Vital Signs

Vital Signs

Vital signs are physiological indicators of the body's most fundamental processes. Vital signs, also called cardinal signs, include blood pressure, temperature, pulse, and respiration measurements. To keep track of the body's key processes, it is important to examine all of these symptoms together. A symptom known as pain is frequently referred to as the fifth vital sign and should be evaluated together with the other four. Additionally frequently examined along with the standard vital signs is oxygen saturation. Vital sign measurements give information about a client's typical state of health as well as their reaction to physical and psychological strain as well as medical and nursing therapy. subjective

A change in vital signs may suggest the need for medical or nursing intervention since they can reflect changes in physiological functioning or changes in comfort. Vital signs can be assessed in a hospital, at home, during an emergency medical situation, or in other places. Vital sign measurement is a quick and effective way to keep track of a client's health, spot problems, and gauge how well an intervention worked.

Purposes of Measuring Vital Signs

• To evaluate a person's state of health.
• To provide the starting points for comparisons in the future.
• Routine component of a full physical evaluation.
• To comprehend the current issues.
• To support diagnosis
• To organize and carry out nursing care.
• To comprehend the efficacy of the therapy.
• To alter or switch the treatment plan.
• To assess the patient's healing from their disease.

Timing of Taking Vital Signs

The type of sickness and the patient's health will determine how frequently vital signs are checked. For instance, a general patient requires four hours of care every 24 hours, but postoperative patients require measurements every 15 minutes to an hour depending on the patient's state. The following are typical scenarios for vitals measurements:

• When a patient is admitted to a medical facility.
• In the hospital on a regular schedule as per a doctor's order or hospital policy.
• Prior to and following any surgical operation.
• Any invasive diagnostic procedure both before and after.
• Before and after taking drugs like paracetamol or digoxin that affect how your heart, lungs, and body regulates temperature.
• When the client's overall physical condition changes, such as when they go unconscious or experience more severe pain.
• Before and after nursing interventions that affect a vital sign, such as applying a cold compress, exercising the patient's range of motion, and ambulating them.
• Throughout the recovery from surgery.
• When a client complains of vague physical suffering, such as feeling strange or odd.
• When a patient visits a clinic or a doctor's office.
• Prior to, during, and following a blood product transfusion.
• Throughout a routine physical screening.

Guidelines for Measuring Vital Signs

• Vital sign monitoring is the duty of the nurse providing care for the patient.
• To ensure accurate results, equipment should be functioning and suitable for the client's size and age.
• Be familiar with the client's typical range of vital indicators.
• The nurse can spot anomalies by being aware of the typical range for each vital sign.
• Learn about the client's medical history, treatments, and medications. Vital sign changes are predicted side effects of several diseases or treatments. Control or reduce environmental factors that may have an impact on vital signs, such as measuring the client's pulse after an exercise session or taking their temperature in a warm environment.
• When taking vital signs, be orderly and methodical.
• The vital indicators might be changed depending on how you approach the person. The nurse shows skill in using the tools required for taking vital signs as she approaches the client in a composed, compassionate manner.
• Depending on the patient's state, decide how often to measure the vital signs. Vital signs are regularly checked after surgery, for instance, to look for problems.
• In many cases, the nurse is in the best position to evaluate all clinical findings on a client.
• Put this information with other information gathered about the person after examining vital signs. Analyze the facts and the overall state of health.
• During the first eight hours after admission, recheck the vital signs at least twice on a new patient.
• Be familiar with the vital sign measurements from the prior shift. These facts will make it easier to determine whether the patient's condition is getting better or getting worse.
• Verify any substantial changes in vital signs and let others know. You will be able to spot variations in vital signs by using baseline measures.

Temperature

Heat is measured in degrees and expressed as gemperature. It refers to the level of warmth or the equilibrium between the heat generated by bodily processes and the quantity of heat lost to the environment outside. The level of heat that the body keeps itself at might be referred to as body temperature. Gender, recent exercise, food and hydration intake, time of day, and, in women, menstrual cycle stage all affect a person's typical body temperature. A healthy adult's normal body temperature can range from 97.8 degrees Fahrenheit to 99 degrees Fahrenheit for a healthy adult. 

