VITAL SIGNS

SP 128 Medical Rehabilitation Lectures

for Speech Pathology Students

Ferdiliza Dandah S. Garcia, MD, SP

 Learning Objectives

●
At the end of the session, the student will be
able to:
– Enumerate the vital signs
– Identify the normal values for each vital sign
– Discuss the possible causes for an
abnormal value
– Explain the procedure of taking each vital
sign
– Demonstrate how each vital sign is taken
 Vital Signs

– What ?
– Why ?
– How?
– When?
 What are the vital signs?

Vital
– Concerned with or necessary to the
maintenance of life
– Fundamental
– Indispensable

Sign
– Notice for giving direction or warning
– Indicator
Merriam Webster Dictionary, 1997
 What are the vital signs?

●
Temperature
●
Respiratory rate
●
Pulse
●
Blood pressure
 What is temperature?

●
Measure of sensible heat associated
with metabolism of the human body,
normally maintained at 37°C (98.6°F) for
adults and 35.5°C to 37.5°C(96°F to
99.5°F)
 Abnormalities in Temperature
(Fever/pyrexia)
Elevated body temperature
– Hyperpyrexia(extreme) – 41.1°C
(106°F)
– Causes:
● Infection

● Trauma (surgery/crushing injury)

● Malignancies

● Infarctions

● Blood disorders

● Drugs

● Immune disorders
 Abnormalities in Temperature
(Hypothermia)
●
Abnormally low temperature, below 35°C
(95°F)
●
Causes:
– Exposure to cold
– Decreased muscular movement (paralysis)
– Interference with vasoconstriction
(alcohol and sepsis)
– Starvation
– Hypothyroidism
– Hypoglycemia
– Elderly (susceptible)
 When to take the temperature?

●
Take it if symptoms or signs suggest a
possible abnormality

– Shivers/Chills
– Restless
– Sweating excessively
– Hot/cold skin to touch
 How do we measure temperature?

●
Oral
●
Axillary
●
Rectal
●
Aural
 How do we measure temperature?

●
Oral route is more convenient
●
Unadvisable to take oral temperatures
when the patient is
– Unconscious
– Restless
– Unable to close their mouths
 How do we take oral temperature?

●
Glass
– Shake until below 35.5°C (96°F)
– Insert under the tongue
– Instruct patient to close both lips
– Wait for 3-5 minutes
– Reinsert and read
– Continue reinserting until reading
becomes stable
 How do we take oral temperature?

●
Electronic
– Accurate digital recording takes about
10 seconds
 How do we take
oral temperature?

●
Whether an oral temperature is taken
with a glass or an electronic
thermometer, drinking hot or cold liquids
may alter it artifactually. Wait 10-15
minutes before measurement
●
Average: 37°C (98.6°F)
●
Range: 35.8°C (96.4°F)- 37.3°C
(99.1°F)
 How do we take rectal temperature?

●
Usually for newborns
●
Insert properly lubricated rectal thermometer
3-4cm (1½ in)
into the anal canal pointing towards the
umbilicus
●
Remove and read after 3 mins
●
Average: 0.5°C (0.7 to 0.9°F) higher than oral
readings
 What does a rectal
thermometer look like?
●
Rectal thermometer
(stubby tip)
 How do we take the aural temperature?

● Use electronic temperatures

● Quick, safe, measures core
body temperature
● 0.8°C (1.4°F) higher
than oral temp
● Done by placing the probe in the ear canal for
2-3 secs until digital reading appears
 Mechanics of Breathing

●
Automatic
●
Controlled by brain
●
Mediated by muscles of respiration
 Mechanics of Breathing

●
Diaphragm – primary muscle for inspiration
– Contracts
– Descends in the chest
– Enlarges the thoracic cavity
– Compresses abdominal cavity and pushes
abdominal wall outward
●
Other muscles expand the thorax during
inspiration
– Rib cage (parasternals)
– Neck (scalenes)
 Mechanics of Breathing

●
Thoracic enlargement decreases intra-
thoracic pressure, draws in air, expands
lungs, oxygen diffuses into blood while
CO2 diffuses from blood to alveoli
●
After inspiration, chest wall and lungs
recoil, diaphragm rises passively, air
flows outward, chest and abdomen
return to resting position
 Mechanics of Breathing

●
Normal breathing
– Quiet and easy
– When person lies supine
●
Less thoracic movements seen
●
Abdominal movements evident
– Sitting – thoracic movements evident
 Mechanics of Breathing

●
Extra effort as evidenced by use of
accessory muscles (SCM, scalenes)
Exercise
Diseases
 How do we measure
respiratory rate?

●
A normal resting adult breathes quietly
and regularly about 14 to 20 times a
minute while infant rates reach up to 44
times per minute
(Bates, 1997)
 How do we measure
respiratory rate?

