Vital Signs

M. Shahab Khan
BSN (G) DUHS
MPH KMU Peshawar

1
 OBJECTIVES
Define Vital Signs.
Define terms related to Vital sign.
Describe the physiological concept of temperature,
respiration and blood pressure.
Describe the principles and mechanisms for
normal thermoregulation in the body.
Identify ways that affect heat production and heat
loss in the body.
Define types of body temperature according to its
characteristics.
2
 OBJECTIVES
Identify the sign and symptoms of fever
List the factors affecting Temperature, Pulse,
Respiration.
Describe the characteristics of Pulse and Respiration.
List factors responsible for maintaining normal blood
pressure.
Describe various methods and sites used to measure T.P
& B.P.
Recognize the signs of alert while taking TPR and B.P.

3
 Introduction
Vital sign are the indicator of the body’s
physiologic status and response to physical
environment and psychological stressor.
The vital sign or the cardinal sign are temperature,
pulse, respiration, and blood pressure. The findings
are governed by the vital organs.

4
 Definition
Vital sign are called cardinal signs because of their
importance. These are the indicator of health
status, as these indicate the effectiveness of
circulatory, respiratory, neural, & endocrine body
functions.
1. Temperature
2. Pulse
3. Respiration
4. Blood pressure
5. oxygen saturation
6. Pupillary reaction / pain
5
 When to take Vital Signs
Upon admission.
On a routine basis.
Before and after invasive procedure.
Before and after administration of medication.
Any deterioration of patient’s general condition.
Before and after nursing intervention that may
influence vital sign.
Prior to medical emergency

6
 Temperature
Body Temperature: It is the hotness or coldness of the body.
OR
It is balance between the heat produced by the body and
heat lost from the body.

Heat produced – Heat lost = Body temperature

Types: There are two kinds of temperature..

1. Core Temperature
2. Surface Temperature

7
 Temperature
Core Temperature: is the temperature of the deep tissues
of the body. It remains constant and varies very little as +
1 F except when a person has a fever. We measure it with
a thermometer.
Surface Temperature: by contrast the temperature of the
surface or skin, fluctuate (rises or fall) in response to the
environment.
Normal body temperature: is not an exact point on a
scale but a range of temperatures. When measured orally
for an adult, on an average it is between 36-38 C (96.8 –
100 F)
8
 Regulation of Body Temperature
The system that regulates body temperature has 3 main parts:
1. Sensors in the periphery and in the core,
2. An integrator in the hypothalamus, and
3. An effector system that adjusts the production and loss of heat.
Most sensors or sensory receptors are in the skin. The skin has more receptors
for cold than warmth. Therefore, skin sensors detect cold more efficiently than
warmth.
When the skin becomes chilled over the entire body, three physiological
processes to increase the body temperature take place:
1. Shivering increases heat production.
2. Sweating is inhibited to decrease heat loss.
3. Vasoconstriction decreases heat loss.

9
 Regulation of Body Temperature
Body temperature is regulated by balancing the
amount of heat the body produces with the amount of
heat the body loses.
Body heat is produced as a by-product of metabolism,
which is the sum of all biochemical and physiological
processes that take place in the body.
The hypothalamus, a gland located in the brain, acts as
a thermoregulator. It is able to adjust body temperature
that results in either increasing or decreasing heat
production throughout the day.

10
 • Regulation of Body Temperature
The anterior Hypothalamus promotes heat loss
through vasodilatation and sweating
The posterior Hypothalamus promotes: – Heat
conservation by vasoconstriction – Heat
production And maintains the core temperature

11
 Thermoregulation
Thermoregulation: Balance between heat
production and heat loss. When the amount of heat
produced by the body exactly equals the amount of
heat lost, the person is in heat balance.
1. Heat production
2. Heat loss
Heat production in the body is called
thermogenesis. Heat loss to the environment is
called thermolysis.