Kinds of Body Temperature

Core Body Temperature: Core temperature is the temperature of the deep tissues of the body such as the abdominal cavity: liver, and pelvic cavity. It remains relatively constent.

Surface Body Temperature: It is the temperature of the skin, the subcutaneous tissue, and fat. It rises and falls in response to the environment. 

Basal Body Temperature: Basal body temperature is the lowest temperature attained by the body during rest (usually during sleep). It is generally measured immediately after awakening and before any physical activity has been undertaken, although the temperature measured at that time is somewhat higher than the true basal body temperature.

Regulation of Body Temperature

Body temperature reflects the difference between heat production and heat loss. The body continually produces heat as a byproduct of metabolism. When the amount of heat produces by the body equals the amount of heat lost, the person is in heat balance. Thermoregulation is the ability of an organism to keep its body temperature within certain boundaries, even when the surrounding temperature is very different. Thermoregulation is the balance between heat production mechanisms and heat loss mechanisms that occur to maintain a constant body temperature. The balance between heat lost and heat produced is precisely regulated by physiological and behavioural mechanisms. For the body temperature to study constant and within an acceptable range, the relationship between heat production and heat loss must be maintained. The relationship is regulated by neurological and cardiovascular mechanisms.

Neural and Vascular Control

The core body temperature of a healthy person is maintained within a fairly constant range by the thermoregulatory center in the hypothalamus. A comfortable temperature is the "set point" at which a heating system operates. The hypothalamus senses minor changes in body temperature. This center receives messages from cold and warm thermal receptors located throughout the body, compares that information with its temperature set point, and initiates responses to either produced or conserve body heat or to increase heat loss.

The anterior hypothalamus controls heat loss, and the posterior hypothalamus controls heat production. When nerve cells in the anterior hypothalamus become heated beyond the set point, impulses are sent out to reduce body temperature. The skin is the primary site of heat loss. Mechanisms of heat loss include sweating, vasodilatation and inhibition of heat production. The circulating blood brings heat to the skin's surface, where small connections between the arterioles and the venules lie directly below the surface. These connections, called arteriovenous shunts, may remain open to allow heat to dissipate to the skin and then to the external environment, or they may close and retain heat in the body.

The sympathetic nervous system controls the opening and closing of the shunts in response to changes in core body temperature and in environmental temperature. If the posterior hypothalamus senses the body's temperature is lower than the set point, heat conservation mechanisms are instituted. Vasoconstriction of blood vessels reduces blood flow to the skin and extremities. Compensatory heat production is stimulated through voluntary muscles contraction and muscle shivering. When vasoconstriction is ineffective in preventing additional heat loss, shivering begins. Disease or trauma to the hypothalamus or to the spinal cord, which carries hypothalamic massages, can cause serious alteration in temperature control.

Heat Production

Metabolism: Metabolism is the body's main source of heat production. Basal metabolism accounts for the heat produced by the body at absolute rest. The sympathetic neurotransmitters, epinephrine and norepinephrine, which are released when an increase in body temperature is needed, act at the cellular level to shift metabolism so energy production is reduce and heat production is increased. This is one of the reasons fever tends to produce feelings of weakness and fatigue. The average basal metabolic rate depends on the body surface area. Thyroid hormones also affect the BMR by promoting the breakdown of body glucose and fat. Thyroid hormones increase the rate of chemical reactions in almost all cells of the body. The male sex hormone testosterones increase BMR so man has higher BMR than women. In the normal adult a heat produced under resting conditions is about 70 kilocalories per hour.

Muscle Activity (Exercise)

Voluntary Movement: Such as muscular activities during exercise require additional energy. The metabolic rate can be increased up to 2000 times during activity and heat production can increase up to 50 times than normal.

