Ministry of higher education and scientific research

Erbil polytechnic university

Erbil health technical college
physiotherapy department
2nd stage-4th semester
Subject: fundamental of nursing
study year 2020-2021

What Home
is work
What is vital sign and what are
vital type of it?
sign
and Subject Lecturer:

what Ghariba Hasan Ali

Prepared By:
Shakar Mudrik Omer

are
type
of it?
Contents:
 Introduction to Vital Signs
 Purpose of doing vital sign

 The four main vital signs

1. Body Temperature
2. Pulse Rate
3. Respiratory Rate
4. Blood Pressure

References

Vital Signs:
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Vital signs are an objective measurement for the essential physiological functions of a
living organism. They have the name "vital" as their measurement and assessment is the
critical first step for any clinic evaluation. The first set of clinical examinations is an
evaluation of the vital signs of the patient.

Vital signs are measures of various physiological status, in order to assess the most basic body
functions. When these values are not zero, they indicate that a person is alive. All of these vital signs
can be observed, measured, and monitored. This will enable the assessment of the level at which an
individual functioning. Normal ranges of measurements of vital signs change with age and medical
condition. Vital signs are useful in detecting or monitoring medical problems. Vital signs can be
measured in a medical setting, at home, at the site of a medical emergency, or elsewhere.

Vital signs (also known as vitals) are a group of the four to six most important medical signs that
indicate the status of the body’s vital (life-sustaining) functions. These measurements are taken to help
assess the general physical health of a person, give clues to possible diseases, and show progress
toward recovery. The normal ranges for a person’s vital signs vary with age, weight, gender, and
overall health.

Purpose:

The purpose of recording vital signs is to establish a baseline on admission to a hospital, clinic,
professional office, or other encounter with a health care provider. Vital signs may be recorded by a
nurse, physician, physician's assistant, or other health care professional. The health care professional
has the responsibility of interpreting data and identifying any abnormalities from a person's normal
state, and of establishing if current treatment or medications are having the desired effect.
Abnormalities of the heart are diagnosed by analyzing the heartbeat (or pulse) and blood pressure. The
rate, rhythm and regularity of the beat are assessed, as well as the strength and tension of the beat,
against the arterial wall.

Vital signs are usually recorded from once hourly to four times hourly, as required by a person's
condition. The vital signs are recorded and compared with normal ranges for a person's age and
medical condition. Based on these results, a decision is made regarding further actions to be taken. All
persons should be made comfortable and reassured that recording vital signs is normal part of health
checks, and that it is necessary to ensure that the state of their health is being monitored correctly. Any
abnormalities in vital signs should be reported to the health care professional in charge of care.
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The four main vital signs routinely monitored by medical professionals and health
care providers include the following:

 Body temperature

 Pulse rate

 Respiration rate (rate of breathing)

 Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with
the vital signs.)

Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a
medical setting, at home, at the site of a medical emergency, or elsewhere.

1. Body Temperature:

The normal body temperature for a

healthy adult is approximately 98.6
degrees Fahrenheit/37.0 degrees
centigrade. The human body temperature
typically ranges from 36.5 to 37.5
degrees centigrade (97.7 to 99.5 degrees
Fahrenheit).

Health care providers use the axillary,

rectal, oral, and tympanic membrane
most commonly used to record body
temperature, and the electronic and
infrared thermometers are the devices
most commonly used.

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Sites for measurement of body temperature

1. Oral temperature: It is the most commonly used method, is considered very convenient and
reliable. Here we place the thermometer under the tongue and close the lips around it. The
posterior sublingual pocket is the area that gives the highest reliability.

2. Tympanic temperature: In this method, the thermometer is inserted into the ear canal. This site
is convenient but less accurate and hence not recommended.

3. Axillary temperature: In this, we place the thermometer in the axilla while adducting the arm of
the patient. This site is convenient but generally considered less accurate and hence not
recommended.

4. Rectal temperature: The thermometer is inserted through the anus into the rectum after applying
a lubricant. This method is very inconvenient, but since it measures the internal measurement, it
is very reliable. It is usually considered the "gold standard" method of recording temperature.

5. Skin temperature: Digital thermometer can be used to measure the quick temperature from the
skin of the forehead. It has been widely used now in this COVID-19 pandemic to avoid cross-
contamination as the thermometer is kept 3-5cm away from the patient's forehead.

Body temperature is affected by many sources of internal and external variables. Besides the site of
measurement, the time of day is an essential factor leading to variability in the temperature record,
secondary to the circadian rhythm. Other factors influencing body temperature are gender, recent
activity,  a person's relative physical fitness, food, and fluid consumption, and, in women, the stage of
the menstrual cycle. 