12
 Heat Production
Heat production:
Basal metabolic rate: Basal metabolic rate
(BMR) is the total number of calories that your
body needs to perform basic, life-sustaining
functions like breathing and circulation etc.
Muscle activity: Body cells are constantly
producing and breaking down ATP (Adenosine
triphosphate) and these chemical reactions produce
heat during.

13
 Heat Production
Thyroxin: Thyroid hormones stimulate diverse
metabolic activities most tissues, leading to an increase
in basal metabolic rate
Epinephrine, nor epinephrine and
sympathetic stimulation:
Epinephrine and nor epinephrine are released by the
adrenal medulla and nervous system respectively. They
are the flight/fight hormones that are released when the
body is under extreme stress. During stress, much of the
body's energy is used to combat imminent danger.

14
 Heat loss
Radiation: The emission of energy as electromagnetic
waves from the body.
Conduction: It is the transfer of heat from one surface
to the other through direct contact. Heat is transferred
via solid material
Convection: Convection is the dispersion of heat by air
currents
Conversion/Vaporization: Evaporation is the
continuous evaporation of moisture from the respiratory
tract and from the mucosa of the mouth as well as from the
skin.
15
 Heat loss

16
 Normal range of body temperature
(Adults)

17
 Factors affecting body temperature:
Age Infants greatly influenced by the temperature, children more labile than adult
and elderly are extremely sensitive to environmental change due to decreased
thermoregulatory control

Diurnal variation Body temperature normally change throughout the

day, varying as much as 1.0 °C between early morning and late afternoon The point
of highest body temperature is usually reached between 8pm and 12 midnight and the
lowest point is reached during sleep between 4 a.m. and 6 a.m.

Exercise increased temperature.

Hormones Women usually experience more hormone fluctuations than men,
progesterone secretion in women raises body temperature.

Stress Epinephrine and nor epinephrine increases metabolic activity and

heat production
18
Environment
 Alteration in body temperature

19
 Alteration in body temperature
The normal range for adults is considered to be between 36°C
and 37.5°C (96.8°F to 99.5°F).
There are two primary alterations in body temperature:
1. Pyrexia or Hyperthermia
2. Hypothermia.
1. Pyrexia
A body temperature above the usual range is called pyrexia,
hyperthermia, or (in lay terms) fever. A very high fever, such
as 41°C (105.8°F), is called hyperpyrexia.
Febrile: The client who has a fever is referred to as febrile.
Afebrile: The one who does not, is called afebrile .

20
21
 Pyrexia
1. Low Pyrexia: The fever does not rise more than
99 to 100 F
2. Moderate Pyrexia: Body temperature remain
between 100-103 degree F
3. High Pyrexia: Body temperature remain
between 103- 105 degree F
4. Hyperpyrexia: Temperature above 105 degree F

22
Types of fevers
Intermittent Remittent
fever fever
•A wide range of
• Body temperature temperature
alternates at regular fluctuations (more
intervals between than 2°C [3.6°F])
periods of fever occurs over the 24-
and periods of normal hour period, all of
or subnormal which are above
temperatures. normal
•E.g. malaria. • e.g. in cold or
influenza
08/03/2022
Types of fevers…
Relapsing
Constant fever
fever

• Short febrile periods

•The body temperature
of a few days are
interspersed with fluctuates minimally
periods of 1 or 2 days but always remains
of normal temperature. above normal.
•Common in vector •This can occur with
born diseases typhoid fever.
•Dengue, meningitis
etc
08/03/2022
25
 Pyrexia (Conti…)
Fever Spikes: A temperature that rises to fever level
rapidly following a normal temperature and then
returns to normal within a few hours is called a fever
spike. Bacterial blood infections often cause fever
spikes.
Inverse Fever: The highest range of temperature is
recorded in morning hours and lowest in the
evening.
Hectic Or Swinging Fever: When difference
between high and low temperature is very great.
26
 Alteration in body temperature
In some conditions, an elevated temperature is not a true
fever. Two examples are heat exhaustion and heat stroke.
Heat exhaustion: is a result of excessive heat and
dehydration. Signs of heat exhaustion include paleness,
dizziness, nausea, vomiting, fainting, and a moderately
increased temperature (38.3°C to 38.9°C [101°F to 102°F]).
Heat stroke: Persons experiencing heat stroke generally
have been exercising in hot weather, have warm, flushed
skin, and often do not sweat. They usually have a
temperature of 41.1°C (106°F) or higher, and may be
delirious, unconscious, or having seizures

