🩺 Objective Data: Vital Signs

• 🌡 Temperature
• 💓 Pulse
• 🌬 Respiratory Rate
• 💉 Blood Pressure

📊 General Notes

• Tracked throughout patient experiences across settings
• Help monitor health trends & detect deterioration
• Always follow facility guidelines
• Use nursing judgment to decide if additional assessments are needed

🌡 Temperature

🌡 Standard Body Temperature Values

🌡 Procedures for Measuring Temperature

📏 Temperature Scales

• Report in °C unless agency uses °F
• Always report value + route (e.g., 37.5 °C rectal)
• 🔄 Conversion:
• °C = 5/9 × (°F − 32)
• °F = (9/5 × °C) + 32

You could use 1.8 instead of 5/9

• °C = (°F − 32) ÷ 1.8
• °F = (1.8 × °C) + 32
• 💡 Easier to learn °C scale than constantly convert

💓 Vital Signs: Pulse

📌 Definition

• Pulse = palpable flow in periphery from pressure wave created by stroke volume
• Provides data on:
• ❤️ Rate
• ⏱ Rhythm
• 💪 Force
• 🧵 Elasticity of artery

✋ Palpation Technique

• Use pads of first 3 fingers
• Palpate radial pulse at wrist
• Count:
• Regular rhythm: 30 sec × 2
• Irregular rhythm: full 1 min
• Always assess rate, rhythm, force, elasticity

🧍 Heart Rate

• Normal adult resting: 60–100 bpm
• 👶 Infants/children: faster
• 👵 Older adults: moderate
• ♀️ Females (post-puberty): slightly faster than males

⚠️ Abnormal Rates

• < 60 bpm = Bradycardia
• Normal in well-trained athletes (larger stroke volume, fewer beats)
• > 100 bpm = Tachycardia
• Normal with anxiety, exercise, increased metabolism

🎵 Heart Rhythm

• Normally regular, even tempo
• Sinus Dysrhythmia (common in children/young adults):
• Rate ↑ at inspiration, ↓ with expiration
• Caused by temporary ↓ stroke volume during inspiration → heart compensates by ↑ rate
• Any other irregularity → auscultate heart sounds

💪 Heart Force (Strength of Pulse)

• Reflects stroke volume strength
• Weak, thready pulse (1+) → ↓ stroke volume (e.g., hemorrhagic shock)
• Full, bounding pulse (3+) → ↑ stroke volume (anxiety, exercise, some conditions)

🔢 Pulse Force Scale

• 3+ = Full, bounding
• 2+ = Normal
• 1+ = Weak, thready
• 0 = Absent

🌬 Vital Signs: Respirations

• Normal breathing = relaxed, regular, automatic, silent
• Normal adult rate: 10–20 breaths/min
• ⚠️ Do not mention you’re counting → awareness may alter breathing
• Trick: Count respirations while taking radial pulse
• ⏱ Count 30 sec (×2) if regular; 1 min if abnormal (Same as in Pulse)
• ❌ Avoid 15 sec count (error margin ±4 breaths/min)
• Pulse: Respiration ratio ≈ 4:1
• Both pulse & respiration rise with exercise or anxiety

💉 Vital Signs: Blood Pressure (BP)

• Definition: Force of blood pushing against vessel walls
• 🔄 Changes with cardiac cycle

Key Components:

• Systolic (top number):
• Maximum pressure during left ventricular contraction (systole)
• Diastolic (bottom number):
• Resting/recoil pressure between contractions
• Pulse Pressure = Systolic − Diastolic
• Reflects stroke volume
• Mean Arterial Pressure (MAP):
• Pressure forcing blood into tissues, average over cardiac cycle

📏 Normal Reference

• Average young adult BP: 120/80 mmHg
• Normal variations occur due to multiple factors

📊 Factors Affecting Blood Pressure

• 👶 Age: Gradual rise from childhood → adulthood
• ♀️ Gender: Females lower after puberty; higher than males after menopause
• 🌍 Race: Influenced by genetics + environment
• ⏰ Diurnal Rhythm: Peaks in late afternoon/evening; lowest in early morning
• ⚖️ Weight: Obesity ↑ BP
• 🏃 Exercise: Transient ↑ during activity
• 😡 Emotions: Sympathetic response → ↑ BP
• 😥 Stress: Chronic stress/tension → ↑ BP

