Vital Signs
Assessing Respiration and Blood
Pressure
Nur 102
Fall semester 2014/2015
Dr Khulood Shattnawi
Respiration
Is the act of breathing
Inhalation or inspiration: intake of air into lungs
Exhalation or expiration: breathing out
Ventilation: movement of air in and out of lungs
Two types of breathing:
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
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
–
–
Costal (thoracic) breathing: external intercostal muscles &
accessory muscles (observed by the movement of the
chest)
Diaphragmatic (abdominal) breathing: contraction and
relaxation of diaphragm (observed by the movement of
abdomen)


Inspiration in adults takes about 1-1.5 Sec.
Expiration lasts 2-3 sec, twice more than
inspiration.
Assessing Respiration
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1.
2.
3.
4.
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The Nurse should be aware of the following:
The client’s normal breathing pattern
The influence of the client’s health problems on
respirations
Any medications or therapies that might affect respiration
The relationship of the client’s respirations to
cardiovascular function
Resting respirations should be assessed
Assess the rate, depth, rhythm, quality and effectiveness of
respiration
Characteristics of Respiration
1.

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Rate: breath per min
Eupnea: normal rate and depth (12-20 )
Bradypnea: abnormally slow respiration
Tachypnea (polypnea): abnormally fast
respiration.
Apnea: Absence of breathing
2. Depth: Movement of chest
 Normal: normal Volume of air inhaled and exhaled (Tidal
volume =500ml)
 Deep respiration: large volume of air is inhaled and exhaled,
inflating most of lungs (more than 500ml)
 Shallow Respiration: small volume of air inhaled and
exhaled inflating minimal size of lung tissue ( less than 500
ml)
 Hyperventilation: very deep, rapid respiration
 Hypoventilation: very shallow respiration
3. Respiratory rhythm: regularity of inspiration and expiration
(Regular or irregular)
4. Respiratory quality or character: aspects of breathing that are
different from normal breathing.
Two of these aspects are:

The amount of effort exert to breath:
–
–
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Normal breathing no noticeable effort.
Labored breathing: need effort (substantial effort)
Sound of breathing.
–
–
Normal: silent (with no use of stethoscope)
Abnormal breathing sounds (obvious wheeze to the ear)
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The effectiveness of respiration is measured
in part by the uptake of oxygen from the air
into the blood (O2 Saturation) and the
release of CO2 from the blood into expired
air
Pulse oximeter: pulse rate and O2 saturation;
the amount of Hg in arterial bld that is
saturated with O2
Factors Affecting Respiration:
I- Factors that increasing rate:
1.
Exercise
2.
Increase metabolism
3.
Stress
4.
Increased environmental Temp
5.
Low O2 concentration at increased altitudes
6.
Fever
7.
Health status such as anemia
II- Factors decreasing Resp. Rate:
1.
Decreased environmental Temp.
2.
Certain medication
3.
Increased intracranial pressure
4.
Body position affect amount of air that can
inhaled
Blood Pressure

1.
2.
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Arterial blood pressure: is a measure of the pressure exerted by
the blood as it flows through the arteries.
Systolic Pressure: Is the pressure of blood as a result of
contraction of the ventricles, that is the pressure of the height of
blood wave.
Diastolic pressure: Is the pressure when the ventricles are at
rest, then is the lower pressure present
Pulse pressure: Is the difference between Diastolic and Systolic
pressure (40 mmHg) but can be as high as 100 during Exercise.
Pulse pressure may increase due to arteriosclerosis or decrease
due to heart failure.
Blood Pressure (Bp) =
Systolic/Diastolic= 120/80 mmHg
120/80
Systolic Pressure
Diastolic Pressure
 Contraction of left
ventricle
 Top or first number
 Heart at rest
 Bottom or second
number
Determinant of Blood Pressure