27
 Stages / Phases of Fever
• Invasion, onset of Fever, Period of rising
• Also called Cold or Chilled Phase
Onset

• Stadium, fever has reached its peak level and

remains constant
Course • Also called Plateau Phase

• Defervescence, elevated temperature declines

ABATEME • Also called as Flush Phase
NT
28
 Clinical Manifestation of Fever
ONSET (COLD OR CHILL PHASE)
Increased heart rate, Increased respiratory rate and depth,
Shivering
Pallid, cold skin ,Complaints of feeling cold , Cyanotic nail beds
“Gooseflesh” appearance of the skin ,Cessation of sweating
COURSE (PLATEAU PHASE)
Absence of chills ,Skin that feels warm , Photosensitivity ,
Glassy-eyed appearance , Increased pulse and respiratory rates ,
Increased thirst Mild to severe dehydration , Drowsiness,
restlessness, delirium, or convulsions ,Herpetic lesions of the
mouth , Loss of appetite (if the fever is prolonged) ,Malaise,
weakness, and aching muscles
29
DEFERVESCENCE (FEVER ABATEMENT/FLUSH PHASE)
 Hypothermia
Hypothermia is a core body temperature below the lower
limit of normal i.e. 95 F or 35 C. The three
physiological mechanisms of hypothermia are
(a) Excessive heat loss,
(b) Inadequate heat production to counteract heat loss,
(c) Impaired hypothalamic thermoregulation
If skin and underlying tissues are damaged by freezing cold,
this results in frostbite. Frostbite most commonly occurs in
hands, feet, nose, and ears in which ice crystal forms inside
the cell and damage it.

30
 Clinical Manifestation of Hypothermia
Decreased body temperature, pulse, and respirations
Severe shivering (initially)
Feelings of cold and chills
Pale, cool, waxy skin
Frostbite (discolored, blistered nose, fingers, toes)
Hypotension
Decreased urinary output
Lack of muscle coordination, Disorientation,
drowsiness progressing to coma

31
 Types of Hypothermia
1. Induced hypothermia: is the deliberate lowering of
the body temperature to decrease the need for oxygen
by the body tissues such as during certain surgeries.
2. Accidental hypothermia: can occur as a result of
(a) exposure to a cold environment,
(b) immersion in cold water, and
(c) lack of adequate clothing, shelter, or heat.
In older adults, the problem can be compounded by a
decreased metabolic rate and the use of sedative
medications.

32
 Sites to Measure Temperature
 Oral
 Rectal
 Axillary
 Tympanic membrane
 Temporal artery

Condition of resident determines which is the best site for measuring

body temperature.

33
Advantages and Disadvantages of Sites for Body
Temperature Measurement

34
 Types Of Thermometer

35
 Thermometer

36
 Thermometer
Two parts of thermometer-bulb and stem
Blub is fragile part, containing mercury, sensitive
to temperature.
Stem is hollow tube in which mercury can rise.
There are two scales, Fahrenheit and Celsius

Mercury, a liquid metal, with silvery appearance is used in

thermometers, because it is very sensitive to a small changes
in temperature, expansion of mercury is uniform, easily
visible.

