3.01 Understand Diagnostic and Therapeutic Services Vital Signs Provide information about body function Include: temperature pulse respiration blood pressure Changes may be the first sign of disease 3.01 Understand Diagnostic and Therapeutic Services 1

Vital Signs Accuracy is imperative! REPORT ABNORMAL RESULTS OF ANY VITAL SIGN IMMEDIATELY 3.01 Understand Diagnostic and Therapeutic Services 2

PATIENT ASSESSMENT AND DIAGNOSIS Measuring and Recording Temperature Measurement of balance between heat produced and heat lost by the body. Lost through: Perspiration Respiration Excretion Produced by: Metabolism of food Muscle and gland activity

PATIENT ASSESSMENT AND DIAGNOSIS If metabolism and muscle/gland activity increase temperature, when would your temperature be the highest during the day???? Temperature is usually higher in the evening. Temperature is measured in: F = Fahrenheit C = Celsius

PATIENT ASSESSMENT AND DIAGNOSIS Factors that  body temperature Illness Infection Exercise Excitement High temperatures in the environment

PATIENT ASSESSMENT AND DIAGNOSIS Factors that  body temperature Starvation or fasting Sleep Decreased muscle activity Exposure to cold in the environment Certain diseases

PATIENT ASSESSMENT AND DIAGNOSIS Fever elevated temperature, above 101º F “febrile” “pyrexia” words to indicate fever “afebrile” without fever Hyperthermia elevated temperature, above 104º F Temperatures above 106º F can lead to convulsions and death

PATIENT ASSESSMENT AND DIAGNOSIS Hypothermia below 95º F Caused by prolonged exposure to cold Death when temp below 93º F

Vital Signs Temperature Sites to measure temperature: Oral – mouth Rectal – rectum Aural – auditory canal Axillary – armpit 3.01 Understand Diagnostic and Therapeutic Services 9

PATIENT ASSESSMENT AND DIAGNOSIS Oral In the mouth (probe is blue) Most common Normal 98.6º F or 37º C Eating, drinking hot or cold liquids, or smoking can alter oral temperature. Wait 15 minutes before taking the temperature. Rectal Most accurate (probe is red) Normal 99.6º F or 38.6C

PATIENT ASSESSMENT AND DIAGNOSIS Aural In the ear Usually in less than 2 seconds Normal 98.6º F, measures “core” or “blood temperature” Axillary Armpit Normal 97.6º F Least accurate

PATIENT ASSESSMENT AND DIAGNOSIS Measuring and Recording Pulse The pressure of blood pushing against the wall of an artery as the heart beats and rests There are 3 that should be noted about every pulse: Rate Rhythm Volume

PATIENT ASSESSMENT AND DIAGNOSIS RATE number of beats per minute, when using radial pulse, counted for 15 seconds and x 4 Average pulse =72 Normal range= 60-100 Bradycardia below 60 beats per minute Tachycardia above 100 beats

PATIENT ASSESSMENT AND DIAGNOSIS RHYTHM Is the pulse regular OR Irregular What is an irregular rhythm called?? arrhythmia

PATIENT ASSESSMENT AND DIAGNOSIS VOLUME indicates strength/intensity Is the pulse “bounding” and strong or is it weak and “thready”

PATIENT ASSESSMENT AND DIAGNOSIS Pulse can be increased by: Exercise Stimulant drugs Excitement Fever Shock Nervous tension Pulse can be decreased by: Sleep Depressant drugs Heart disease Coma

PATIENT ASSESSMENT AND DIAGNOSIS Radial Artery Temporal Artery Carotid Artery Brachial Artery Femoral Artery Popliteal Artery Dorsalis Pedis Artery

PATIENT ASSESSMENT AND DIAGNOSIS Apical Pulse Taken with a stethoscope, at the apex of the heart Heart sounds heard resemble “lubb-dubb” Why would you take an apical pulse instead of a radial pulse?? Irregular pulse Infant/child due to rapid pulse rate

PATIENT ASSESSMENT AND DIAGNOSIS Measuring and Recording Respiration Respiration is the process of exchanging O2 and CO2 Pulmonary Ventilation =1 inspiration + 1 expiration Normal rate = 14 – 18 per minute

PATIENT ASSESSMENT AND DIAGNOSIS Character – depth and quality of respirations Are they: Deep Shallow Labored/Difficult Moist (fluid heard in lungs)

PATIENT ASSESSMENT AND DIAGNOSIS Dyspnea – difficult or labored breathing Apnea – absence of respirations Cheyne-Stokes – periods of dyspnea followed by periods of apnea; noted in the dying patient Tachypnea > 25 breaths /minute

PATIENT ASSESSMENT AND DIAGNOSIS Bradypnea < 10 breaths/minute Wheezing high pitched sound, heard in asthmatics Rales – bubbling sounds caused by fluids or mucus in the air passages, heard in bronchitis

PATIENT ASSESSMENT AND DIAGNOSIS Measuring and Recording Blood Pressure BP is the pressure blood exerts on the walls of arteries Read in millimeters (mm) of mercury (Hg) Instrument is known as a sphygmomanometer or BP cuff Usually aneroid or mercury, although many hospitals are using electronic.

PATIENT ASSESSMENT AND DIAGNOSIS Systolic: pressure on the walls of arteries when the heart contracts to pump blood to the body This is the 1st sound heard when obtaining a BP Normal range – 100 to 140 mm Hg Diastolic: constant pressure on heart/arteries even when they are at rest or in the relaxation phase This is the last sound heard when obtaining a BP Normal range – 60 to 90 mm Hg Blood pressure is recorded as a fraction = systolic/diastolic 120/80 132/70

PATIENT ASSESSMENT AND DIAGNOSIS Factors that  blood pressure Excitement, anxiety, nervous tension Stimulant drugs Exercise and eating Factors that  blood pressure Rest or sleep Depressant drugs Shock Excessive loss of blood

PATIENT ASSESSMENT AND DIAGNOSIS Hypertension BP > 140/90 Hypotension BP < 100 systolic Orthostatic hypotension BP when you get up suddenly, Body isn’t able to respond to sudden change in BP BP is highest when you are lying down and lowest when you are standing

PATIENT ASSESSMENT AND DIAGNOSIS Measuring/Recording Height and Weight Used to determine if a patient is underweight or overweight Height/weight chart used as averages + or - 10% considered normal

PATIENT ASSESSMENT AND DIAGNOSIS When are height-weight measurements routinely done in a health care setting? Admission to the hospital Part of a general physical Babies and children Necessary for calculating medicine dosages and some lab values

PATIENT ASSESSMENT AND DIAGNOSIS Daily Weights Usually ordered for patients with edema due to heart, kidney, or other diseases. (fluid weight) Be sure to: Use the same scale every day Weigh the patient at the same time each day patient is wearing the same amount of clothing each day (2 lbs.) OBSERVE SAFETY PRECAUTIONS!

PATIENT ASSESSMENT AND DIAGNOSIS Types of Scales Clinical scales contain a balance beam and measuring rod. Bed scales or chair scales. Infant scales

PATIENT ASSESSMENT AND DIAGNOSIS When weighing an infant…keep one hand slightly over but not touching the infant A tape measure is used to measure infant height. Make a mark on the exam table paper at the top of the head. Stretch out the infant's leg and make a mark the paper at the heel. Use a tape measure to measure from mark to mark.