Vital Signs Signs of life

Vital signs: 1. Temperature - T 2. Pulse – HR (heart rate) 3. Respirations – RR (respiration rate) 4. Blood pressure - BP 5. Pain level on a scale 1-10 6. Oxygen saturation – O2SAT

What can vital signs tell us?

Regulatory center - Hypothalamus Temperature Regulatory center - Hypothalamus

Core temperature 36.8±0.7 °C, or 98.2±1.3 °F 97.6 – 99.6 per Hartman Oral – mouth Rectal – rectum Tympanic – ear  36.8±0.7 °C, or 98.2±1.3 °F 97.6 – 99.6 per Hartman

Celsius vs. Fahrenheit 36.8±0.7 °C

Fahrenheit 98.2±1.3 °F

Circadian rhythm Normal body temperature may differ as much as 0.5 °C (1.0 °F) from day to day. The lowest temperature occurs about two hours before the person normally wakes up

Oral temperature Oral temperatures are influenced by drinking, chewing, smoking, and breathing with the mouth open. Cold drinks or food reduce oral temperatures; hot drinks, hot food, chewing, and smoking raise oral temperatures

Wait to take oral T for 10-20 min If patient just chewed gum, ate, smoke, or had hot or cold drink

Oral temperature Do not take an oral temperature on a confused patient. Why? Facial trauma Using O2 Just had cold or hot drink Younger than 6 years old Why do you think the tympanic (ear) thermometer is a preferred method of taking temperature at health care facilities?

Research on oral T National Institute of Health – NIH: http://www.ncbi.nlm.nih.gov/ pubmed/22488144 Read a conclusion, discuss the trustworthiness of the research article.

Tympanic temperature

Rectal temperature

Rectal temperature Insert a thermometer ½ to 1 inch into rectum and hold onto thermometer at all times. Why?

Rectal thermometers for the home use

Rectal vs. Oral Probe Rectal probe/thermometer is red Oral probe/thermometer is blue

Fertility Rectal Temperature Application Ovulation and pregnancy cycle:

Ovulation and pregnancy cycle:

No ovulation cycle

Auxiliary temperature (Ax) Hold a glass thermometer in underarm space for 5 min Hold an electronic thermometer till the beep

(Ax) Good alternative for rectal on kids, but you need to convert it to rectal, since Ax is much lower as core temperature

Sliding thermometer against temporal artery Temporal Temperature Sliding thermometer against temporal artery Safe and easy

Medical research hasn't determined an exact correlation between oral, rectal, ear, armpit, and forehead temperature measurements. Generally, the correlation of temperature results are as follows: The average normal oral temperature is 98.6°F (37°C). A rectal temperature is 0.5°F (0.3°C) to 1°F (0.6°C) higher than an oral temperature. An ear (tympanic) temperature is 0.5°F (0.3°C) to 1°F (0.6°C) higher than an oral temperature. An armpit (axillary) temperature is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature. A forehead (temporal) scanner is usually 0.5°F (0.3°C) to 1°F (0.6°C) lower than an oral temperature.

Charting Temperature 36.6° C (O) 98.8° F (Ax) 101.3° F (R) 37.5° C (T)

Oxygen Saturation – O2Sat Normal range 93-100% Measuring O2SAT http://www.youtube.com/watch?v=cxaoxc-xMKs Oximetry http://www.youtube.com/watch?v=irVEYvEIb6o

Respiration Rate- RR Normal rate 12-20 Patients shouldn’t know when you start counting their RR, because they can start breathing either too slow or too fast. Keep your fingers on radial pulse, pretending that you counting pulse, but count respirations instead (in real life, but not for the state test)

Cardiovascular VS – HR and BP Anatomy and physiology Intro to anatomy of the heart https://www.youtube.com/watch?v=DAXa4eR1s0M Visible Body. Cardiologist explains heart anatomy 4 https://www.youtube.com/watch?v=QXckE_DlFAM

Khan Academy Khan academy – Meet the Heart! https://www.youtube.com/watch?v=Vi1JK6IYVt8 Homework – Khan academy: Layers of the heart, Lub Dub, Flow through the heart Activity – Draw a heart with four chambers, identify four valves, and eight major vessels. Option for extra credit – make heart out of clay.