37
 Temperature: Safety Precautions
Hold rectal and axillary thermometers in place 
Stay with resident when taking temperature 
Prior to use, shake liquid in glass down 
Shake thermometer away from resident and hard
objects 
Wipe from end to tip of thermometer prior to reading 
Delay taking oral temperature for 10 - 15 minutes if
resident has been smoking, eating or drinking hot/cold
liquids

38
 Conti…
Oral – most common, most convenient
Rectal – registers one degree Fahrenheit higher
than oral, most accurate
Axillary – least accurate; registers one degree
Fahrenheit lower than oral
Tympanic – probe inserted into the ear canal

39
 Pulse
The pulse is an index of the heart’s rate and rhythm.
Pulse provides valuable data about person’s
cardiovascular status.

DEFINITIONS- “
The pulse is a wave of blood created by contraction
of the left ventricle of the heart.”

40
 Physiology of Pulse
Blood flows through the body in a continues circuit.
Electrical impulses originating from the SA node travel
through heart muscle to stimulate cardiac contraction.
Approximately 60 to 70 ml (stroke volume) of blood
enters the aorta with each ventricular contraction.
With each stroke volume ejection, the wall distends,
creating a pulse wave that travels rapidly toward the distal
ends of the arteries.
When a pulse wave reaches a peripheral artery, it can be
felt by palpating the artery lightly against underlying bone
or muscles.
41
 Regulation of Pulse
Pulse is regulated by the Autonomic Nervous System through the Sino-atrial
node.( Often called pace-maker.)
Para sympathetic stimulation decreases the heart rate
Sympathetic stimulates increase the heart rate.
The quantity of blood forced out of the left ventricle during each contraction is
called stroke volume.(70 ml for an average adult).
Cardiac output = Stroke volume × Pulse rate =70ml × 80 BPM =5600
ml =5.6 L/min
The number of pulsing sensation occurring in 1minute is the pulse rate.
The volume of blood pumped by the heart during 1 minute is the Cardiac
output.
Pulse rate X Stroke Volume = Cardiac out put
70 beats per minute X 70 ml / beat = 4.9 L/min
42 60 beats per minute X 85 ml / beat = 5.1 L/min
 Pulse assessment:
A pulse is commonly assessed by palpation (feeling) or
auscultation using stethoscope. A pulse is normally palpated by
applying moderate pressure with the three middle fingers of the
hand. The pads on distal aspects of the finger are the most
sensitive areas for detecting a pulse with gentle pressure. A
stethoscope is used for assessing apical pulse. While palpating a
pulse a nurse should assess the followings…….
 Pulse Rate
 Pulse Rhythm
 Pulse Volume
 Character
 Bilateral Equality
43
 Conti..
Pulse Rate :- It is stated as number of pulses or beats
per minute. Count the pulses for not less than half
minute. BPM
Normal 60-100 b/min (80/min)
Adult PR > 100 BPM is called tachycardia
Adult PR < 60 BPM is called bradycardia

44
 Conti..
Pulse Volume, or force, refers to the strength of the pulse when
the heart contracts. The pulse volume is also called the pulse
strength or quality, refers to the force of blood with each beat
It can be range from absent to bounding.
Bounding- Strong full force pulse.
Thready / weak- Difficult to palpate, a pulse of diminished
strength.
Absent- No palpable pulse.

Volume is influenced by the forcefulness of the heartbeat, the

condition of the arterial walls, and hydration or dehydration.

45
 Conti …
Pulse  Rhythm refers to the regularity, or equal
spacing, of all the beats of the pulse. Normally, the
intervals between each heartbeat are of the same
duration.
A pulse with an irregular rhythm is known as a
dysrhythmia or arrhythmia.
Equal time elapses between beat of a normal pulse;
this steady beat is called Pulsus regularis.
A pulse with an irregular rhythm is referred to an
Arrhythmia.
46
 Conti…
Bilateral Equality or Symmetry of Pulse
When assessing peripheral pulse to determine the
adequacy of blood flow to a particular area of the
body.
To check the blood flow of bilateral is important.