1.
2.
3.
4.
Bp is a result of many Factors:
Pumping action of the heart: Determining Cardiac output
(weak= ↓ Bp, strong = ↑ Bp)
Peripheral Vascular Resistance: due to decrease
arterioles and capillaries capacity, compliance of the
arteries (elasticity), and viscosity of the blood.
Blood Volume: (↓ with hemorrhage or dehydration = ↓
Bp. ↑ with rapid IV infusion = ↑Bp
Blood Viscosity: Bp ↑ when blood is thick
Factors affecting Blood Pressure
1.
2.
3.
4.
5.
6.
7.
8.
9.
Age: the pressure rises with age
Exercise:
Stress: increase heart rate, cardiac output and vasoconstriction due to
stimulation of sympathetic nervous system.
Race: African American is more than European American
Gender: female less than male but after menopause, women will have
higher Bp than before
Medication
Obesity: predispose to hypertension
Diurnal variation:
Medical conditions: any condition affect CO, Blood Volume, Blood
viscosity and compliance of the arteries.
Hypertension
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
1.
2.
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Is a blood pressure that is persistently above normal.
It is usually asymptomatic and may cause MI
Two Types:
Primary Hypertension: Unknown cause
Secondary Hypertension: Known cause
Patient considered hypertensive when Diastolic more than 90
mmHg or Systolic more than 140 mmHg for more than two
readings
Classification of Blood Pressure
Category
Systolic (mmHg)
Normal
< 120
Prehypertension
Diastolic (mmHg)
and
< 80
120-139
or
80-89
Hypertension, stage 1
140-159
or
90-99
Hypertension, stage 2
> 160
or
> 100

Factors associated with HTN : arteriosclerosis,
inelasticity, cigarette smoking, obesity, heavy
alcohol consumption, lack of physical exercise, high
cholesterol level, and stress.
Hypotension
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Is blood pressure below normal (systolic is 85110 mmHg)
Orthostatic Hypotension: falling of Bp due to
sitting or standing. Result from peripheral
vasodilatation in which blood leaves the central
body organs.
Other causes: Analgesia, bleeding, sever burns,
and dehydration
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1.
2.
3.
4.
5.
6.
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When assessing orthostatic hypotension:
Place patient in supine position for 10 min
Record pulse and blood pressure
Assist the patient to slowly sit or stand
Immediately recheck the pulse and BP in the same
sites as previously.
Repeat the pulse and blood pressure after 3 min
Record the results
rises of pulse of 15-30 beats/min or a drop of BP of
20 mmHg systolic or 10 mmHg diastolic indicates
orthostatic hypotension
Assessing Blood Pressure
Bp is measured by blood
pressure cuff,
sphygmomanometer and
stethoscope
Types of sphygmomanometer:
 Aneroid
 Mercury
 Electronic/ digital

Cuff size
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

The cuff should be in correct
width and length for pt arm
The width of the bladder should
be 40% of the arm
circumference
The length of the bladder affect
accuracy of measure ( it should
cover 2\3 of the arm
circumference)
Sites for measuring BP
 Upper arm ( brachial artery)
 Thigh (Popliteal artery)
Method of measuring BP:
 Direct (invasive as arterial line)
 Indirect ( by auscultatory or palpatory method)
Bp not measured at pt arm when:
 The shoulder, arm or hand is injured or diseased
 A cast over the arm
 Arm with intravenous fluid
 Arm near mastectomy and removal of LN
 Arm with arteriovenous fistula
Measured from thigh:
 When we can’t use arm
 When we want to compare upper and lower
extremity pressure
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Sound heard
during BP
measurement
called
Korotkoff's
sound
5 Phases of this
sound
Common error in assessing Bp
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Bladder cuff too narrow (high)
Bladder cuff too wide ( low)
Arm unsupported ( high)
Insufficient rest before measurement ( high)
Repeating Bp rapidly (high)
Deflating cuff too quickly or too slowly( low SBP and
high DBP)
Arm above heart level (low)
Assessing immediately after a meal or smoking (high)