THE VITAL SIGNS:
TEMPERATURE, PULSE,
RESPIRATIONS AND BLOOD
PRESSURE
Abbreviated: TPR BP or
simply VS
THE VITAL SIGNS
 Take a moment and close your eyes and
concentrate on your breathing, the heat of
your body and the flow of blood through
your blood vessels as your heart beats.
 These are the crucial, automatic processes
that occur continuously to maintain your
life.
 They are indeed vital to life—and thus
called the Vital Signs
SIGNS VS. SYMPTOMS
 Symptoms can only be described / validated
by the patient.
– Pain, nervousness, dizziness, fatigue
 Signs are able to be measured / observed by
others besides the patient
– Vital signs, wound drainage, color of sputum,
blood cell counts
TEMPERATURE
The measurement of core body
heat
ROUTES TO MEASURE
TEMPERATURE
 Axillary: Under the arm in the armpit
 Orally: By mouth
 Rectally: By rectum
 Tympanic: In the ear
 Temporal: through the skin of the temple
TYPES OF
THERMOMETERS
 Digital Electronic: To be used for oral,
rectal, and axillary
 Thermoscan - Digital: To be used for
tympanic /temporal
 Mercury or glass: To be used for oral,
rectal, and axillary. Rarely used anymore
due to health risks r/t mercury and risk of
sharps injury if broken
NORMS
 Orally: 97.6 - 99.6 degrees Fahrenheit
 Rectally: 98.6 - 100.6 degrees Fahrenheit
 Tympanic - manufacturers say to measure
as for rectal
 Axillary: 96.6 - 98.6 degrees Fahrenheit
 Temporally: Manufacturers say to measure
as axillary.
HOW SHOULD
THERMOMETER BE USED?
 Tympanic: Special device with plastic
covers, placed snugly in ear canal.
 Electronic: Oral, rectal & axillary routes.
Probes that are red in color for rectal
temperatures; blue in color for oral and
axillary, always retain hold of thermometer.
 Mercury: same as electronic. Red ends are
rectal; blue ends oral and axillary, always
retain hold of thermometer.
DURATION FOR TAKING
TEMPERATURES
 Tympanic: As long as it takes to push a
button
 Temporal: Until the thermometer beeps
 Electronic: Until the thermometer beeps
 Mercury Oral: Three minutes
 Mercury Rectal: Three minutes
 Mercury Axillary: Ten minutes
BE CAREFUL ON RECTAL
AND AXILLARY TEMPS
 Always hold the thermometer in place while
measuring temperatures by these routes
 Always use lubricant with rectal
temperatures
 Always remove clothing around axilla and
maintain arm pressed to side of torso
READING THE
THERMOMETER
 Mercury Fahrenheit thermometers are read
by degree and 0.2 of a degree
 Long lines indicate degrees
 Short lines indicate 0.2 of a degree
 Four short lines between each long line (0.2,
0.4, 0.6, 0.8)
 All other types give a digital display to the
tenth of a degree.
PULSE
The felt wave of blood created by
the heart pumping, that travels
along the arteries.
WHERE TO FIND PULSES
 Locations called “pulse points”
 Felt at areas where the artery is between
finger tips and a bony prominence or
section
 Felt with 2-3 fingers, but never the thumb
PULSE POINTS AND THEIR
LOCATIONS
 Temporal
 Femoral
 Carotid
 Popliteal
 Apical
 Post Tibial
 Brachial
 Dorsal Pedalis
 Radial
HOW TO MEASURE?