47
 Types of Pulse
1. Peripheral pulse is a pulse located away from
the heart, for example, in the foot or wrist.
Assessed via fingers
2. The apical pulse, in contrast, is a central pulse;
that is, it is located at the apex of the heart. It is
also referred to as the point of maximal impulse
(PMI).
Assessed or taken via stethoscope

48
 Pulse Sites
1. Radial – base of thumb
2. Temporal – side of forehead
3. Carotid – side of neck
4. Brachial – inner aspect of elbow
5. Femoral – inner aspect of upper thigh
6. Popliteal - behind knee
7. Dorsalis pedis – top of foot
8. Posterior tibial
9. Apical pulse – over apex of heart
taken with stethoscope
left side of chest

49
 Pulse Sites

50
 Variations in Pulse by Age

51
 Factors Affecting Pulse
Age
Sex
Exercise or Physical training
Body fluids
Position
Drugs
Illness
Emotions
Temperature

52
 Factors Affecting Pulse
Age
As age increases, the pulse rate gradually decreases overall. See
Table 29–2 for specific variations in pulse rates from birth to
adulthood.
Sex
After puberty, the average male’s pulse rate is slightly lower than
the female’s.
Exercise
The pulse rate normally increases with activity. The rate of
increase in the professional athlete is often less than in the
average person because of greater cardiac size, strength, and
efficiency.

53
 Factors Affecting Pulse
Hypovolemia/dehydration. Loss of blood from the
vascular system increases pulse rate. In adults, the loss of
circulating volume results in an adjustment of the heart
rate to increase blood pressure as the body compensates
for the lost blood volume.
Stress. In response to stress, sympathetic nervous
stimulation increases the overall activity of the heart.
Stress increases the rate as well as the force of the
heartbeat. Fear and anxiety as well as the perception of
severe pain stimulate the sympathetic system

54
 Factors Affecting Pulse
Fever
The pulse rate increases (a) in response to the
lowered blood pressure that results from peripheral
vasodilation associated with elevated body
temperature and (b) because of the increased
metabolic rate.
Medications.
Some medications decrease the pulse rate, and others
increase it. For example, cardiotonics (e.g., digitalis
preparations) decrease the heart rate, whereas
55
epinephrine increases it.
 Factors Affecting Pulse
Position. When a person is sitting or standing, blood
usually pools in dependent vessels of the venous
system. Pooling results in a transient decrease in the
venous blood return to the heart and a subsequent
reduction in blood pressure and increase in heart
rate.
Pathology. Certain diseases such as some heart
conditions or those that impair oxygenation can alter
the resting pulse rate.

56
 Respiration:
Respiration: Respiration is the mechanism the body
uses to exchange gases between the atmosphere and
the blood and the blood and the cell. Respiration
involves the following processes....
Ventilation; the movement of gases between in and
out of the lungs (inspiration and expiration).
Diffusion; the movement of oxygen and carbon
dioxide between the alveoli and the red blood cells.
Perfusion; the distribution of red blood cells to and
from the capillaries.
57
 Physiological control:
The respiratory center (medulla oblangata) in the brain stem
regulates the involuntary (adults normally breathe in a smooth,
uninterrupted pattern, 12- 20 times / min) control of respiration.
Ventilation is regulated by CO2, O2, and hydrogen ion
concentration (PH) in the arterial blood.
The most important factor in the control of ventilation is the
level of CO2 in the arterial blood.
An elevation in the Co2 level causes the respiratory control
system in the brain to increase the rate and depth of breathing.
The increased ventilatory effort removes excess CO2 by
increasing exhalation.

58
 Mechanism of breathing:
1. Inspiration/ inhalation ( active process)
2. Expiration / exhalation ( passive process)
3. Pause

59
 Mechanism of breathing
1. Inspiration:
During this phase the respiratory center sends impulses
along the phrenic nerve, causing the diaphragm to contract.
Abdominal organs move downward and forward, increasing
the length of the chest cavity to move air into the lungs.
The diaphragm moves approximately 1 cm, and the ribs
retract upward from the body’s midline approximately 1.2 -
2.5 cm.
During a normal, relaxed breath, a person inhales 500ml of
air. This amount is referred as Tidal volume (TV).