●
Pediatric rates
– <2 months <60 cpm
– 2-12 months <50 cpm
– 1-5 years <40 cpm
– 6-8 years <30 cpm
 Signs of
respiratory problems

●
RATE
●
RHYTHM – longer expiration?
●
DEPTH – shallow?
●
EFFORT – Use of accessory muscles
●
SKIN COLOR – Cyanosis
●
ADVENTITIOUS SOUNDS – Wheezes
 How do we assess respiratory rate?

●
For adults,
adults observe the thoracic
movement or while taking the pulse,
place your hand on the patient’s
abdomen. Count for a minute.
●
For children,
children the pattern should be
observed for more than the usual 30-60
seconds to determine the true rate. The
sleeping RR is the most reliable.
 What are pulses?

●
With each contraction of the heart, the
left ventricle ejects a volume of blood
into the aorta and on into the arterial
tree. The ensuing pressure wave moves
rapidly through the arterial system,
where it is felt as the
ARTER IA L PULSE
 What are the normal
rates of arterial pulses?

●
Adult
– 60-100 beats per minute (bpm)
●
Pediatric
– newborn: 110-150 bpm
– 2 years: 85-125 bpm
– 4 years: 75-115 bpm
– > 6 years: 60-100 bpm
 Why do we need
to know the pulse?

●
By examining the arterial pulse you can
count the RATE OF THE HEART and
determine its RHYTHM and sometimes
detect obstructions to blood flow.
 How do we assess the arterial pulse?

●
For adults, the Radial Pulse is commonly
used to assess the heart rate.
●
With the pads of your index and middle
fingers, compress the radial artery until a
maximal pulsation is detected.
 How do we assess the arterial pulse?

●
If the rhythm is regular and rate seems
normal, count the rate from 15 seconds
and multiply by 4. If the rate is unusually
fast or slow, however, count it for 60
seconds.
 Other pulses

●
CAROTID
ARTERY
 Other pulses

●
BRACHIAL
ARTERY
 Other pulses

●
FEMORAL
What is Blood Pressure(BP)?
 What is Blood Pressure (BP)?

●
The pressure exerted by the circulating
volume of blood on the walls of the
arteries, veins, and the chambers of the
heart.
 What is Blood Pressure (BP)?

●
It is maintained by the homeostatic
mechanisms of the body (blood volume,
lumen of the arteries and arterioles, force
of cardiac contraction)
 What are the
normal BP values?

●
Adult:
Optimal: 120/80 mmHG
Range:
Systolic BP +/-20
Diastolic BP +/-10
 What are the
normal BP values?

●
Pediatric:
– Newborn: 95 mmHg SBP
– 8-30 d: 105 mmHg
– 1 mo-2y: 115/75 mmHg
– 2y-5y: 130/80 mmHg
– 6-11y: 135/85 mmHg
– >12y: 140/90 mmHg
 How is arterial BP measured?
●
CHOICE OF SPHYGMOMANOMETER
– Proper size would give a correct
reading
– Inflatable bladder

Width: 40% of upper arm

circumference
(12-14 cm in average adult)
Length: 80% of circumference
(encircle arm)
– Mercurial vs Anaeroid
How is arterial BP measured?
 How is arterial BP measured?

●
PRIOR TO THE READING
– Avoid smoking and ingesting caffeine
for 30 mins
– Well rested for
at least 5 mins
– Room should be quiet and comfortable
 How is arterial BP measured?

●
ARM USED
– Free of clothing, resting
– Brachial artery is felt
– At heart level
(4th inter-space at junction with
sternum)
– Free of arteriovenous fistulas for
dialysis, scarring from brachial artery
cutdown and lymphedema
How is arterial BP measured?
 How is arterial BP measured?

●
Center the inflatable bladder over the
brachial artery

●
Lower border of the cuff: 2.5 cm above
the antecubital crease

●
Elbow slightly flexed
 How is arterial BP measured?

●
Estimate the cuff pressure
– Feel the radial artery
– Rapidly inflate the cuff until pulse
disappears
– Read the pressure on the manometer
and add 30
– Deflate cuff promptly and completely
and wait 15-30 seconds
How is arterial BP measured?
 How is arterial BP measured?

●
AUSCULTATORY METHOD
– Korotkoff sounds:
vibrations from the artery under
pressure
– Press the bell of the stet lightly over
the brachial artery and note the
pressure reading at which sounds first
become audible (systolic)
 How is arterial BP measured?

●
AUSCULTATORY METHOD
– As the deflation proceeds, the sounds
become louder then they become
muffled until the sounds disappear
(diastolic)
 How is arterial BP measured?

●
PALPATION METHOD
– To check the results by auscultation
– Used when the korotkoff sounds are
imperceptible
– Palpate the radial artery distal to the
cuff
– Note the systolic pressure as the point
in which the pulse waves first appear