Vital Signs

Original Editor - Manisha Shrestha Top Contributors - Kalyani Yajnanarayan, Manisha Shrestha, Lucinda hampton, Vidya Acharya and Kim Jackson

Original Editor - User Name

Top Contributors - Kalyani Yajnanarayan, Manisha Shrestha, Lucinda hampton, Vidya Acharya and Kim Jackson  

Introduction

Vital signs are an objective measurement for the essential physiological functions of a living organism. It is named "vital" as their measurement and assessment is the critical first step for any clinical evaluation.

Vital signs are indicators of one's health condition and the assurance of proper circulatory, respiratory, neural, and endocrinal functions. Vital signs are a mechanism to universally communicate a patient's condition and severity of the disease. Vital signs are the simplest, cheapest, and probably the most important information gathered on hospitalized patients.

Unfortunately, vital signs can be influenced by a number of factors and there are many situations in which vital signs are less than reliable. They vary based on age, time, gender Abnormal vital signs can be an indicator of underlying pathology, a variant due to medication, or a result of the environment. Thus, Healthcare providers must understand the various physiologic and pathologic processes affecting these sets of measurements and their proper interpretation.

Importance of vital signs.

• Vital signs play an important role in emergency departments (ED) and on the wards, to determine patients at risk of deterioration.
• The degree of vital sign abnormalities may also predict the long-term patient health outcomes, return emergency room visits, and frequency of readmission to hospitals, and utilization of healthcare resources. 
• Vital signs help to predict physical therapy indications, contraindications, and outcomes.
• Vital signs are appropriate to characterize or quantify cardiovascular and pulmonary signs and symptoms as part of an assessment of aerobic capacity and endurance.

Components

Traditionally, vital signs consist of temperature, respiratory rate (RR). pulse rate (PR) and blood pressure (BP) but later oxygen saturation

Body temperature

The normal body temperature for a healthy adult is approximately 98.6 degrees Fahrenheit/37.0 degrees centigrade. The human body temperature typically ranges from 36.5 to 37.5 degrees centigrade (97.7 to 99.5 degrees Fahrenheit).

Health care providers use the axillary, rectal, oral, and tympanic membrane most commonly used to record body temperature, and the electronic and infrared thermometers are the devices most commonly used.

• Oral temperature: It is the most commonly used method, is considered very convenient and reliable. Here we place the thermometer under the tongue and close the lips around it. The posterior sublingual pocket is the area that gives the highest reliability.
• Tympanic temperature: In this method, the thermometer is inserted into the ear canal. This site is convenient but less accurate and hence not recommended.
• Axillary temperature: In this, we place the thermometer in the axilla while adducting the arm of the patient. This site is convenient but generally considered less accurate and hence not recommended.
• Rectal temperature: The thermometer is inserted through the anus into the rectum after applying a lubricant. This method is very inconvenient, but since it measures the internal measurement, it is very reliable. It is usually considered the "gold standard" method of recording temperature.
• Skin temperature: Digital thermometer can be used to measure the quick temperature from the skin of the forehead. It has been widely used now in this COVID-19 pandemic to avoid cross-contamination as thermometer is kept 3-5cm away from the patient's forehead.

Body temperature is affected is by many sources of internal and external variables. Besides the site of measurement, the time of day is an essential factor leading to variability in the temperature record, secondary to the circadian rhythm. Other factors influencing body temperature are gender, recent activity,  a person's relative physical fitness, food, and fluid consumption, and, in women, the stage of the menstrual cycle.

Hypothermia vs hyperthermia

normative value

Pulse Rate

Pulse rate is defined as is the wave of blood in the artery created by contraction of the left ventricle during a cardiac cycle. The most common sites of measuring the peripheral pulses are the radial pulse, ulnar pulse, brachial pulse in the upper extremity, and the posterior tibialis or the dorsalis pedis pulse as well as the femoral pulse in the lower extremity. Clinicians also measure the carotid pulse in the neck. In day to day practice, the radial pulse is the most frequently used site for checking the peripheral pulse, where the pulse is palpated on the radial aspect of the forearm, just proximal to the wrist joint. 

Parameters for assessment of pulse include its rate, rhythm, volume, amplitude, rate of increase, and symmetry.

Rate: The normal range used in an adult is between 60 to 100 beats /minute with rates above 100 beats/minute and rates and below 60 beats per minute, referred to as tachycardia and bradycardia, respectively. Changes in the rate of the pulse, along with changes in respiration is called sinus arrhythmia. In sinus arrhythmia, the pulse rate becomes faster during inspiration and slows down during expiration.

Rythym: Assessing whether the rhythm of the pulse is regular or irregular is essential. The pulse could be regular, irregular, or irregularly irregular. Irregularly irregular pattern is more commonly indicative of processes like atrial flutter or atrial fibrillation.

Volume: Assessing the volume of the pulse is equally essential. A low volume pulse could be indicative of inadequate tissue perfusion; this can be a crucial indicator of indirect prediction of the systolic blood pressure of the patient.

Symmetry: Checking for symmetry of the pulses is important as asymmetrical pulses could be seen in conditions like aortic dissection, aortic coarctation, Takayasu arteritis, and subclavian steal syndrome.

Amplitude and rate of increase:  Low amplitude and low rate of increase could be seen in conditions like aortic stenosis, besides weak perfusion states. High amplitude and rapid rise can be indicative of conditions like aortic regurgitation, mitral regurgitation, and hypertrophic cardiomyopathy.

Respiratory Rate

The respiratory rate is the number of breaths per minute. The normal breathing rate is about 12 to 20 beats per minute in an average adult. In the pediatric age group, it is defined by the particular age group.

Resources

• https://www.physiospot.com/research/clinical-decision-making-regarding-the-use-of-vital-signs-in-physical-therapy/