60
 Mechanism of breathing
2. Expiration / Exhalation:
During expiration the diaphragm relaxes and the
abdominal organs return to their original position.
The thorax decreases in size, and thus the lungs are
compressed.
The ribs move downward and inward
The sternum moves inward
3. Pause: the relaxation time between inspiration and
expiration.
The normal (breath) rate and depth of ventilation is called Eupnoea,
interrupted by sigh.
61
 Types of breathing
1. Costal (thoracic)
Observed by the movement of the chest up ward and
downward.
Commonly used for adults
2. Diaphragmatic (abdominal)
Involves the contraction and relaxation of the
diaphragm, observed by the movement of abdomen.
Commonly used for children.

62
 Factors affecting respiration:
Body position
Exercise
Acute pain
Medications
Smoking
Hemoglobin function
Anxiety
Abdominal trauma
Neurological Injury

63
 Characteristics of the respiration:
When the respiration rate is taken, several
characteristics should be noted:
Rate,
Rhythm,
Depth, and
The quality or characteristics of breathing.

64
 Characteristics of the respiration:
Respiratory Rate: It is the number of respirations per
minute. The normal respiration rate for healthy adults
at rest is 12 to 20 cycles per minute. Children have a
more rapid rate of breathing than adults. Respiratory
Rate Ranges of Various Age Groups
Newborn 30–50
1–2 years old 20–30
3–8 years old 18–26
9–11 years old 16–22
12–Adult 12–20
65
 Characteristics of the respiration:
Respiratory Rate:
Tachypnea—quick, shallow breaths
Bradypnea—abnormally slow breathing
Apnea—cessation of breathing

66
 Characteristics of the respiration:
 Respiratory Rhythm: It refers to the regular and
equal spacing of breaths. In a regular respiratory
rhythm, the cycles of inspiration and expiration have
about the same rate and depth. With irregular
breathing patterns, the depth and amount of air
inhaled and exhaled and the rate of respirations per
minute will vary.

67
 Characteristics of the respiration:
Respiratory Depth: The depth of respiration is the
volume of air that is inhaled and exhaled. It is
described as either “shallow” or “deep.” Rapid but
shallow respirations occur in some disease
conditions, such as high fever, shock, and severe
pain.
Hyperventilation refers to deep and rapid
respirations, and hypoventilation refers to shallow
and slow respirations.

68
 Characteristics of the respiration:
Respiratory Quality: Respiratory quality or character
refers to breathing patterns — both normal and
abnormal. Labored breathing refers to respirations that
require greater effort from the patient.
Dyspnea—difficult and labored breathing during which the individual
has a persistent, unsatisfied need for air and feels distressed
Orthopnea—ability to breathe only in upright sitting or standing
positions
Breath Sounds: Normal respirations do not usually
have any noticeable sounds. However, certain diseases
and illnesses can cause irregular respiration sounds.
69
 Characteristics Of The Respiration:
Abnormal breath sounds that are audible without
amplification include the following:
Stridor: A shrill, harsh sound, heard more clearly during
inspiration but that can occur during expiration. This
sound may occur when there is airway blockage, such as
in children with croup and patients with laryngeal
obstruction. –
Stertor (stertorous breathing): Noisy sounds during
inspiration, sounds similar to those heard in snoring.
Crackles (also called rales): Crackling sounds
resembling crushing tissue paper, caused by fluid
accumulation in the airways.
70
 Characteristics Of The Respiration:
 Rhonchi — Rattling, whistling, low-pitched sounds made
in the throat. Rhonchi can be heard in patients with
pneumonia, chronic bronchitis, cystic fibrosis, or COPD.
 Wheezes — Sounds similar to rhonchi but more high
pitched, made when airways become obstructed or severely
narrowed, as in asthma or COPD.
 Cheyne-Stokes breathing — Irregular breathing that may
be slow and shallow at first, then faster and deeper, and that
may stop for a few seconds before beginning the pattern
again. This type of breathing may be seen in certain patients
with traumatic brain injury, strokes, and brain tumors.

