Virtual Skills Lab

Vital Signs
 Student Learning
Outcome
• Explain the physiologic processes
involved in homeostatic
regulation of temperature, pulse,
respiration, and blood pressure.
• Describe the normal ranges for
body temperature, pulse,
respirations, and blood pressure
across the lifespan.
 Normal
Ranges for • Oral temperature—37.0°C, 98.6°F

Vital Signs • Pulse rate—60 to 100 (80 average)

• Respirations—12 to 20 breaths/min
• Blood pressure—120/80

for Healthy
Adults
 • Being human, we are homeothermic; we are
warm-blooded and maintain body
temperature independently of our
environment. Our body generates heat as it
Temperatu burns food. It loses heat through the lungs
(breathing), through the skin (sweating), and
re in body discharges (urine, feces, vomitus, or
blood). Body temperature is defined as the
measure of the heat inside the body: the
balance between heat produced and heat
lost.
 • Body temperature is one of
six vital signs that are
monitored when a person is
ill.
Temperatu • Abnormal body
re temperature, such as
hypothermia or
hyperthermia, may indicate
signs of illness and warrant
treatment.
 • Primary source is metabolism.

Heat
• Hormones, muscle movements, and
exercise increase metabolism.
• Epinephrine and norepinephrine are

Productio released when additional heat is required,

and can alter metabolism.
• Thyroid hormone and shivering also

n increase heat production. Energy

production decreases and heat
production increases.
Sources
• Skin (primary source)
• Evaporation of sweat

of Heat • Warming and humidifying inspired air

• Eliminating urine and feces

Loss • All can affect body temperature

Transfer of
Body Heat
to
External
Environme
nt
 Heat Loss

Heat loss occurs through the following:

(1) Conduction--direct physical contact with an object.

(2) Convection--when body heat warms surrounding air which rises and is
replaced by cooler air.

(3) Radiation--body heat warms surrounding objects without physical contact.

(4) Evaporation--perspiration that is removed from the body surface by change

from a liquid to a vapor.
Factors • Circadian rhythms

Affecting • Age and gender

• Physical activity
Body • State of health
Temperatu • Environmental temperature
re
 Temperature can be measured several
different ways:
Oral with a glass, paper, or electronic
thermometer (normal 98.6F/37C)
Axillary with a glass or electronic
Temperat thermometer (normal 97.6F/36.3C)
Rectal or "core" with a glass or electronic

ure thermometer (normal 99.6F/37.7C)

Aural (the ear) with an electronic
thermometer (normal 99.6F/37.7C)
Note: Of these, axillary is the least and
rectal is the most accurate.
Types of Thermometers
Cont
Checking a
• https://www.youtube.com/watch?v=nvl1qQfgz
Temperatur uw

e
 1. Best done immediately after taking the
patient's pulse. Do not announce that you
are measuring respirations
2. Without letting go of the patient's wrist
begin to observe the patient's breathing. Is
it normal or labored?

Respiration 3. Count breaths for 15 seconds and

multiply this number by 4 to yield the
breaths per minute. (Note when you are
beginning in your career count breaths for
1 full minute).
4. In adults, normal resting respiratory rate
is between 12-20 breaths/minute.
5. Rapid respiration is called tachypnea.
?? What is Bradypnea, Orthopnea, Apnea
 • Pulmonary ventilation: movement of air in and out
of lungs
• Inhalation: breathing in
• Exhalation: breathing out
Respirations • Diffusion: Exchange of oxygen and carbon dioxide
between the alveoli of lungs and circulating blood
• Perfusion: Exchange of oxygen and carbon dioxide
between circulating blood and tissue cells
 • Changes in response to tissue
demands
• Controlled by respiratory centers
in the medulla and pons
• Activated by impulses from
chemoreceptors
• Increase in carbon dioxide is the
most powerful respiratory
Rate and stimulant
Depth of
Breathing
 Eupnea: normal, Tachypnea: increased
unlabored respiration; respiratory rate; may
one respiration to four occur in response to an
heartbeats increased metabolic rate

Respiratory Bradypnea: decreased

respiratory rate; occurs in Apnea: periods when no

Rates
some pathologic breathing occurs
conditions

Orthopnea: changes in
Dyspnea: difficult or
breathing when sitting or
labored breathing
standing
 • Exercise
• Respiratory and cardiovascular disease
• Alterations in fluid, electrolyte, and
acid-base balances
Factors • Medications
Affecting • Trauma

Respirations • Infection
• Pain
• Emotions
 • https://www.youtube.com/watc
h?v=IDFaPKFbIO8