Involuntary Movement: Shivering is an involuntary body response to temperature differences in the body. Shivering is initiated by impulses from the hypothalamus. The skeletal muscle movement during shivering requires significant energy. Shivering can increase heat production 4 to 5 times greater than normal.

Strong Emotions: Due to nervousness, anxiety, excitement autonomic nervous system is stimulated. It causes stimulation of different organs in the body and activity is increased. So heat is produced in the body.

Change in Atmospheric Temperature: Change in external condition e.g. high room temperature or high external temperature prevents evaporation process.

Disease Condition: Bacterial invasion.

Heat Loss

Heat flows from higher temperature to lower temperature. When the body is too hot, it decreases heat production and increases heat loss.

Through Skin: The skin helps in the regulation of body temperature and the regulation is controlled by hypothalamus. Heat is lost through the skin by means of conduction, convection, radiation and evaporation. One way of increasing heat loss is through peripheral vasodilation. When these vessels dilate, large quantities of warmed blood from the core of the body are carried to the skin, where heat loss may occur via radiation, convection and conduction.

• Conduction: Conduction is the transfer of heat from one object to another through direct contact. Heat conducts through contact with solids, liquids and gases. In the body, heat is conducted from the warm internal tissues to the skin surface. It is then lost to the environment. When the warm skin touches a cooler object, heat is lost until their temperatures are similar. For instance, if a person sits on the cold ground, heat moves from the body to the cold ground. We can increase a client's conductive heat loss by applying an ice pack or bathing a client with cool water. Applying several layers of clothing reduces conductive loss. It can also lose heat to water during swimming or tepid baths.
• Convection: Convection is the transfer of heat from a warmer to a cooler object by the movement of air or liquid moving past the body or by means of circulating fluid or gas. For example, the body loses excess heat as surrounding air currents carry the heat to the cooler environment. The rate of heat lost from the hotter object to a cooler one is proportional to  the temperature differences between the objects. The rate of heat lost by convection depends on the difference between skin and air/water temperature as well as air Convection also operates within the body. The transfer of heat from the blood stream to the viscosity rapidly skin is very important. In a cold environment, vasoconstriction, a decrease in the size of the blood vessels lumen, prevents heat loss by convections thus; less heat reaches the body's surface to be carried away by the air. In a hot environment or during increased muscular activity vasodilatation increases heat flow to the surface, increasing heat loss.
• Radiation: Radiation is the transfer of heat from the surface of one object to the surface of another without direct contact between the two. Radiation is when heat is transferred by electromagnetic waves, like radio waves, infrared waves, X-rays and even visible light. It involves the transfer of heat through the air or a vacuum. Up to 85% of the human body's surface area radiates heat to the environment. The ability to dissipate body temperature by radiation depends on the temperature of the environment. Environmental temperature must be less than that of the body temperature for the heat loss. The nurse increases heat loss through radiation by removing clothes or blankets.
• Evaporation: Evaporation is the transfer of heat through the conversion of water to vapor or transfer of heat when a liquid is changed to a gas. The body continuously loses heat by evaporation. As long as body temperature is greater than the atmospheric temperature, heat is lost through radiation. About 600 to 900 ml a day evaporates from the skin and lungs, resulting in water and heat loss. Examples of evaporation include diaphoresis during exercise or when one is febrile.

Through the Lungs: Humans constantly lose fluids from the skin and in exhaled air. When the individual breaths out, warm air is exhaled out and heat is lost through it. Some of the fluid is also vaporized and is lost through the expired air. About 300 ml of water vaporizes daily from lungs. The unconscious loss of fluid is called insensible perspiration.

Through the Kidneys: The kidney secretes urine which is warmed by the heat taken from the body. When the urine is excreted the heat is also lost from the body.

Through Bowel: The faeces absorb heat from the body. So during defecation, heat is also lost from the body.

Sleep: Body temperature is low. (As body is less active)

Fasting: Body temperature decreases when the patient is on prolonged fasting. It leads to decreased heat production.