71
 Assessment of respiration Respiratory
rate
Eupnoea ( 12 – 20/ min)
Ventilatory depth: The depth of respiration is
assessed by observing movement of chest wall
A deep respiration involves a full expansion of the lungs
with full exhalation.
Ventilatory depth: Diaphragmatic breathing results
from the contraction and relaxation of the diaphragm
and is best observed by watching abdominal
movements.

72
 Conti…
Ventilatory diffusion and perfusion:
The respiratory process of diffusion and perfusion
can be evaluated by measuring the oxygen saturation
of the blood.
Color of skin
Capillary refill

73
 Alterations In Respirations
Apnea: Absence of breathing.
Eupnea: Normal breathing
Orthopnea: Only able to breathe comfortable in upright
position (such as sitting in chair), unable to breath laying
down.
Dyspnea: Subjective sensation related by patient as to
breathing difficulty.
Paroxysmal nocturnal dyspnea attacks of severe shortness
of breath that wakes a person from sleep
Hyperpnea: Increased depth of breathing
Tachypnea: Increased frequency without blood gas
abnormality
74
Bradypnea: is a respiratory rate that is lower than normal for
 Alterations in respiration
 Hyperventilation: Increased rate or depth, or
combination of both.
Hypoventilation: Decreased rate or depth, or
some combination of both.
Kussmaul's Respiration: is a deep and labored
breathing pattern often associated with severe
metabolic acidosis, particularly diabetic
ketoacidosis (DKA) but also kidney failure.

75
 Blood Pressure
BLOOD PRESSURE
Blood pressure (BP) is one of the most important vital
signs because it aids in diagnosis and treatment,
especially for cardiovascular health. Blood pressure
readings are almost always taken at every medical visit,
even if it is the only vital sign obtained.
Definition:
Blood pressure is the amount of force exerted on the
arterial walls while the heart is pumping blood—
specifically, when the ventricles contract.

76
 Blood Pressure
Blood pressure is measured by gauging the force of
this pressure through two specific readings: Systolic
and Diastolic.
Systolic blood pressure is the highest pressure that
occurs as the left ventricle of the heart is contracting.
Diastolic blood pressure is the lowest pressure level
that occurs when the heart is relaxed and the
ventricle is at rest and refilling with blood.

77
 Blood Pressure
Blood pressure is read in millimeters (mm) of mercury
(Hg), or “mmHg”. Blood pressure is recorded using
just the systolic (highest pressure) reading over the
diastolic (lowest pressure), similar to writing a
fraction.
For example, 120/80 would indicate a systolic
pressure of 120 (mmHg) and a diastolic reading of 80
(mmHg).

78
 Conti..
Pulse pressure: PP is the difference between the
systolic and diastolic readings and calculated by
subtracting the diastolic reading from the systolic
reading. If the blood pressure is 120/80, the pulse
pressure is 40.
In general, a pulse pressure that is greater than 40 mmHg
is considered widened, and one that is less than 30
mmHg is considered to be narrowed.
.

79
 Conti..
Pulse pressure
A widened pulse pressure may be an indicator for
cardiovascular disease and anemia
A narrowed pulse pressure may be an indicator for
congestive heart failure (CHF), stroke, or shock.
Although pulse pressure is useful in predicting
cardiovascular risk in patients, it should not be used
alone and depends on various other factors, such as
the patient’s BP and age.