2. Pulse Rate

Pulse rate is defined as the wave of blood in the artery created

by contraction of the left ventricle during a cardiac cycle. The
most common sites of measuring the peripheral pulses are the
radial pulse, ulnar pulse, brachial pulse in the upper extremity,
and the posterior tibialis or the dorsalis pedis pulse as well as
the femoral pulse in the lower extremity. Clinicians also measure the carotid pulse in the neck. In day
to day practice, the radial pulse is the most frequently used site for checking the peripheral pulse, where
the pulse is palpated on the radial aspect of the forearm, just proximal to the wrist joint. 
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Parameters for assessment of pulse:

Rate: The normal range used in an adult is between 60 to 100 beats /minute with rates above 100
beats/minute and rates and below 60 beats per minute, referred to as tachycardia and bradycardia,
respectively. Changes in the rate of the pulse, along with changes in respiration is called sinus
arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and slows down
during expiration.

Rhythm: Assessing whether the rhythm of the pulse is regular or irregular is essential. The pulse
could be regular, irregular, or irregularly irregular. Irregularly irregular pattern is more commonly
indicative of processes like atrial flutter or atrial fibrillation.

Volume: Assessing the volume of the pulse is equally essential. A low volume pulse could be
indicative of inadequate tissue perfusion; this can be a crucial indicator of indirect prediction of the
systolic blood pressure of the patient.

Symmetry: Checking for symmetry of the pulses is important as asymmetrical pulses could be seen
in conditions like aortic dissection, aortic coarctation, Takayasu arteritis, and subclavian steal
syndrome.

Amplitude and rate of increase: Low amplitude and low rate of increase could be seen in
conditions like aortic stenosis, besides weak perfusion states. High amplitude and rapid rise can be
indicative of conditions like aortic regurgitation, mitral regurgitation, and hypertrophic
cardiomyopathy.

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 3. Respiratory Rate:

The respiratory rate/the number of breaths per minute is defined as the one breath to each movement of
air in and out of the lungs. The normal breathing rate is about 12 to 20 beats per minute in an average
adult. In the pediatric age group, it is defined by the particular age group.

Parameters that need to be included are its rate, depth of breathing, and its pattern
rate of breathing.

Rates: Rates higher or lower than expected are termed as tachypnea and bradypnea, respectively.
Tachypnea described as a respiratory rate more than 20 beats per minute could occur in physiological
conditions like exercise, emotional changes, pregnancy, and pathological conditions like pain,
pneumonia, pulmonary embolism, asthma, etc. Bradypnea which is ventilation less than 12
breaths/minute can occur due to worsening of any underlying respiratory condition leading to
respiratory failure or due to usage of central nervous system depressants like alcohol, narcotics,
benzodiazepines, or metabolic derangements. Apnea is the complete cessation of airflow to the lungs
for a total of 15 seconds which may appear in cardiopulmonary arrests, airway obstructions, the
overdose of narcotics and benzodiazepines.

Depth of breathing: Hyperpnea is described as an increase in the depth of breathing.

Hyperventilation, on the other hand, is described as both an increase in the rate and depth of breathing
and hypoventilation describes the decreased rate and depth of ventilation. Depth of breathing involves
what muscle groups they are using—for example, the sternocleidomastoid (accessory muscles) and
abdominal muscles—the movement of the chest wall in terms of symmetry. The inability to speak in
full sentences or increased effort to speak is an indicator of discomfort when breathing

The pattern of breathing: There are many conditions which are based on the variation in the pattern
of breathing. Biot’s respiration is a condition where there are periods of increased rate and depth of
breathing, followed by periods of no breathing or apnea. Cheyne-Stokes respiration is a peculiar pattern
of breathing where there is an increase in the depth of ventilation followed by periods of no breathing
or apnea. Kussmaul’s breathing refers to the increased depth of ventilation, although the rate remains
regular. Orthopnea refers to difficulty in respiration occurring on lying horizontal but gets better when
the patient sits up or stands. Paradoxical ventilation refers to the inward movement of the abdominal or
chest wall during inspiration, and outward movement during expiration, which is seen in cases of
diaphragmatic paralysis, muscle fatigue, trauma to the chest wall.
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 4. Blood Pressure.

Blood pressure is the force of circulating blood on the walls of the arteries, mainly in large arteries of
the systemic circulation. Blood pressure is taken using two measurements: systolic (measured when the
heartbeats, when blood pressure is at its highest) and diastolic (measured between heartbeats, when
blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed
by the diastolic blood pressure

The direct measurement of BP requires an intra-arterial

assessment but it is not practical in clinical practice so BP
is measured via non-invasive means. Earlier BP is
measure with a stethoscope while watching a
sphygmomanometer (i.e auscultation). However,
semiautomated and automated devices that use the
oscillometry method, which detects the amplitude of the
BP oscillations on the arterial wall, have become widely
used over the past 2 decades.

References:

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[Link]
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