Checking
Respiratory
Rate
Pulse Oximeter

• A pulse oximeter is a device intended for the

non-invasive measurement of arterial blood
oxygen saturation and pulse rate.
• Most appropriate noninvasive technique for
continuous SpO2 monitoring and spot checks
• It uses probes with two LEDs (light-emitting
diodes) generating red and infrared lights.
• The LEDs transmits light pulses through
capillary beds.
• The ratio of light absorbed at systole and
diastole is translated into an oxygen
saturation measurement.
Pulse Oximetry
•SpO2 - Saturation of oxygen by pulse oximeter.
•SaO2 - Saturation of oxygen by arterial blood
•SpO2 is accurate in patients with good
perfusion and saturation is 70% or higher.
•Always trust the ABG oxygen saturations over
the pulse oximeter readings. Draw ABG’s if
pulse oximeter saturations are questionable.
•Pulse oximeter monitoring is recommended
for sleep apnea, critically ill patients, during
simple oxygen therapy, post op patients,
patients receiving pain control and sedation
(PCA pump), and during rest & exercise tests
Pulse Oximetry • Factors that influences
accuracy of pulse oximetry:
Cont’d • Movement - tremors and
spastic movements
• Low perfusion - shock
• Hypovolemia
• Peripheral vasoconstriction
• Hypothermia
• Dyes
• Contrast dyes used
in cardiac
catheterization.
• Dark nail polish
• Ambient lights
Pulse Oximetry •Pulse oximeter probes:
•Pulse oximeter has
Cont’d disposable & non
disposable probes.
•Disposable probes should
be changed every 24 hrs &
prn.
•Probe placement:
•Finger, toe, earlobe,
temporal or bridge of
nose.
•Probe placed with the
light and cord on top.
 • Regulated by the autonomic nervous system

Pulse through cardiac sinoatrial node

• Parasympathetic stimulation—decreases
heart rate

Physiolo • Sympathetic stimulation—increases heart

rate

gy
• Pulse rate = number of contractions over a
peripheral artery in 1 minute
 •A normal adult heart rate is between 60
and 100 beats per minute.
•A pulse greater than 100 beats/minute is
defined to be tachycardia.

Pulse • A pulse less than 60 beats/minute is

defined to be bradycardia.

Cont. • In some cases tachycardia and

bradycardia are not necessarily abnormal.
Athletes tend to be bradycardic at rest
(superior conditioning). Tachycardia is a
normal response to stress or exercise.
 •Sit or stand facing your patient.
•Grasp the patient's wrist with your free (non-watch bearing) hand
(patient's right with your right
•or patient's left with your left). There is no reason for the patient's arm
to be in an awkward

Checking a •position, just imagine you're shaking hands.

•Compress the radial artery with your index and middle fingers.

Patient’s •Count the pulse for 15 seconds and multiply by 4 (Always count for a
full minute if the pulse is irregular).

Pulse • Record the rate and rhythm

•Note whether the pulse is regular or irregular:
•Regular - evenly spaced beats, may vary slightly with respiration
•Regularly Irregular - regular pattern overall with "skipped" beats
•Irregularly Irregular - chaotic, no real pattern, very difficult to measure
rate accurately
•Interpretation
Sites for Detecting Pulse
by Light Palpations
• Rate: Normal, tachycardia,
bradycardia
• Amplitude and quality (strong or
weak)
• Rhythm
• Volume of blood ejected with each
heartbeat (stroke volume)
 Check the radial pulses on both sides. If the radial
pulse is absent or weak, check the brachial pulses.
Check the posterior tibia and dorsalis pedis pulses on
both sides. If these pulses are absent or weak, check
the popliteal and femoral pulses.
Location of pulses
a) Carotid – neck

Pulse b) Brachial – upper arm

c) Radial – wrist
d) Femoral – groin
e) Popliteal – behind knee
f) Posterior tibial – back of leg near Achilles tendon
g) Dorsalis pedis (pedal) – top of foot. Requires light
touch
Grading force of
pulse

• Grading force of pulse

• 0 absent
• 1+ weak, thready
• 2+ normal
• 3+ increased, full, bounding
 • https://www.youtube.com/watch
?v=JmfABHbL-HM

Assessing
the pulse
 Blood pressure (BP) is the pressure by circulating blood on the
walls of blood vessels. Arterial refers systemic circulation.
During each heartbeat, blood pressure varies between a
maximum systolic and a minimum diastolic pressure. The blood

Blood
pressure in the circulation is principally due to the pumping
action of the heart. Differences in mean blood pressure are
responsible for blood flow from one location to another during
circulation. The rate of mean blood flow depends on the
resistance to flow presented by the blood vessels. Mean blood
pressure decreases as the circulating blood moves away from

