Prepared
by:
Vincent Raphael V. Manarang
PhRN, UKRN, MAN
Definition
Also called cardinal signs, are measures of
various physiological statistics, often taken
by health professionals, in order to assess the
most basic body functions.
4 Primary Vital Signs
Body Temperature
Pulse rate (or heart rate)
Blood pressure
Respiratory rate
Body Temperature
It is the balance between the heat
produced by the body and the heat lost
from the body.
2 Types:
1. Core Temperature - deep tissues
2. Surface Temperature – skin,
subcutaneous tissue and fat
Alterations
in Body
Temperature
Ways to Measure Body
Temperature
Oral
Rectal
Axillary
Tympanic
Temporal Artery
Oral
Route
Rectal Route
1. Apply disposable gloves. Lubricate (2 inches)
2. Instruct the client to take a slow deep breath during
insertion.
3. Never force the thermometer if resistance is felt.
4. Insert in a rotating motion.
1 ½ inches for adults, 1 inch for child and ½ inch for
infant.
Axillary
Pat the axilla dry if very moist. The bulb is placed in
the center of the axilla
Tympanic
1. Pull the pinna slightly upward and backward.
2. Point the probe slightly anteriorly, toward the eardrum.
3. Insert the probe slowly using a circular motion until
snug.
Temporal Artery
Normal Reading and waiting time:
Rectal – 37 – 38.1 C (1-2 mins)
Oral – 36.5 – 37.5 C (3-5 mins)
Axilla – 35.8 – 37 C (5-10 mins)
Tympanic Membrane – 37 C (2-5 secs)
Pulse
It is a wave of blood created by
contraction of the left ventricle of the
heart.
It is expressed in bpm.
2 Types:
- Central
- Peripheral
When assessing the pulse, there is a need
to take note of the following:
Rate (tachycardia/bradycardia)
Rhythm – patterns of beat and interval
between beats (dysrhythmia/arrhythmia)
Pulse Assessment Sites
Temporal – superior and lateral to the eye.
Carotid – side of the neck below the lobe of ear.
Apical – left of sternum at the 5th intercostal
space
Brachial – inner aspect of biceps of arm or
medially in the antecubital space.
Radial – thumb side of the inner aspect of the
wrist.
Femoral – inguinal ligament.
Popliteal – behind the knee
Posterior Tibial – medial surface of
ankle
Dorsalis Pedis – dorsum of the foot on
an imaginary line from the middle of
ankle to the space between big toe and
second toe.
Respiration
It is the act of breathing; it includes the intake
of oxygen and output of carbon dioxide.
Inhalation/ Inspiration
Exhalation/ Expiration
Ventilation
2 Types of Breathing
Costal Breathing
Diaphragmatic Breathing
Breathing Patterns
Eupnea
Tachypnea
Bradypnea
Apnea
Dyspnea
Orthopnea
Cheyne-Stokes breathing/ respiration
Blood Pressure
This is the measure* of the force blood
exerts against the blood vessel walls.
Systolic pressure – maximum (VC)
Diastolic pressure – minimum (VR)
Mercury (Hg) manometer/
sphygmomanometer
Korotkoff sounds
Pulse Pressure
Measuring Blood
Pressure (Non-invasive
Indirect Methods)
1. Auscultatory
2. Palpatory
Fifth Sign
The phrase "fifth vital sign" usually refers
to pain, as perceived by the patient on a pain
scale of 0–10. However, some doctors have
noted that pain is actually a
subjective symptom, not an objective sign, and
therefore object to this classification.
Types of Pain
Based on Etiology
1. Nociceptive Pain (experienced when an intact, properly
functioning nervous system sends signals that tissues are damaged,
requiring attention and proper care)
a. Somatic
b. Visceral
2. Neuropathic Pain - associated with damaged or
malfunctioning nerves due to illness
a. Peripheral Neuropathic
b. Central Neuropathic
Pain Scales
11-point rating scale
Oxygen Saturation
The percent of all hemoglobin binding
sites that are occupied by oxygen.
95-100%
Pulse oximeter
- finger, toe, nose, or earlobe (or around
the hand or foot of a neonate).
Normal Vital Sign Readings:
AGE PULSE RESPIRATION
Newborn 130 (80-180) 35 (30-80)
1 year 120 (80-140) 30 (20-40)
5-8 years 100 (75-120) 20 (15-25)
10 years 70 (50-90) 19 (15-25)
Teen 75 (50-90) 18 (15-20)
Adult 80 (60-100) 16 (12-20)
Older Adult 70 (60-100) 16 (15-20)
Classification of Blood Pressure:
CATEGORY SYSTOLIC DIASTOLIC
Normal <120 <80
Prehypertension 120-139 80-89
Hypertension 140-159 90-99
Stage 1
Hypertension >160 >100
Stage 2