 Measured in beats per minute
 Count the felt waves for 60 seconds
 Or, count the felt waves for 30 seconds –
then multiply by 2
NORMS
 Pulse norms are 60 - 100 beats per minute
 Pulses between 90 - 100 are in a gray area - high
normal
 Faster than 100 - tachycardia
 Slower than 60 – bradycardia
 Caveat: well trained athletes may have “normal”
pulse rates of 45-60, depending on level of fitness
QUALITY OF PULSE
 Rhythm: regular or irregular
 Rate: Bradycardic, Within the normal
limits, Tachycardic
 Strength: Thready, Weak, Strong,
Bounding
WHAT AFFECTS PULSE
RATES AND QUALITY
 Body Temperature
 Emotions
 Activity Level
 Health of the Heart / vascular volume
RESPIRATION
The exchange of gases at the
alveolar-cellular level that results
from the mechanical act of
breathing in air (inspiration) and
expelling air (expiration) from the
body
RESPIRATION
 Measured in breaths per minute
 Normal range is 12 - 24 breaths per minute
 Count for 1 full minute or for 30 sec. x 2
 Greater than 24 is tachypnea
 Less than 12 is bradypnea
 Watch for rate, depth, listen for quality of
breath (adventitious vs. vessicular sounds),
and difficulty in breathing (SOB/labored)
METHOD OF MEASURING
TPR
 If using a mercury thermometer, measure
the pulse and respiration while waiting for
the temperature
 If using another method of measuring the
temperature, complete the temperature then measure the pulse and respiration
 Keep your fingers on the pulse while
measuring the respiration
BLOOD PRESSURE
 The measurement of the force of blood
against artery walls.
 Measured using device called
sphygmomanometer and a stethescope.
 Measured as a fraction in mm/Hg
 Upper number (numerator) called the
Systolic blood pressure.
 Lower number (denominator) called the
Diastolic blood pressure.
MEASURING BLOOD
PRESSURE
 The last sound heard (diastolic blood
pressure) – is the measure of the pressure in
an artery when the heart (ventricles) relaxes
between contractions.
 Normal Ranges SBP: 90-130, DBP: 60-80
 Hypertensive: 140/90 and above
 Hypotensive: 80/50 and below
 Grey areas: between norms and hyper/hypo
CAUSES & S/S
HYPOTENSION
 Causes may include:
– Medications
– Illness
– Injury
– dehydration
 Signs & symptoms may include:
– Dizziness / light-headedness
– Lethargy / fatigue / generalized weakness
– might faint
CAUSES & S/S
HYPERTENSION
 Hypertension is called the silent killer
because there are often no symptoms.
 Causes may include:
– family history / high salt diet / overweight
– emotional upset /physical pain
– illness / medications / fluid overload
 Some people might experience:
– Headache / Pressure in the head / Tinnitis
– General feeling of malaise
CAUSES OF HTN-(CON’T)
 Genetics: More prevalent in African Americans
than other ethnicities
 Age: More prevalent in middle-aged and elderly
people than younger people
 Body size: More prevalent in obese people than
thinner people
 Lifestyle: More prevalent in heavy drinkers than
moderate to non-drinkers
 Co-morbidities: People with diabetes, gout or
kidney dx
.
CHARTING
 Chart in order: temperature - pulse – respiration –
blood pressure.
 Do not write T =, etc.
 Number for temp with no route designation=oral
 Write (Ax) after axillary temperatures
 Write (R) after rectal temperatures
 Write (Tymp.) for tympanic
 Write (Temporal) for temporal
ABBREVIATIONS
 SOB - Short of breath
 QID - Four times a
day
 QS - Every shift
pulse, and respiration
 QD - Every day
 WNL-Within normal
limits
 PRN - As needed
 VSS-Vital signs stable  Ad Lib - At liberty (as
desired)
 P.O. - By mouth
 B/P - Blood Pressure
 BID -Twice a day
 TID -Three times a day  VS - Vital Signs
 HTN-hypertension
 TPR - Temperature,
TERMS
 Eupnea - Normal





breathing
Orthopnea - Sitting
upright to breath more
easily
Apnea - No breathing
Hyperpnea - Fast, deep
breathing
Hypopnea- slow shallow
breathing
Tachypnea – Fast
breathing
 Bradypnea - Slow
breathing
 Dyspnea - Painful or
difficult breathing
 Tachycardia - Pulse
rate in excess of 100
bpm
 Bradycardia - pulse
rate less than 60 bpm
TERMS
 Bounding pulse -
excessively strong pulse
 Weak pulse – softer
pulsation than normally
felt
 Hypertensive – blood
pressure 140/90 & above
 Hypotensive-blood
pressure 80/50 & less
 Thready pulse - Pulse rate
difficult to palpate because the
heart is not beating hard
enough to produce a strong
wave of blood. Feels as
though there is “a piece of
thread” running or fluttering
under the fingertips.