Vital Signs

• Factors that influence body temperature

  • Age
  • Diurnal variations
  • Exercise
• Hypothalamus


  Thermoregulatory center of the body
• Surface temperature

  Skin, subcutaneous tissue, and fat cells
• Temperature

  Balance between the heat produced by the body and the heat lost from the body
• When we are exercising
• Elderly clients are more sensitive to environmental temperature
• Normal body temperature is 36.7°C - 37°C or 98.6°F
• Kinds of temperature

  • Surface temperature
  • Core temperature
• Infants are poikilothermic, meaning their body temperature is easily altered
• Diurnal variations in body temperature

  • Lowers when asleep and higher when active
  • 8 pm to 12 midnight
  • 4 am to 6 am
• Core temperature


  Temperature of deep tissue of the body
• Heat loss

  1. Radiation: Body heat lost to nearby objects without physical touch

  2. Conduction: Body heat lost through direct physical touch

  3. Convection: Body heat lost to surrounding air

  4. Evaporation: Body heat lost through perspiration
• Environment

  The temperature of the surroundings affects body temperature
• Stress


  Sympathetic nervous system stimulation increases epinephrine production, leading to a higher metabolic rate and body temperature
• Exercise

  Increase in muscle activity leads to an increase in adrenaline production, which increases body heat
• Terminologies in body temperature

  • Hyperpyrexia: Body temperature above 106.7°F due to hypothalamus changes
  • Febrile/Pyrexia or Hyperthermia: Abnormally high body temperature
  • Hypothermia: Caused by prolonged exposure to cold temperatures
  • Afebrile: Without fever
  • Common types of fever: Intermittent, Remittent, Relapsing/Recurrent, Constant/Continuous
• Management for fever

  1. Take temperature and assess symptoms

  2. Rest

  3. Stay hydrated or increase fluid intake
• Illness

  Infection leads to higher body temperature
• Types of thermometer

  • Glass thermometers: Mercurial, shaken before use, shorter tips for oral use, longer tips for rectal use
  • Strip thermometer: Contains thermochromic liquid crystals
  • Digital thermometer: Used for verification and calibration
• Hormones

  1. Release of progesterone increases body temperature

  2. Release of estrogen lowers body temperature
• Ovulation


  Body temperature decreases and then rises during ovulation
• Signs and symptoms of fever

  • Sweating
  • Chills, shivering or shaking
  • Hot or flushed skin
  • Headache
  • Body ache
  • Fatigue/weakness
  • Loss of appetite
  • Increased heart rate
  • Dehydration
• Diurnal variations

  • Body temperature lowers when asleep and is higher when active
  • Specific time intervals: 8 pm to 12 midnight, 4 am to 6 am
• Axillary temperature measurement


  • Safe and noninvasive
  • The thermometer must be left in place for a long time to obtain an accurate measurement
• Oral temperature measurement


  • Accessible and convenient
  • Thermometers break if bitten
  • Inaccurate if the client ingested hot or cold food, fluid or smoke
  • Could injure the mouth following oral surgery
• Management for fever

  1. Take your temperature and assess symptoms

  2. Stay in bed and rest

  3. Keep hydrated or increase fluid intake

  4. Stay cool or manage stress

  5. Tepid sponge bath/use of cold compress

  6. Take over the counter medication or take medication as prescribed
• Rhythm


  Refers to the regularity
• Pulse rate averages for different age groups

  • Newborn: 120-160
  • 1 year: 80-140
  • 5-8 years: 75-120
  • 10 years: 50-90
  • Teens: 50-90
  • Adult: 60-100
  • Older Adult: 60-100
• Temporal temperature measurement

  • Safe and noninvasive
  • Very fast
  • Requires electronic equipment that may be expensive or unavailable
  • Variation in technique needed if the client has perspiration on the forehead
• Factors affecting the pulse rate
• Factors affecting the pulse rate

  • Infants have high pulse rates
  • Adults have weak pulse rates
  • Males have higher pulse rates because they are generally more active than females
  • The heart pumps faster during exercising and when having a fever
  • Some medications affect heart rates like Digoxin
  • During bleeding, the heart pumps faster to compensate blood loss
  • Emotions affect the heart rate
  • Different types of position also affect the heart rate
• Pulse points

  • Temporal
  • Brachial
  • Carotid
  • Radial
  • Femoral
  • Dorsalis Pedis
  • Popliteal
  • Posterior Tibialis
• Tympanic temperature measurement


  • Readily accessible
  • Reflects the core temperature
  • Very fast
  • Can be uncomfortable and involves risk of injuring the measurement if the probe is inserted too far
  • Repeated measurements may vary, right and left measurements may differ
  • Very expensive
• Fever symptoms


  • Chills, shivering or shaking
  • Hot or flushed skin
  • Headache
  • Body ache
  • Fatigue/weakness
  • Loss of appetite
  • Increased heart rate
  • Dehydration
• Sites for temperature measurement

  • Oral
  • Rectal
  • Axillary
  • Tympanic
  • Temporal
• Rectal temperature measurement

  • Reliable measurement
  • Inconvenient and more unpleasant for clients
  • Difficult for client who cannot turn to the side
  • Could injure the rectum following rectal surgery
  • Presence of stool may interfere with thermometer placement
• Pulse


  1. Pulse rate or Heart rate

  2. Wave of blood created by contraction of the left ventricle of the heart
• Characteristics of pulse rate

  • Refers to the number of pulsations per minute
  • Adult: 60-100 per minute
  • Infant: 100-160 beats per minute
• Pulse rate averages for different age groups
• Types of pulse

  • Central (Apical Pulse): Located on the apex of the heart and monitored using a stethoscope
  • Peripheral: Pulses that can be on the periphery of the body by palpating an artery over a bony prominence