⚙️ Physiologic Determinants of BP

• ❤️ Cardiac Output: ↑ CO → ↑ BP; ↓ CO → ↓ BP
• 🩸 Peripheral Vascular Resistance: Vasoconstriction ↑ BP; Vasodilation ↓ BP
• 💧 Blood Volume: Fluid retention ↑ BP; Hemorrhage ↓ BP
• 🧴 Viscosity: Thicker blood ↑ BP
• 🧱 Elasticity of Vessel Walls: Stiffer (less elastic) arteries ↑ BP

🩺 Measuring Blood Pressure

• Equipment: Stethoscope + Aneroid Sphygmomanometer
• ⚠️ Aneroid gauge must be recalibrated yearly; needle at zero
• Cuff bladder width = 40% of arm circumference
• Cuff bladder length = 80% of arm circumference

🖐 Procedure: Arm Pressure

• Position: Patient sitting or lying, bare arm supported at heart level
• Palpate brachial artery
• Place cuff 2.5 cm (1 in) above artery, wrap evenly
• Inflate cuff until pulsation obliterated + 20–30 mmHg beyond
• ⚠️ Prevents missing auscultatory gap (when Korotkoff sounds briefly disappear)
• Deflate cuff quickly & completely
• ⏳ Wait 15–30 seconds before reinflating (so trapped blood dissipates)

• 🎯 Place bell of stethoscope over brachial artery → light but airtight seal
• 🔊 Diaphragm usually fine, but bell picks up low-pitched Korotkoff sounds
• 💨 Inflate cuff to maximal inflation level
• ⏬ Deflate slowly & evenly → ~ 2 mmHg per heartbeat
• 👂 Note:
• 1️⃣ First sound (appearance)
• 2️⃣ Muffling
• 3️⃣ Final disappearance

🔊 Korotkoff Sounds (Phases I–V)

• 1️⃣ Phase I: First tapping = Systolic BP
• 2️⃣ Phase II: Swishing sounds (Sushi 😉)
• 3️⃣ Phase III: Crisper, louder sounds
• 4️⃣ Phase IV: Muffling of sound
• 5️⃣ Phase V: Disappearance = Diastolic BP
• ⚠️ If >10–12 mmHg difference between IV & V → record both values
• 📝 Clear documentation = 🏥 accurate diagnosis & care

⚠️ Common Errors in BP Measurement

✅ Memory tip:

• Memorize the 🔵 Leads to Low Readings
• Understand the 🟡 Can Cause High OR Low (Observer / Equipment Error)
• Read the 🔴 Leads to High Readings

🔵 Leads to Low Readings

• ⬆️ Arm above heart level → Removes hydrostatic pressure
• 🛑 Not inflating high enough → Misses initial systolic tapping / auscultatory gap
• 📏 Cuff too large

🟡 Can Cause High OR Low (Observer / Equipment Error)

• 💪 Improper arm/leg position
• 🎚 Wrong cuff size
• ⏩ Deflating too quickly → Falsely low systolic OR falsely high diastolic
• 🧠 Examiner bias / assumptions (age, race, gender, history)
• ⚡ Haste / poor technique
• 🔢 Digit preference (rounding to 0)
• 👂 Poor hearing acuity
• ⚙️ Defective or uncalibrated equipment

🔴 Leads to High Readings

• 😡 Taking BP when patient is anxious, angry, or just active → Sympathetic stimulation
• ⬇️ Arm below heart level → Gravity adds pressure
• ✋ Patient supports own arm → Falsely high diastolic (isometric contraction)
• 🦵 Legs crossed → Falsely high systolic & diastolic
• 🩹 Cuff too narrow
• 🎚 Cuff too loose / uneven, or bladder balloons out
• 🔄 Reinflating during procedure
• 🐌 Deflating too slowly → Venous congestion → falsely high diastolic
• ⏸ Halting & reinflating mid-descent → Falsely high diastolic
• ⏱ Not waiting 1–2 min before repeating → Falsely high diastolic

📊 Orthostatic (Postural) Vital Signs

Take serial pulse & BP measurements if:

• 💧 Suspect volume depletion
• 💊 Known hypertension / taking antihypertensives
• 😵 Reports fainting or syncope
• ⬆️ With supine → standing: normal = slight systolic drop (<10 mmHg) When laying down you are relax.

