VITAL SIGNS
Vital signs are a group of 4 to 6 most important medical signs that indicate the
status of the body’s vital functions. These measures are taken to help assess the
general physical health of a person, give clues to possible disease and show
progress towards recovery. The 4 main vital signs routinely monitored are
temperature, pulse rate (heart), respiration rate (rate of breathing) and blood
pressure (BP). Pain is often included as the fifth vital sign.
The American journal of critical care states that the combination of changes in
respiratory rate and heart rate have been deemed the most crucial predictions,
while all other vital signs are also important indicators of patient’s status. Vital
signs can be measured in a medical setting, at home, at site of a medical
emergency or elsewhere. A change in vital sign indicates a change in health.
KEY POINTS
- In the hospital, vital signs are checked 4hourly, daily.
- It is the nurses’ responsibility
- If a patient has abnormal or unusual physical signs or symptoms, or has
unexpected changes in vital signs, the nurse should double check.
BODY TEMPERATURE
Body temperature is the difference between the amount of heat produced by the
body and the amount of heat lost to the environment measured in degrees. It can
also be defined as the hotness or coldness of the body, measured with a
thermometer (a caliberated glass tube containing mercury). Normal body
temperature is 36-37.5 degree celsius or 97.5- 98.6 Fahrenheit.
Heat is generated by metabolic processes in the core tissues of the body,
transferred to the skin surface by the circulating blood, and dissipated to the
environment. Core body temperature is higher than surface body temperature.
PHYSIOLOGY OF BODY TEMPERATURE
Core body temperature of a healthy person is maintained within a fairly constant
range by the thermo-regulator set point of the hypothalamus. This centre
receives messages from cold and warm thermal receptors located throughout
the body, compares that information with its temperature set point and initiates
responses to either produce or conserve body temperature or to increase heat
loss. The primary source of heat in the body is metabolism. Thyroid hormone
produced by the thyroid gland also increases metabolism and heat production.
FACTORS AFFECTING BODY TEMPERATURE
1) Age: extremes of age are sensitive to changes in environmental
temperature. Also, older adults lose some thermoregulatory control with
aging.
2) Gender: women tend to experience more fluctuation in body temperature
due to hormonal changes.
3) Environmental temperature: Most people respond to changes in
environmental temperature by wearing clothes that either allows
increases heat loss when it is hot or retains heat when it is cold.
4) stress
A person with normal temperature is referred to as Afebrile ( without fever)
Fever ( Pyrexia) is an increased body temperature above normal.
Body temperature can be abnormal due to hyperthermia (high fever) or
hypothermia (low temperature). Fever occurs when the body temperature rises
about 1 degree or more above he normal temperature, while hypothermia is a
drop in body temperature below 36 degree celsius. A person with fever is
termed Febrile.
A thermometer works on the principle that solids and liquids expand on heating.
TYPES OF FEVER
1) Intermittent Fever: The body temperature alternates regularly between
a period of fever and a period of normal or subnormal temperature.
2) Remittent fever: The body temperature fluctuates several degrees more
than above normal but does not reach normal between fluctuations.
3) Constant fever: The body temperature remains consistently elevated
and fluctuates less than 2 degrees.
4) Crises fever: Fever returns to normal gradually.
Fever generally occurs due to infection and increased immune function.
Neurogenic fever occurs when there is an injury to the hypothalamus, which
can be due to intracranial pressure, trauma, intracranial bleeding. This type of
fever does not respond to antipyretic medication.
Sites for temperature
Oral (mouth): while using this site, patient must be able to close his or her
mouth around the probe. If a patient just had a cold or hot fluid, wait 15-30mins
before checking temperature.
Rectal (rectum): this site is contraindicated in patients with injury in the anus.
Axillary (underarm)
Tympanic (ear)
forehead
PULSE RATE
The pulse rate is a measurement of the heart rate or the number of times the
heart beats per minute. As the heart pushes blood through the arteries, the
arteries expand and contract with the flow of the blood. Taking a pulse not only
measures the heart rate but can also indicate the heart rhythm.
Normal pulse rate is 60-100b/m(beats per minute). The pulse rate may fluctuate
and increase with exercise, illness, injury and emotions. Females aged 12 and
above in general, tend to have faster rates than males. Athletes who do a lot of
cardiovascular conditioning may have rates near 40b/m and experience no
problems. Pulse rate for children is about 110-160b/m.
