THE VITAL SIGNS:TEMPERATURE, PULSE,

RESPIRATIONS AND BLOOD PRESSURE

Abbreviated: TPR BP or

simply VS

THE VITAL SIGNS

Take a moment and close your eyes and concentrate on your breathing, the heat of your body and the flow of blood through your blood vessels as your heart beats.

These are the crucial, automatic processes that occur continuously to maintain your life.

They are indeed vital to life—and thus called the Vital Signs

SIGNS VS. SYMPTOMS

Symptoms can only be described / validated by the patient. – Pain, nervousness, dizziness, fatigue

Signs are able to be measured / observed by others besides the patient– Vital signs, wound drainage, color of sputum,

blood cell counts

TEMPERATURE

The measurement of core body heat

ROUTES TO MEASURE TEMPERATURE

Axillary: Under the arm in the armpit Orally: By mouth

Rectally: By rectum

Tympanic: In the ear Temporal: through the skin of the temple

TYPES OF THERMOMETERS

Digital Electronic: To be used for oral, rectal, and axillary

Thermoscan - Digital: To be used for tympanic /temporal

Mercury or glass: To be used for oral, rectal, and axillary. Rarely used anymore due to health risks r/t mercury and risk of sharps injury if broken

NORMS Orally: 97.6 - 99.6 degrees Fahrenheit Rectally: 98.6 - 100.6 degrees Fahrenheit

Tympanic - manufacturers say to measure as for rectal

Axillary: 96.6 - 98.6 degrees Fahrenheit Temporally: Manufacturers say to measure

as axillary.

HOW SHOULD THERMOMETER BE USED? Tympanic: Special device with plastic

covers, placed snugly in ear canal. Electronic: Oral, rectal & axillary routes.

Probes that are red in color for rectal temperatures; blue in color for oral and axillary, always retain hold of thermometer.

Mercury: same as electronic. Red ends are rectal; blue ends oral and axillary, always retain hold of thermometer.

DURATION FOR TAKING TEMPERATURES

Tympanic: As long as it takes to push a button

Temporal: Until the thermometer beeps Electronic: Until the thermometer beeps Mercury Oral: Three minutes Mercury Rectal: Three minutes Mercury Axillary: Ten minutes

BE CAREFUL ON RECTAL AND AXILLARY TEMPS

Always hold the thermometer in place while measuring temperatures by these routes

Always use lubricant with rectal temperatures

Always remove clothing around axilla and maintain arm pressed to side of torso

READING THE THERMOMETER

Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree

Long lines indicate degrees Short lines indicate 0.2 of a degree Four short lines between each long line

(0.2, 0.4, 0.6, 0.8) All other types give a digital display to the

tenth of a degree.

PULSE

The felt wave of blood created by the heart pumping, that travels

along the arteries.

WHERE TO FIND PULSES

Locations called “pulse points”

Felt at areas where the artery is between finger tips and a bony prominence or section

Felt with 2-3 fingers, but never the thumb

PULSE POINTS AND THEIR LOCATIONS

Temporal

Carotid

Apical

Brachial

Radial

Femoral

Popliteal

Post Tibial

Dorsal Pedalis

HOW TO MEASURE?

Measured in beats per minute

Count the felt waves for 60 seconds

Or, count the felt waves for 30 seconds – then multiply by 2

NORMS Pulse norms are 60 - 100 beats per minute

Pulses between 90 - 100 are in a gray area - high normal

Faster than 100 - tachycardia Slower than 60 – bradycardia

Caveat: well trained athletes may have “normal” pulse rates of 45-60, depending on level of fitness

QUALITY OF PULSE

Rhythm: regular or irregular

Rate: Bradycardic, Within the normal limits, Tachycardic

Strength: Thready, Weak, Strong, Bounding

WHAT AFFECTS PULSE RATES AND QUALITY

Body Temperature

Emotions

Activity Level

Health of the Heart / vascular volume

RESPIRATIONThe exchange of gases at the

alveolar-cellular level that results from the mechanical act of

breathing in air (inspiration) and expelling air (expiration) from the

body

RESPIRATION Measured in breaths per minute Normal range is 12 - 24 breaths per minute Count for 1 full minute or for 30 sec. x 2 Greater than 24 is tachypnea Less than 12 is bradypnea Watch for rate, depth, listen for quality of

breath (adventitious vs. vessicular sounds), and difficulty in breathing (SOB/labored)

METHOD OF MEASURING TPR

If using a mercury thermometer, measure the pulse and respiration while waiting for the temperature

If using another method of measuring the temperature, complete the temperature - then measure the pulse and respiration

Keep your fingers on the pulse while measuring the respiration

BLOOD PRESSURE

The measurement of the force of blood against artery walls.

Measured using device called sphygmomanometer and a stethescope.

Measured as a fraction in mm/Hg Upper number (numerator) called the

Systolic blood pressure. Lower number (denominator) called the

Diastolic blood pressure.

MEASURING BLOOD PRESSURE

The last sound heard (diastolic blood pressure) – is the measure of the pressure in an artery when the heart (ventricles) relaxes between contractions.

Normal Ranges SBP: 90-130, DBP: 60-80 Hypertensive: 140/90 and above Hypotensive: 80/50 and below Grey areas: between norms and hyper/hypo

CAUSES & S/S HYPOTENSION

Causes may include:– Medications– Illness– Injury – dehydration

Signs & symptoms may include:– Dizziness / light-headedness – Lethargy / fatigue / generalized weakness– might faint

CAUSES & S/S HYPERTENSION

Hypertension is called the silent killer because there are often no symptoms.

Causes may include: – family history / high salt diet / overweight– emotional upset /physical pain– illness / medications / fluid overload

Some people might experience:– Headache / Pressure in the head / Tinnitis– General feeling of malaise

CAUSES OF HTN-(CON’T)

Genetics: More prevalent in African Americans than other ethnicities

Age: More prevalent in middle-aged and elderly people than younger people

Body size: More prevalent in obese people than thinner people

Lifestyle: More prevalent in heavy drinkers than moderate to non-drinkers

Co-morbidities: People with diabetes, gout or kidney dx

.

CHARTING Chart in order: temperature - pulse – respiration –

blood pressure. Do not write T =, etc. Number for temp with no route designation=oral Write (Ax) after axillary temperatures Write (R) after rectal temperatures Write (Tymp.) for tympanic Write (Temporal) for temporal

ABBREVIATIONS SOB - Short of breath TPR - Temperature,

pulse, and respiration WNL-Within normal

limits VSS-Vital signs stable P.O. - By mouth BID -Twice a day TID -Three times a day

QID - Four times a day

QS - Every shift QD - Every day PRN - As needed Ad Lib - At liberty (as

desired) B/P - Blood Pressure VS - Vital Signs HTN-hypertension

TERMS Eupnea - Normal

breathing Orthopnea - Sitting

upright to breath more easily

Apnea - No breathing Hyperpnea - Fast, deep

breathing Hypopnea- slow shallow

breathing Tachypnea – Fast

breathing

Bradypnea - Slow breathing

Dyspnea - Painful or difficult breathing

Tachycardia - Pulse rate in excess of 100 bpm

Bradycardia - pulse rate less than 60 bpm

TERMS

Bounding pulse - excessively strong pulse

Weak pulse – softer pulsation than normally felt

Hypertensive – blood pressure 140/90 & above

Hypotensive-blood pressure 80/50 & less

Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is “a piece of thread” running or fluttering under the fingertips.