Behavioural Control

Healthy individuals are able to maintain comfortable body temperature when exposed to temperature extremes. The ability of a person to control body temperature depends on the degree of temperature extreme, the person's ability to sense feeling comfortable or uncomfortable, through processes or emotions, and the person's mobility or ability to remove or add clothes. Individuals are unable to control body temperature if any of these abilities is lost. For example, infants are to sense uncomfortable warm conditions but need assistance in changing their environment. Older adults sometimes need help in detecting cold environments and minimizing heat loss. Illness, a decreased level of consciousness, or impaired thought processes results in an ability to recognize the need to change behavior for temperature control. When the environmental temperature becomes extremely hot or cold, person assumes health promoting behaviours such as removing and adding clothing, seeking a  cooler place and moving to a warmer place, lowering and raising the thermostat, set on a furnace, stopping and increasing muscular activity, or sit with arms and legs tightly wrapped together or take a cool shower.

Factors Affecting Body Temperature

Humans and other mammals are homoeothermic, able to maintain a relatively constant body temperature despite widely ranging environmental temperatures. Although the average human body temperature is 37 Degrees Celsius, this temperature varies depending on individual differences, time of day, the stage of sleep, and the ovulatory cycle in women. Changes in body temperature within an acceptable range occur when the relationship between heat production and heat loss is altered by physiological or behavioural variables. Understanding the factors that can affect body temperature helps nurses accurately assess the significance of body temperature variations.

Age: Body temperature is generally lower in older adults than in other age groups. In contrast, infants and young children have body temperature slightly higher than the adult.

Exercise: Body temperature increases with exercise. Muscle activity requires an increased blood supply and an increased carbohydrate and fat breakdown. This increased metabolism causes an increase in heat production. Prolonged strenuous exercise, such as long distance running can temporally raise body temperature up to 410c (105. 80f).

Environment: Environment influences body temperature. If body temperature is measured in a very warm room, the body temperature will be elevated, if the client has just been outside in the cold without warm clothing, body temperature may be low because of extensive radiant and conductive heat loss. Infants and older adults are most likely to be affected by environmental temperature because their temperature regulating mechanism is less effective.

Hormone level: Women generally experience greater fluctuations in body temperature than men. Female hormone levels also affect body temperature. When a woman is ovulating or menstruating, her body temperature will fluctuate. Progesterone, a female hormone secreted at ovulation, increases body temperature 0.3 to 0.60 C above baseline. Body temperature changes also occur in women during menopause. Women, who have stopped menstruating may experience periods of intense body heat and sweating lasting from 30 seconds to 5 minutes. There may be intermittent increase in skin temperature of up to 40C during these periods, referred to as hot flashes. This is due to the instability of the vasomotor controls for vasodilatation and vasoconstriction. Thyroxin, epinephrine and non-epinephrine also elevate body temperature by increasing heat production.

Stress: Physical and emotional stress increases body temperature through hormonal and neural stimulation. When stress stimulates the sympathetic nervous system, circulating levels of epinephrine and non-epinephrine increase. As a result the metabolic rate increases, this in turn, increases heat production. Stressed or anxious clients may have an elevated temperature without underlying pathology.

Circadian rhythm (time of day): Body temperature normally fluctuates (0.5-10c) throughout the day or during a 24 hour period. Temperature is usually lowest around 3 am and highest from 5 to 7 pm.

Illness, disease and trauma: Fever can be caused by infection or illness; this is the body's way of fighting the infection. Certain diseases, such as arthritis, hyperthyroidism and leukemia may also cause elevated body temperature. Alternatively, diabetes and hypothyroidism result in lowered body temperatures. Shock and sepsis may also cause low body temperatures.

Exposure: Exposure to extreme heat or cold can change body temperature. Hot weather, especially with high humidity, can result in heat exhaustion and even heat stroke, which elevates temperature to dangerously high levels. Sunburn can also cause fever. Exposure to cold temperatures can result in hypothermia, or a body temperature that is dangerously low.