Characteristics of pulse
- Rate
- Quality (strong or weak)
- Rhythm
Sites for checking Pulse
- Temporal artery
- Carotid artery
- Brachial artery
- Radial artery
- Femoral artery
- Popliteal artery
- Posterior tibial artery
- Dorsalis pedis artery
HOW TO CHECK PULSE RATE: As the heart forces blood through the arteries, you
feel the beats by firmly pressing on the arteries which are located close to the
surface of the skin at certain parts of the body which include; side of the neck
(common carotid artery), inside the elbow (brachial artery), or at the wrist
(radial artery). While using the lower neck, be sure not to press too hard and
never press on both sides of the lower neck the same time to avoid restricting
blood flow to the brain.
When taking pulse;
- Using the first and second fingers, press firmly but gently on the arteries
until you feel a pulse.
- Begin counting the pulse when the clock’s second hand is on the 12.
- Count your pulse for 60seconds (or for 15secs and multiply by 4).
- When counting, do not watch the clock continuously but concentrate on
the beats of the pulse.
- If unsure about your result, ask another person to count for you.
RESPIRATION
Respiration rate is the number of breaths a person takes per minute. It is
measured when a person is at rest and simply involves counting. When checking
respiration, it is important to also note if the person has any difficulty breathing.
Normal respiratory rate for adult ranges between 12-20b/m. normal respiratory
rate for children varies by age.
Age Rate (in breaths per minute)
Birth to 6months 30 to 60
6months to 1year 30 to 50
1y to 3years 24 to 40
3 to 5 years 22 to 34
5 to 12 years 16 to 30
HOW TO MEASURE RESIRATORY RATE
Respiratory rate can be measured in 3 steps:
1) Set a timer to 1 minute
2) Sit or lie down to get yourself in a state of rest. Avoid strenuous activity
beforehand
3) Start the timer and measure the amount of breaths taken in 1 minute.
This can be done counting how many times the chest rises.
FACTORS THAT DECREASE / SLOW RESPIRATORY RATES
- Alcohol
- Opioids
- Medications ;certain sleeping medications
- Metabolic issues e.g hyperthyroidism
- Brain injury or stroke
- Sleep apnea
FACTORS THAT INCREASES RESPIRATORY RATE
- Fever
- Dehydration
- Asthma
- COPD( chronic obstructive pulmonary disease) and other lung conditions
- Heart conditions
- Stimulants
- Infections
- Anxiety or panic attacks
BLOOD PRESSURE
This is the force exerted on the walls of the artery by blood during the
contraction and relaxation of the heart muscles. Each time the heart beats, it
pumps blood into the arteries resulting in the highest pressure as the heart
contracts. When the heart relaxes, the blood pressure falls. In measuring blood
pressure, two numbers are recorded. The higher number known as the
SYSTOLIC PRESURE refers to the pressure inside the artery when the heart
contracts and pumps blood through the body. The lower number known as the
DIASTOLIC PRESSURE refers to the pressure inside the artery when the heart is
at rest and it’s filling with blood. Both the systolic and diastolic pressures are
recorded in millimeters of mercury (mmHG). This recording represents how
high the mercury column in the sphygmomanometer is raised by pressure of the
blood. A high blood pressure increases the risk of heart attack, heart failure and
stroke.
Normal BP for Adults is between 90/60 to 130/80
BEFORE MEASURING BLOOD PRESSURE
- Do not smoke or drink coffee for 30mins before measurement
- Relax for 5mins
THINGS TO NOTE :
- take multiple readings one minute apart and record all results
- take your blood pressure at same time every day or as recommended by
the health care provider.
- Record date, time and BP reading
- Notify your provider if any abnormality.
RISK FACTORS OF HIGH BLOOD PRESSURE (HYPERTENSION)
- Overweight or obesity
- High salt intake
- Inactivity or lack of exercise
- Too much Alcohol or caffeine intake
- Insufficient sleep or rest
- Age (above 65)
- Medical conditions ( heart diseases, kidney disease, diabetes, etc)
- Drugs ( contraceptive pills, NSAIDs-ibuprofen etc)
RISK FACTORS FOR LOW BLOOD PRESSURE (HYPOTENSION)
- Pregnancy
- Heart conditions
- endocrine conditions
- Dehydration
- Severe infection
- Severe allergic reaction (anaphylaxis)
- Malnutrition
N/B: Hypotension is when the blood pressure goes below 90/60mmHg
Orthostatic hypotension is when the BP decreases due to changes in
position to standing. This normally occurs as due to dehydration, long
sleeping or lying position.