80
 Physiology and Regulation:
There are two basic mechanisms for regulating blood
pressure:
(1) short-term mechanisms, which regulate blood
vessel diameter, heart rate and contractility
(2) long-term mechanisms, which regulate blood
volume

81
82
83
 Conti..
2. Long-term mechanisms, which regulate blood
volume Kidneys regulate arterial blood pressure by
Direct renal mechanism
Indirect renal (renin-angiotensin-aldosterone)
mechanism

84
85
 Physiology of arterial blood pressure
A person’s blood pressure reflects the interrelation
ship of followings…..
1. Cardiac out put
2. Peripheral Vascular Resistance
3. Blood volume
4. Blood viscosity
5. Artery elasticity

86
 Blood Pressure Guidelines

87
 Blood Pressure Guidelines

88
 Factors affecting blood pressure
Race
Exercise
Age
Diurnal variation
Stress
Gender
Medications

89
 Blood Pressure Assessment
Equipment used are
blood pressure cuff, a sphygmomanometer, and a stethoscope.
Types of sphygmomanometers:
Mercury
Aneroid
Electronic
1. Direct (invasive, arterial blood pressure monitoring)
2. Indirect
I. Auscultatory method
II. Palpatory method

90
 Blood Pressure Assessment
1.Direct method- A monitor is used for this method.
This is a continuous method which measures mean
pressures. A needle or catheter is inserted into the
brachial, radial or femoral artery and a monitor displays
arterial pressure in wave form.
Direct (invasive) blood pressure monitoring is
recommended in sick and compromised patients, those
who are at risk of developing major blood loss during
surgery or for whom abnormal blood gases are
anticipated (patients with respiratory disease or
undergoing thoracotomies).
91
 Blood Pressure Assessment
2. Indirect method- Taking blood pressure by using
sphygmomanometer.
Palpatory method
In the palpatory method of blood pressure
determination, instead of listening for the blood flow
sounds, the nurse uses light to moderate pressure to
palpate the pulsations of the artery as the pressure in
the cuff is released. The pressure is read from the
sphygmomanometer when the first pulsation is felt

92
Indirect (non-invasive) BP
Mercury Sphygmomanometer

Aneroid sphygmomanometer

 Digital sphygmomanometer
 Conti..
The auscultatory method is most commonly used in
hospitals, clinics, and homes. External pressure is applied
to a superficial artery and the nurse reads the pressure
from the sphygmomanometer while listening with a
stethoscope. When carried out correctly, the auscultatory
method is relatively accurate.
When taking a blood pressure using a stethoscope, the
nurse identifies phases in the series of sounds called
Korotkoff’s sounds. The systolic pressure is the point
where the first tapping sound is heard while the diastolic
pressure is the point where the sounds become inaudible .
94
 BP Assessment sites:
1. Upper arm
2. Thigh
3. Leg
4. Forearm
Upper arm (using brachial artery (commonest)
Thigh around popliteal artery
Fore -arm using radial artery
Leg using posterior tibial or dorsal pedis

95
 Alteration in Blood Pressure
1.Hypertension
2.Hypotension:
3. Orthostatic Hypotension or Postural Hypotension

96
 Alteration In Blood Pressure
1. Hypertension:
It is an often a symptomatic disorder characterized by
persistently elevated blood pressure. The diagnosis of
hypertension is made when an average of two or more
diastolic readings on at least two visits is 90 mm Hg or
higher. Or
when the average of multiple systolic blood pressures on
two or more subsequent visits is consistently higher than
135 mm Hg.

97
 Alteration in Blood Pressure
2. Hypotension: is generally considered present
when the systolic blood pressure falls 90 mm Hg or
below.
3. Orthostatic Hypotension or Postural
Hypotension:
It occurs, when a normotensive person develops
symptoms of and low blood pressure when rising to
an upright position. Or change his position from
lying to sitting and to standing position.

98
 REFERENCES
kozier & Erb’s Fundamental of Nursing ,8th edition
( Audrey Berman ,Shirlee J. Synder).

Fundamentals of Nursing: Standards & Practice, 2nd Edition

( Sue C. DeLaune Patricia K. Ladner.)

www.slideshare.com

www.google.com

99
100