📝 Procedure

• 🛏 Rest supine 2–3 min → take baseline pulse & BP
• ↕️ Repeat sitting → then standing
• 🪑 If too weak to stand: measure supine → sitting with legs dangling
• Record:
• ✅ BP (even numbers)
• ✅ Position, arm, cuff size (if nonstandard)
• ✅ Pulse rate & rhythm

🦵 Thigh Pressure

Used if arm BP very high → rule out coarctation of aorta (congenital narrowing)

• 👦 Commonly checked in adolescents & young adults
• 🛌 Position: prone (face down)
• Wrap large cuff around lower ⅓ of thigh (over popliteal artery, behind knee)
• 🎧 Auscultate popliteal artery
• ✅ Normal:
• Thigh systolic = 10–40 mmHg higher than the arm
• Diastolic = same as arm

👵 The Aging Adult: Vital Signs

🌡 Temperature

• ↓ Thermoregulation → less likely to have fever, ↑ risk hypothermia
• ↓ Sweat gland activity → unreliable index of health

💓 Pulse

• Normal: 60–100 bpm
• Rhythm may be slightly irregular
• Radial artery may feel stiff/tortuous, but not always disease
• Rigid arteries = faster upstroke → pulse easier to palpate

🌬 Respirations (shallow and increased)

• ↓ Vital capacity + ↓ inspiratory reserve
• Inspirations more shallow
• Respiratory rate often increased

💉 Blood Pressure

• Aorta & arteries stiffen with age
• Heart pumps against stiffer wall → systolic ↑ → widened pulse pressure
• Both systolic & diastolic may rise → hard to separate normal aging vs hypertension

🫁 Oxygen Saturation (SpO₂)

📟 Pulse Oximeter

• Noninvasive; sensor on finger or ear lobe
• Emits light → detector compares HbO₂ vs reduced Hb
• Converts to % oxygen saturation
• May not work properly or can give an inaccurate reading if you have black nail polish.

✅ Normal Values

• Healthy adult (no lung disease/anemia): 97–98%
• In patients with COPD: 88% and 92%
• Probes:
• ☝️ Finger probe = spring clip (comfortable, not painful)
• 👂 Ear lobe probe = more accurate at low saturations, less affected by vasoconstriction

🎧 Doppler Techniques

• Used when pulse & BP are hard to measure with standard methods

🩺 Uses

• Locate peripheral pulse sites
• Augments Korotkoff sounds in BP measurement
• Helpful in:
• 🚨 Critically ill patients with low BP
• 👶 Infants (small arms)
• ⚖️ Obese patients (fat muffles sounds, cone-shaped arms)
• 💡 For obese patients: place cuff on forearm + probe over radial artery

📝 Procedure

1. 💧 Apply coupling gel to transducer
2. 🔛 Turn Doppler on
3. 📍 Place probe perpendicular to artery (maintain skin contact)
• 🎵 Listen for whooshing, pulsatile sound
• 🔄 Rotate probe slightly if needed
• ⚠️ Do not press too hard → pulse may disappear
4. 💨 Inflate cuff until sounds disappear → go 20–30 mmHg beyond
5. ⏬ Slowly deflate cuff → note first whooshing sound = systolic BP

⚠️ Abnormal Findings: Vital Signs

⬇️ Hypotension

• Causes:
• ❤️ Acute MI (Myocardial Infraccion)
• 🩸 Shock
• 💉 Hemorrhage
• 🔓 Vasodilation
• 🧬 Addison’s disease

⬆️ Hypertension (HTN)

• Essential / Primary HTN (most common)
• Guidelines: ACC/AHA Task Force & JNC-8
• 📊 Risk factors (target organ damage):
• 🚬 Smoking
• 🩺 Dyslipidemia
• 🍬 Diabetes mellitus
• 👴 Age > 60
• ♂ Men & postmenopausal women
• 👨‍👩‍👧 Family history of cardiac disease

🥗 Lifestyle Modifications for HTN

• ⚖️ Weight loss if overweight
• 🍷 Limit alcohol intake
• 🏃 Increase aerobic exercise
• 🧂 Reduce sodium intake
• 🥬 Ensure adequate potassium, calcium, magnesium
• 🚭 Stop smoking
• 🥩 Reduce saturated fats & cholesterol