PAIN
Pain is one of the human’s body’s defense mechanism that indicates that a
person is experiencing a problem. Pain is subjective (only the patient can
describe the type of pain).
TYPES OF PAIN
Pain can be classified according to the following; duration, location, mode of
transmission and etiology.
ACCORDING TO DURATION
1) Acute pain: This type of pain usually has a rapid onset and moves from
mild to severe. After the underlying cause is resolved, acute pain
disappears. Examples include; sore throat, surgery, pricked finger or cut.
2) Chronic pain: this type of pain is limited, intermittent or persistent. It has
a long duration. E.g is pain associated with cancer or other progressive
disorders. Chronic pain may lead to withdrawal, anger, depression and
fraustration.
ACCORDING TO SOURCE/LOCATION
1) Cutanous pain (superficial): usually involves skin or subcutaneous
tissues
2) Somatic pain (deep): originates from tendons, bones, blood vessels and
nerves.
3) Visceral pain: poorly localized pain, and originates from organs in the
thorax, cranium and abdomen.
ACCORDING TO MODE OF TRANSMISSION
1) Referred pain: this type of pain originates in one part of the body, but is
perceived in an area distant from its point of origin. E.g pain associated
with myocardial infarction. Heart attack can be felt in the neck or
shoulder.
ACCORDING TO ETIOLOGY (CAUSE)
1) Neuropathic pain: pain associated with the central and peripheral
nervous system .
2) INTRACTABLE PAIN: this type of pain is resistant to therapy
3) Phantom pain: this pain is seen in patients with an amputated leg, where
pain receptors and nerves are clearly absent.
4) Psychogenic pain: this type of pain is not of physical cause but mental.
FACTORS AFFECTING PAIN EXPERIENCE
- Culture
- Gender
- Environment
- Anxiety or other stressors
DESCRIPTION OF PAIN BASED ON QUALITY
- Sharp pain: pain that is striking in nature
- Dull pain: more annoying than painful
- Diffuse pain: pain that covers a large area
- Shifting pain: moves from one area to the other.
DESCRIPTION OF PAIN BASED ON SEVERITY
Here pain is usually weighed on a scale of 1-10
- Severe or excruciating pain: 8-10
- Moderate pain: 4-7
- Mild pain: 1-3
Based on periodicity, pain can be continous, intermittent, brief or transcient.
ANTHROPOMETRIC MEASUREMENTS
These are a series of quantitative measurements of the muscle, bone and adipose
tissue used to assess the composition of the body. The core elements of
anthropometric are ; height, weight, body mass index (BMI), body circumference
( waist, hip and limbs) and skin folds, thickness, mid-upper arm circumference
(MUAC), head circumference etc.
The anthropometrics are a set of non-invasive quantitative body measurements
used to assess growth, developments and health parameters. Height and weight
are the most common anthropometric measures used to indicate protein energy,
malnutrition status and BMI.
Body mass index (BMI) is a person’s weight in kilograms (or pounds) divided by
the square of height in meters (or feet) a high BMI can indicate high body fatness.
BMI screens for weight categories that may lead to health problems, but it does
not diagnose the body fatness or health of an individual. A BMI of less than 18.5
indicates that a person is underweight. A BMI that is within 18.5-24.9, falls
within the healthy weight range, a BMI of 25.0 to 29.9, falls within the
overweight range. Also, a BMI of 30.0 and above indicates that a person is obese.
OXYGEN SATURATION (SpO2)
This is a measurement of how much oxygen your blood is carrying as a
percentage of the maximum it could carry. A normal level of oxygen is usually
95% or higher. The body needs a certain level of oxygen in the blood or it will not
function efficiently. Low level of oxygen is known as hypoxia which is
characterized by cyanosis. SpO2 is measured using the pulse oximeter, which is
done by placing the pulse oximeter on the finger