Pressur
the heart through arteries, capillaries and veins due to viscous
losses of energy. Mean blood pressure drops over the whole
circulation, although most of the fall occurs along the small
arteries and arterioles. Gravity affects blood pressure via
hydrostatic forces (e.g., during standing) and valves in veins,

e
breathing, and pumping from contraction of skeletal muscles
also influence blood pressure in veins. The measurement blood
pressure without further specification usually refers to the
systemic arterial pressure measured at a person's upper arm
and is a measure of the pressure in the brachial artery, major
artery in the upper arm. A person’s blood pressure is usually
expressed in terms of the systolic pressure over diastolic
pressure and is measured in millimeters of mercury (mmHg).
To measure a Blood Pressure
The patient should not have eaten, smoked, taken caffeine, or engaged in vigorous exercise within the last 30
minutes. The room should be quiet and the patient comfortable.
1. Position the patient's arm so the antecubital fold is level with the heart.
2. Center the bladder of the cuff over the brachial artery approximately 2 cm above the antecubital fold. Proper cuff
size is essential to obtain an accurate reading. Be sure the index line falls between the size marks when you apply the
cuff. Position the patient's arm so it is slightly flexed at the elbow.
3. Palpate the brachial pulse and inflate the cuff until the pulse disappears. This is a rough estimate of the systolic
pressure. Place the stethoscope over the brachial artery. Inflate the cuff 20 to 30 mmHg above the estimated systolic
pressure. Release the pressure slowly, no greater than 5 mmHg per second. The level at which you consistently hear
beats is the systolic pressure. Continue to lower the pressure until the sounds muffle and disappear(This is the
diastolic pressure). 9. Record the blood pressure as systolic over diastolic (120/70). Interpretation Higher blood
pressures are normal during exertion or other stress. Systolic blood pressures below 80 may be a sign of serious
illness or shock.
Blood
Pressure •Normal <130 <85

Cont. •High Normal 130-139 85-89

•Mild Hypertension 140-159 90-99
•Moderate Hypertension 160-179
100-109
•Severe Hypertension 180-209 110-
119
•Crisis Hypertension >210 >120
Factors • Age, gender, race

Affectin • Circadian rhythm

• Food intake

g Blood
• Exercise
• Weight
• Emotional state

Pressur • Body position

• Drugs/medications

e
Decreased Blood Pressure

Hypotension: Systolic reading that is consistently 90– Orthostatic hypotension (postural hypotension): a
115 mm Hg. decrease of 20 mm systolic or 10 mm decrease in
diastolic; that occurs in 3 minutes of position change.
Assessing Blood
• Automatic blood pressure reports systolic and
diastolic.

Pressure • If unable to retrieve a blood pressure with

automatic cuff a doppler is used.
Blood
Pressur • https://www.youtube.com/watch?v=bHXv
hOQ0hYc

e
Basics
Taking
a blood • https://www.youtube.com/watch?v=sYpC
-WZUj0c

pressur
• https://www.youtube.com/watch?v=lKtfw
iwHjLI

e video
Appropri • Screenings at health fairs and
clinics
ate • In the home

Times to
• Upon admission to any health care
agency
• When medications are given that
Measure affect cardiac rate and rhythm
• Before and after invasive
Vital diagnostic and surgical procedures
• In emergency situations

Signs
Factors
Affecting Patient’s
Co-
Frequenc medical
diagnosis
morbidities

y of Vital
Signs Types of
treatments
received
Patient’s
level of
acuity
Assessm
ent
 Nursing Diagnoses
• Hyperthermia
• Dehydration Illness Trauma Vigorous activity
• Flushed skin, tachycardia, tachypnea, temperature above
normal range
• Ineffective Peripheral Tissue Perfusion
• Hypertension, smoking, diabetes mellitus
• Absent / diminished pulses, BP changes, capillary
refill >3 seconds, altered skin characteristics
 • Ineffective breathing pattern
• Anxiety, hyperventilation, pain,
neurologic damage
• Alterations in depth of breathing,
Nursing dyspnea, tachypnea, use of
accessory muscles to breathe

Diagnos • Decreased cardiac output

• Altered heart rate, altered rhythm,
altered contractility, altered

es afterload
• Arrhythmias, palpitations,
orthopnea, variations in blood
pressure readings, decreased
peripheral pulses
 An unconscious patient arrives at the
Emergency room after a night of
drinking. Vital signs are Temperature
98.2 degrees Fahrenheit, Pulse 62
bpm, Respiratory Rate 8 breaths per
minute, Blood Pressure 102/64. The
patient is experiencing
Questions • Hypothermia
• Eupnea
• Bradycardia
• Bradypnea*
This Photo by Unknown Author is licensed under CC BY-ND
A nurse is taking a rectal
temperature on an unconscious
patient. What readings would be
in the normal range?
•96.8 - 100.5 degrees
Fahrenheit
• 97.5 - 101 degrees Fahrenheit
• 96. 4 - 100.5 degrees
Fahrenheit
• 98.7 - 100.5 degrees
Fahrenheit
 If a patient’s oral temperature is 98.0
F, the nurse might expect the rectal
temperature to be ____, because
rectal temperature is a more
accurate measure of ________
temperature than is oral.
a. higher, thermoregulation
b. higher, core
c. lower, baseline
d. lower, core

