Vital Sign's Part 1 Key Concepts, what are Vital Signs & Body Temperature

📑 Outline: Vital Signs & Key Concepts

I. Key Concepts

• Thermoregulation → relates to temperature (how body maintains heat balance).

• Perfusion → relates to pulse/BP (blood flow through the body).

• Oxygenation → relates to respirations (how well the body takes in and uses oxygen).

• These concepts explain why nurses measure vital signs and help interpret findings.

II. What Are Vital Signs?

• Definition: Assessment of vital/critical physiological functions.

• Traditional 4 Vital Signs:

  1. Temperature

  2. Pulse

  3. Respirations

  4. Blood Pressure

• Purpose:

• Variations in VS reflect health status & body system function.

• Frequent nurse responsibility → accurate measurement & documentation are priorities.

• Caution: “Normal” vital signs ≠ guarantee of well-being.

  • Example: Patient may lose significant blood volume but still show stable VS.

• Always interpret VS in context of overall assessment.

III. Additional “Other Vital Signs”

• Some experts recommend including:

  • Pain → sometimes called the 5th vital sign (controversial; tied to opioid crisis).

  • Oxygen Saturation (SpO₂) → measured with pulse oximetry.

  • Smoking Status → impacts body function & vital signs.

  • Emotional Distress → affects physiological stability.

• Takeaway: Regardless of terminology, include these in patient assessment.

IV. Caring During Vital Signs (iCare 18-1)

• Approach patients calmly, respectfully, and unhurriedly.

• Steps:

  1. Introduce yourself.

  2. Make eye contact, use a calm/low voice.

  3. Explain procedure before touching patient.

  4. Ask for consent/permission.

• Reason: Shows respect, promotes autonomy, builds trust, reduces anxiety.

V. When to Measure Vital Signs

• Common Situations:

  • On admission to hospital.

  • At beginning of a shift (inpatient).

  • At provider office/clinic visit.

  • Before, during, after surgery or procedures.

  • To monitor effects of meds/activities.

  • Whenever patient’s condition changes.

• Frequencies (depend on setting & patient condition):

  • Hospital: every 4–8 hrs.

  • Home health: every visit.

  • Clinic: every visit.

  • Skilled nursing facilities: weekly–monthly.

• Key Point:

  • Always obtain baseline VS.

  • Compare variations to baseline.

  • Reassess more frequently when changes occur.

  • Confirm with experienced nurse if unsure.

• Technology Note:

  • Smart beds now monitor HR & respirations continuously.

  • Still need to manually assess BP & temperature.

VI. Documentation of Vital Signs

• Flowsheets used in most agencies.

• If abnormal → also document in nurse’s notes with symptoms.

• Include interventions (e.g., elevated HOB for SOB).

• Document both findings and actions in EHR.

VII. Normal Vital Sign Ranges (Adults)

• Temperature:

  • Oral: 36.7–37°C (98–98.6°F)

  • Rectal: 37.2–37.6°C (99–99.6°F)

• Pulse:

  • Normal: 60–100 bpm (avg. 80).

• Respirations:

  • Normal: 12–20/min.

• Blood Pressure:

  • Normal: <120/<80 mmHg

  • Elevated: 120–129/<80

  • HTN Stage 1: 130–139 or 80–89

  • HTN Stage 2: ≥140 or ≥90

  • Hypertensive Crisis: >180 systolic and/or >120 diastolic

✅ Quick Study Tip:
Think of VS as your patient’s “dashboard.”

• Temp = engine thermostat (heat regulation).

• Pulse/BP = fuel pump & pressure system.

• Respirations = air intake system.

• Pain, O₂ sat, smoking, distress = “warning lights” that affect performance.