Axillary temperatures
 Place patient in seated or lying position
 Place tip of thermometer in middle of axilla with
shaft facing forward
 Probe must touch skin on all sides

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Vital Signs: Pulse and Respiration

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Pulse (heart rate )
 Pulse – number of times the heart beats in
1 minute
 Respiration – number of times a patient breaths in 1
minute
 One breath = one inhalation and one exhalation
 Ratio of pulse to respirations is 4:1

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 Indirect measurement of cardiac output
 Problems if
 Tachycardia
 Bradycardia
 Weak
 Irregular
Sites of measurement
Adults – radial artery
Children – brachial artery
(antecubital space)
Apex of heart
5th intercostal space directly
below center of left clavical
Apical pulse taken with a
stethoscope

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 Locate pulse by pressing lightly with index and middle
finger pads at the pulse site
 Count the number of beats felt in 1 minute
 If regular – may count beats for 30 seconds and
multiply by 2

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 Electronic devices
 Blood pressure machines
 Pulse oximetry
 Infrared light measures pulse and oxygen levels
 Report oxygen level below 92% not improved by deep breathing

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 Respiratory rate – indication of how well the body provides oxygen to the
tissues
 Check by watching, listening, or feeling movement

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 Check respirations
 Look, listen, and feel for movement of air
 Count with a stethoscope
 Count for one full minute
 Rate
 Rhythm – regular
 Effort (quality) –
 normal, shallow, or deep
NOTE: If patients are aware that you are counting
respirations, they may unintentionally alter their breathing.

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 Irregularities – indication of possible disease
 Eupnea - normal breathing
 Hyperventilation – excessive rate and depth
 Dyspnea – difficult or painful breathing
 Tachypnea – rapid breathing
 Hyperpnea – abnormally rapid or deep breathing

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 Other irregularities
 Rales (noisy)
 Constriction or blockage of bronchial passages
 Pneumonia, bronchitis, asthma, or other pulmonary disease
 Cheyne-Stokes respirations
 Periods of increasing and decreasing depth of respiration between periods of
apnea
 Strokes, head injuries, brain tumors, congestive heart failure
 Apnea – absence of breathing

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Blood Pressure
 The force at which blood is pumped against the walls of the
arteries (mmHg)
 Two pressure measurements
 Systolic pressure – measure of pressure when left ventricle
contracts
 Diastolic pressure
 Measure of pressure when heart relaxes
 Minimum pressure exerted against the artery walls at all times

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Equipment
 Sphygmomanometer
 Inflatable cuff
 Pressure bulb or other device for inflating cuff
 Manometer
 Types of sphygmomanometers
 Aneroid
 Electronic
 Mercury

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 Aneroid sphygmomanometers
 Circular gauge for registering pressure
 Each line 2 mmHg
 Very accurate
 Must be checked,
serviced, and
calibrated every
3 to 6 months

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 Electronic sphygmomanometers
 Provides a digital readout of the
blood pressure
 No stethoscope is needed
 Easy to use
 Maintain equipment according to
manufacturer’s instructions

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 Mercury sphygmomanometers
 A column of mercury rises with an increased pressure as
the cuff is inflated
 Limited using this type during the last years
 If in use, must be checked,
serviced, and calibrated every
6 to 12 months

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 Measuring blood pressure
 Place cuff on the upper arm above the brachial pulse site
 Inflate cuff about 30 mmHg above palpatory result or
approximately 180 mmHg to 200 mmHg
 Release the air in cuff and listen for the first heartbeat (systolic
pressure) and the last heartbeat (diastolic pressure)
 Record results with systolic as the top number and diastolic as
the bottom number (i.e., 120/76)

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 Special considerations in adults
 Post exercise, ambulatory disabilities, obese, known
blood pressure problems
 Anxiety or stress
 Avoid measurement in an arm
 Injury or blocked artery is present
 History of mastectomy on that side
 Implanted device is under the skin
 Proper cuff size – improper size results in inaccurate
reading

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 Special considerations in children
 Not routinely taken on each visit
 Take before other tests or procedures
 Cuff size important
 Palpatory method not used with
children
 Heartbeat may be heard to zero; record diastolic when
strong heartbeat becomes muffled

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 Orthostatic or postural hypotension
 Blood pressure becomes low and pulse increases
when the patient moves from lying to standing
 Indicates fluid loss or malfunction of
cardiovascular system
 Vital signs are taken in different positions
 Positive tilt test – increase in pulse > 10 bpm and
a drop in BP > 20 mmHg

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