Understanding Vital Signs: Blood Pressure, Pulse, Breathing, Temperature, and Pain

Posted on May 4, 2024 in Biology

BLOOD PRESSURE

Definition: Force exerted by blood against the arterial wall. It is an indicator of cardiovascular health.

Systolic Pressure

  • Corresponds to ventricular systole (contraction).
  • Represents cardiac output.
  • Reflects changes in the arterial vessels.

Diastolic Pressure

  • Corresponds to ventricular diastole (relaxation).
  • Represents the base pressure of the circulatory system.

Normal Adult Range: Systolic: 120-139 mmHg, Diastolic: 60-89 mmHg

PULSE

Definition: The palpable sensation of blood flow through an artery.

Cardiac output is the volume of blood pumped by the heart in one minute (frequency x stroke volume x ejection fraction).

Normal Adult Range: 60-100 beats per minute

Pulse Characteristics

  1. Frequency: Number of beats per minute (BPM). May be altered in disease and varies by age, sex, height, physical activity, medications, and emotional state.
    • Eucardia or Normocardia: Normal heart rate.
    • Bradycardia: Heart rate lower than the lower limit.
    • Tachycardia: Heart rate higher than the upper limit.
  2. Rhythm: Refers to the pattern of beats.
    • Regular: Healthy.
    • Irregular: Extrasystoles, arrhythmias, complete blocks.
  3. Voltage: Degree of compression of the arterial wall.
    • Mild or Low: If obliterated with light pressure.
    • Strong or High: If obliterated with increased pressure.
  4. Size: Reflects the volume of blood driven against the arterial wall during ventricular contraction.
    • Full or Strong: A readily palpable pulse.
    • Filiform or Weak: A faint or thready pulse.
    • Imperceptible: Unable to feel or hear the pulse.

BREATHING

Definition: The process of inhaling (inspiration) and exhaling (expiration) air.

The quality and efficiency of ventilation are indicated by the speed, depth, and rhythm of respiratory movements.

Breathing Characteristics

  1. Frequency: Number of cycles per minute.
    • Eupnea: Normal breathing frequency, amplitude, and respiratory rate.
    • Normal Adult Range: 12 to 20 breaths per minute
    • Bradypnea: Decreased number of cycles per minute.
    • Tachypnea: Increased number of cycles per minute.
  2. Rhythm: Refers to the regularity of breathing cycles (inspiration-expiration).
  3. Symmetry: Refers to the equal mobility of both sides of the thorax.
  4. Amplitude: Refers to the volume of air inhaled and exhaled with each cycle.
    • Superficial
    • Deep
    • Normal

TEMPERATURE

Definition: Body temperature is the balance between heat production and heat loss.

Mechanisms for heat loss include evaporation (sweating), radiation, conduction, and convection.

Mechanisms for heat production include increased metabolism and shivering.

Normal Adult Range:

  • Axillary temperature: 36.0 to 36.9 °C
  • Rectal temperature: 37.0 to 37.5 °C
  • Oral temperature: 36.2 to 37.8 °C

Temperature Characteristics

  1. Onset:
    • Abrupt or sudden
    • Slow or gradual
  2. Intensity:
    • Feverish: 37.6 to 38.9 °C
    • Hyperthermia: ≥ 39.0 °C
  3. Daily Oscillation:
    • Continuous or constant or sustained: Fever with changes in temperature < 1 °C between morning and afternoon.
    • Remittent: Daily variations above a level without reaching normal.
    • Intermittent: Daily variations reach normal temperature at least once in 24 hours.
    • Relapsing: Alternating periods of fever and normal temperature for several days.

PAIN

Definition: An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Pain Assessment

  • Integrate pain assessment into routine monitoring and treatment.
  • Assess the presence and location of pain.
  • Rate pain intensity.
  • Evaluate the effect of analgesic therapy.
  • Assess for medication side effects and the need for additional treatment.
  • Consider factors influencing pain perception: culture, age, religion, sex, previous experience, emotional factors, and the meaning of pain.

Types of Pain

  1. Time Evolution:
    • Acute Pain: Temporary pain after a structural lesion. It disappears when the lesion heals (e.g., childbirth, post-operative pain, acute renal colic).
    • Chronic Pain: Pain persisting > 6 months or reappearing after stopping pain relief therapy. It produces continuous and unbearable suffering.
  2. Physiology:
    • Somatic Pain: Produced by activation of nociceptors in the skin, bone, and soft tissue. It is dull, continuous, well-located (e.g., bone pain or arthritis). Usually responds well to analgesics.
    • Visceral Pain: Caused by activation of nociceptors in pelvic, abdominal, or thoracic viscera. When acute, it is often accompanied by nausea, vomiting, sweating, tachycardia, and increased blood pressure. The pain may be referred to distant cutaneous sites (e.g., right shoulder pain from biliary or liver injury).
  3. Transmission:
    • Slow Pain: Associated with C fibers. Feeling of dull, diffuse, and unpleasant pain after the initial sharp sensation.
    • Fast Pain: Associated with Aδ fibers. Feeling of precise and localized pain.
  4. Source:
    • Nociceptive Pain: Pain associated with physiological and anatomical mechanisms of pain stimulation and nerve transmission.
    • Psychological Pain: Pain associated with suffering or the emotional component of pain.
  5. Location:
    • Superficial Pain (Epicritic): Severe skin and tissue pain. It is stinging or burning in character and well-localized (e.g., burn).
    • Referred Pain: Pain felt in a body area distant from the viscera or structure that originated the pain (e.g., heart attack, appendicitis).

Objective Pain Evaluation

  • Descriptive Scale: None (0), Mild (1), Moderate (2), Strong (3)
  • VAS (Visual Analogue Scale): A straight line where the left end represents no pain and the right end represents the worst pain imaginable.