Understanding Vital Signs

• Vital signs provide caregivers insights into a client's overall health
• Baseline measures help identify changes due to pathology or exercise
• Patients exhibiting abnormal vital sign values may have a reduced tolerance for physical activity

Traditional Vital Signs

• Blood pressure (BP)
• Heart rate or pulse (HR or P)
• Respiratory rate (RR)
• Temperature (T)

Additional Vital Sign

• Pain assessments provide an overall sense of a client's health
• Pain scales are used to assess pain intensity, chronicity, and functional impact
• Blood oxygen saturation is used in rehabilitation
• Oxygen saturation impacts vital organs and homeostasis

Homeostasis & Patient Safety

• Alterations in vital signs can indicate changes in an individual's homeostasis
• Vital signs are closely monitored in care-intensive situations for patient safety

Temperature

• Body temperature indicates the degree of heat within the body
• The body maintains a constant temperature to maintain homeostasis
• Normal oral core temperature ranges from 36.5 – 37.5 degrees C (97.8 - 99 degrees F)
• An average temperature is 37 degrees C (98.6 degrees F)
• A temperature exceeding 37.5 degrees C (99.5 degrees F) is considered febrile

Common Measurement Sites for Temperature

• Tympanic
• Oral
• Rectal
• Axillary

Factors Affecting Body Temperature

• Time of day: temperatures are usually lower in the morning
• Illness/Infection: increases with major infection
• Oral cavity changes: recent consumption of hot or cold substances or smoking within 14-30 minutes can cause inaccurate measurements
• Physical activity: increases slightly with activity
• Environment: may increase in hot environments
• Menstrual cycle: increases during ovulation and pregnancy
• Age: decreases with age
• Emotional status: increases slightly during stress or emotional situations
• Site of measurement: rectal temperature is slightly higher, while axillary temperature is slightly lower

Pulse (Heart Rate)

• Pulse indicates the rate at which the left ventricle is beating
• Pulse can be palpated at various sites on the body

Sites for Measuring/Palpating Pulse

• Temporal artery
• Carotid artery
• Brachial artery
• Radial artery
• Femoral artery
• Popliteal artery
• Dorsalis pedis artery
• Posterior tibial artery

Normal Values for Resting Pulse

• Adults: 60 – 100 bpm (average of 72 bpm)
• Newborns: 100 - 190 bpm
• Children (1-10 years): 85 – 205 bpm

Pulse Descriptions

• Tachycardia: rapid heart rate, exceeding 100 bpm
• Bradycardia: slow heart rate, below 60 bpm
• Strong: good force to each beat
• Weak: poor force to each beat
• Regular: even beats
• Irregular: both strong and weak beats occur during measurement
• Thready: weak force to each beat and irregular beats

Factors Affecting Pulse

• Age: individuals older than 65 exhibit lower pulse rates
• Gender: female pulse rates are generally higher than male rates
• Emotional status: increases during episodes of anxiety, stress, and emotion
• Environmental temperature: increases with high temperatures and decreases with low temperatures
• Physical activity: rises initially, plateaus, and decreases after activity stops, returning to normal within 3-5 minutes
• Infection: increases with infection and increased body temperature
• Medications: can increase or decrease pulse rate, depending on the medication

Factors Affecting Pulse continued

• Cardiopulmonary disease: hypertension may lower pulse, while hypotension may increase it
• Physical conditioning: greater fitness lowers resting heart rate, with athletes potentially having rates between 40-60 bpm

Respiration Rate

• One respiration consists of one inhalation and one exhalation
• Normal respiration rate for adults is between 12 – 16 respirations per minute
• Abnormal adult values are >20 or 5mmHg for adults
• Systolic pressure consistently < 100 mmHg is hypotension

Abnormal Blood Pressure Responses to Exercise

• Systolic
• Diastolic

Exercise & Activity on Vital Signs

Abnormal Patient Signs & Symptoms

• Vital Signs Change Abnormally
• Sudden Cognitive Changes
• Chest Discomfort or Marked Shortness of Breath
• Profuse Sweating
• Faintness
• Sudden Headache or Facial Pain
• Abdominal Discomfort
• Nausea
• Abnormal Blood Glucose Levels

Ankle – Brachial Index (ABI)

• ABI is important and easily repeated for assessing the severity of lower limb peripheral artery disease
• ABI compares ankle pressure to brachial pressure; lower blood pressure in the leg indicates blocked arteries

ABI Measurement

• Measures Brachial Artery and Dorsalis Pedis (or Posterior Tibial Artery) pressures using Doppler ultrasound and sphygmomanometer
• Resting ABI should be >1 (values > 0.9 are considered normal)
• An ABI of 1.4
• 1.0 - 1.4 Normal range
• 0.9 - 1.0 Acceptable
• 0.8 - 0.9 Some arterial disease
• 0.5-0.8 Moderate arterial disease
• Under 0.5 Severe arterial disease

Contraindications to ABI

• Suspected DVT due to risk of emboli
• Cellulitis due to increased pain
• Severe ischemia due to risk of further tissue damage