This Photo by Unknown Author is licensed under CC BY-ND

 In which of the following situations
should the nurse delay taking vital
signs, assuming the patient’s
situation is not life-threatening or
critical?
a. On admission to a health care
facility.
b. When a patient reports
nonspecific symptoms of physical
distress (e.g., feeling “funny” or
“different”).
c. When a patient is sleeping.
This Photo by Unknown Author is
licensed under CC BY

d. When the patient has finished a

caffeinated beverage with ice.
 If a patient is febrile at 103.3 F, the nurse
may choose to perform which of tasks?
(Select all that apply):
a. Notify the physician.
b. Administer the order for an antipyretic
such as Tylenol 650 mg by mouth as
prescribed.
c. Place ice packs under the patient’s
axilla and in the groin area until the
patient shivers.
d. Assess for other signs of fever and
This Photo by Unknown Author is licensed under CC BY
infection such as tachycardia,
tachypnea, and diaphoresis.
 When assessing a patient’s
blood pressure (BP), the nurse
knows that it is important to
select the proper sized cuff.
Selecting a cuff that is too
wide/large will falsely
__________ the BP, while
This Photo by Unknown Author is licensed under CC BY-SA
selecting a cuff too small/tight
will falsely _________ the BP.
a. Lower, Elevate
b. Elevate, Lower
c. Lower, Lower
d. Elevate, Elevate
 The normal range for an adult
pulse is ____ to______ beats per
minute. Tachycardia is defined as a
pulse rate higher than _______.
Bradycardia is defined as a pulse
rate less than _________.
a. 50 – 100, 60, 100
b. 60 – 120, 120, 60
This Photo by Unknown
Author is licensed under
c. 50-140, 100, 60
CC BY-NC-ND
d. 60-100, 100, 60
Which of the following blood
pressures is most concerning?
a. 35 y/o pregnant patient having
labor pain with a pressure of
140/88
b. 82 y/o thin, elderly female
with a baseline BP of 100/60
c. 45 y/o male with complaints
of chest pain and dyspnea and
a BP of 160/90
d. 22 y/o sleeping patient at 2AM
with BP of 98/72 whose
baseline on admission was
110/75
 The nurse assesses the
patient’s respiratory rate at 14
breaths per minute. What else
is important to routinely assess
and document as far as the
respirations are concerned?

a. Rhythm and depth

b. Open/close mouthed
This Photo by Unknown Author is licensed under CC BY
breathing and depth
c. Regularity and color of lips
d. Cough and depth
 Which of the following factors may contribute to
an increased heart rate (HR) or tachycardia?
(Select all that apply)

a. Exercise
b. Hypothermia
c. Loss of blood or hemorrhage
d. Emotions such as anxiety or fear

This Photo by Unknown Author is licensed under CC BY-SA

Which of the following factors
may contribute to tachypnea
(increased respiratory rate)?
(Select all that apply):

a. Chronic, long term smoking

b. Relaxation techniques
c. Exercise
d. Body Positioning
 A patient presents with a respiratory rate (RR)
of 20 breaths per minute and a regular
rhythm. You place a pulse oximeter on the
patient’s index finger and it reads SpO2 85%.
Before panicking, you should (Select all that
apply):

a. Observe for signs and symptoms of

decreased oxygenation: anxiety,
restlessness, tachycardia, and/or cyanosis.
b. Reposition sensor probe to an alternative
site with increased blood flow, such as
another finger or earlobe.
c. Ask the patient to take several deep
breaths.
d. Call a code blue, it is just a matter of time
before this patient goes into full cardiac
arrest.
•
This Photo by Unknown Author is licensed under CC BY-SA
 The major purpose of the pulmonary
and cardiovascular systems is to
oxygenate blood and then transport
that oxygenated blood throughout the
body, tissues, and organs. Knowing
this, the nurse knows, that if a
patient’s oxygenation saturation
drops, then which of the following
may be an expected finding?

a. An increase in respiratory rate and

a decrease in heart rate
b. A decrease in respiratory rate and a
This Photo by Unknown Author is licensed under CC BY decrease in heart rate.
c. An increase in respiratory rate and
an increase in heart rate.
d. A decrease in respiratory rate and
an increase in heart rate.
 A nurse familiar with the
structure of the heart knows
that the ____________
pumps oxygenated blood to
the body.

a. Right atrium
b.Right ventricle
c. Left atrium
d.Left ventricle

This Photo by Unknown Author is licensed under CC BY-SA

Blood pressure practice
• https://www.practicalclinicalskills.com/blood-pressure-course-conten
ts?courseid=102
Questions