Vital Signs Signs of Life

Vital Signs (VS) Learning Objectives: Overview of Vital Signs 5 main VS Definition of Pulse How to obtain & accurately measure each pulse Identify sites for assessing pulse Practice accurate measuring of pulse and recording results Medical Terminology

Vital Signs Assignments: Discussion Articles Reading Textbook Note taking Handouts Pulse Points Graphic Chart Review

Vital Signs (VS) Discussion How many of you have been to the doctor? What is the first thing they do when you are taken back to the exam room? Why is it important to obtain all patient’s VS? How often should we take a patient’s VS? What can VS tell us about our patients? Is it important to know what a patient’s normal set of VS is? Why? What do we do when VS are abnormal or out of normal range?

Vital Signs Vitals = Life Defintion: Important information about the condition of a patient’s body Detect Changes in normal body function May signal life-threatening condition Provide responses to treatment Usually taken at rest with person sitting or lying down

Types of Vitals Five Main Vital Signs: Documented as: Temperature (T) Pulse(P) = heart rate Respirations(R) Blood Pressure(BP) Pain Score Documented as: TPR, BP and Pain Score

Vitals are Measured Upon admission As often as required by the person’s condition Before and after surgery After a fall or accident When given a drug that can affect a person’s respiratory or circulatory system When patient complains of pain, dizziness, shortness of breath (SOB) or chest pain

Vital Facts about Assessing Vitals Any extreme variations must be reported immediately Extreme abnormal high or low rates must be reported immediately If unable to obtain report immediately Certain factors will change readings of vitals especially pulse, respirations and BP. Increased rate can be affected by Exercise Stimulate drugs Excitement Fever Shock Anxiety

Decreased rates can be affected by: Sleep Depressant drugs Heart Disease Coma Physical Training

Pulse

Read in diversified textbook pages 431-433 15:3

Pulse (P) Definition: pressure of the blood felt against the wall of an artery as the heart beats Pulse Characteristics: Rate = # of beats per minute Rhythm = regularity / irregularity Volume - = strength – described as strong, weak or bounding

Pulse (P) Obtained: by palpation (to feel) of an artery and count the number of beats (lubb dubb is one). If regular can count 15 sec. X 4 or 30 sec. X2. If irregular count full 60 seconds or auscultation (to hear) of an artery Normal: -rate = varies by age, sex and body size - rhythm = regular - volume = strong, not bounding

Bradycardia – less than 60 bpm Tachycardia – greater than 100bpm Pulse (P) Terminology Bradycardia – less than 60 bpm Tachycardia – greater than 100bpm Arrythmia – irregular heart beat -

Pulse Points Temporal – side of the forehead Carotid – neck (used during child/adult CPR) Brachial – inner aspects of forearm at the antecubital (crease of the elbow). Used for BP and infant CPR Apical – below left breast. Most accurate pulse point. Use stethoscope and count for a full minute. Radial – at the inner aspects of the wrist, above the thumb (thumb-side). Most common site to assess pulse. Femoral – at the groin (inner side) Used for assessment and procedures Popliteal – behind the knee. Used for assessment Dorsalis pedis – top of the arch of the foot (between Big Toe and 2nd toe)

Pulse Normal Ranges Age Infant Child 1-7 years old Child 7-12 12 years and older Pulse Per Minute 100-160 80-110 70-90 60-90

Charting Vital Signs See graphing handout

Temperature

Temperature (T) Definition: the measurement of the balance between heat loss and heat produced by the body Obtained: Oral – mouth – 98.6 Rectal – rectum - 99.6 tympanic/aural – 98.6 axillary – armpit or groin - 97.6 Temporal – forehead scan -99.6

Temperature (T) Measured: Degrees Fahrenheit / Celsius Normal Body Temp – 98.6 F / 37 Temp affected by: Body processes Time of day (lower in morning; higher in afternoon after muscular activity) Where temp obtained

Inhale & Exhale Respirations

Respirations(R) Definition: reflection of breathing rate of patient Normal RR = 12-18 or 12-20 Obtained: look, listen, feel Measured by : Rate = # of breaths per minute Rhythm = regular / irregular Character = labored, non-labored, shallow,

Respiratory Terminology Dyspnea-difficult or labored breathing Apnea- absence of breathing Tachypnea- fast breathing Bradypnea- slow breathing Orthopnea-difficulty breathing when position changes Cheyne-Stokes-dyspnea with periods of apnea Rales- bubbling breath sounds fluid in lungs Wheezing- high-pitched whistling during expiration Cyanosis-blue

Blood Pressure Definition – Measurement of the pressure that the blood exerts on the walls of the arteries during the various stages of heart activities. Systolic pressure - occurs in the walls of the arteries when the left ventricle of the heart is contracting. Top number of the blood pressure. Diastolic pressure – is the constant pressure in the walls of the arteries when the left ventricle is relaxing. Bottom number of the blood pressure. Normal Systolic = 90-120 Normal Diastolic = 60-90 120/90 example of writing a BP Hypertension- High BP (systolic > 140 or diastolic >90) Hypotension – Low BP Sphygmomanometer- instrument used to measure blood pressure in millimeters of mercury. Each line is gauged by 2 mmHg

-algia Pain

Pain 5th VS Is a subjective symptom Measured: By severity on a scale of 0 – 10 According to location By description – sharp, stabbing, dull, etc. By occurrence: constant vs. intermittent Obtained: From patient via verbal or non-verbal communication

Review Abbreviations: VS BP R TPR Sx F C bpm

Review Name the 5 VS 2. What is the most common site for taking a pulse? 3. What is the heart rate less than 60 bpm called? 4. Give one reason that an apical pulse should be taken. 5.What is an irregular heart rate called? 6. Why is it important to obtain a person’s VS? 7. Give three instances when vitals should be obtained.