Pulse – Heart Rate - HR Normal range – 60-100 beats per minute - bpm Note rate, rhythm, and strengths

Homework Advanced Circulatory System Physiology in Khan Academy: Health and Medicine https://www.khanacademy.org /science/health-and- medicine/circulatory-system https://www.youtube.com/wat ch?v=QXckE_DlFAM What is blood pressure? 6 http://www.youtube.com/watc h?v=J97G6BeYW0I For Christmas potluck – one documentary and one movie about medicine and health related isssues

Rate Fast Slow Tachycardia HR above 100 bpm Bradycardia HR below 60 bpm

Rhythm Regular Irregular

Strength Strong = normal Weak

Activity Find pulses on yourself.

Radial Pulse

Check apical pulse on yourself Activity Check apical pulse on yourself

Pulse deficit and A-Fib Pulse deficit is the difference between the heart rate and the palpable pulse, as is often seen in atrial fibrillation. Atrial fibrillation or A-Fib is the most common abnormal heart rhythm. It may cause no symptoms, but is often associated with palpitations, fainting, chest pain, or congestive heart failure.

Resting Heart rate Your resting heart rate refers to the body's lowest heart rate, when your body is close to absolute rest, such as upon awakening in the morning.  Lowering your resting heart rate can significantly reduce your risk of heart attack and stroke and increase your endurance and feelings of well-being.

Resting Heart rate Knowing your resting heart rate can help you to assess your overall health and condition and help you set heart rate targets. Fitted athlete's heart rate is 40-60 per minute

Maximum heart rate Maximum heart rate. This is the highest your pulse rate can get. To find yours, follow this formula: 220-(your age)=(predicted maximum heart rate)

Target heart rate Target heart rate. This is 60 to 85 percent of your maximum heart rate. This is usually accomplished through exercise.

Why do I care for target heart rate? If your heart rate is lower than a target rate, then this exercise is good for flexibility or strength training, but wouldn’t train your heart. Aerobic exercise are the ones which train the heart

Diversify your exercise To train Strength - ? flexibility - ? heart - ?

Diversify your exercise To train Strength - ? flexibility - ? heart - ?

Diversify your exercise To train Strength - ? flexibility - ? heart - ?

Diversify your exercise To train Strength - ? flexibility - ? heart - ?

Blood Pressure You need – Stethoscope Sphygmomanometer Alcohol pads

BP – Blood Pressure Measures in mm of mercury – mm Hg due to old sphygmomanometer mercury type:

Blood Pressure 110/70 Systolic Blood Pressure – the top (first) number – the pressure in the heart during systole – the squeezing phase Diastolic blood pressure – the bottom (second) number – the pressure during the relaxation phase of the heart diastole – shows the resistance in the vessels of the body

Normal range for BP Systolic 90-120 – absolute normal. In your book – 100 - 120 120-130 pre hypertension, (New 2017 NIH standards) old ones - 140) above 130 – HTN (New 2017 NIH standards – 130, old ones in your book is 140) Diastolic below 80 - absolutely normal, in your book – range is 60-80 mm Hg 80-90 pre HTN Above 90 – HTN

BP summary Systolic/Diastolic 100-130 mm Hg/ 60-90 mm Hg Average human BP 110/70

Khan Academy Advanced Circulatory System Physiology in Khan Academy: Health and Medicine https://www.khanacademy.org/science/health-and- medicine/circulatory-system What is blood pressure? 6 http://www.youtube.com/watch?v=J97G6BeYW0I

Blood pressure (Korotkoff) sounds Youtube practice reading numbers: https://www.youtube.com/watch?v=YOGtnO6z_Ws Youtube practice reading numbers: http://www.youtube.com/watch?v=NRxCM8f9uwE&oref=http %3A%2F%2Fwww.youtube.com%2Fresults%3Fsearch_quer y%3Dblood%2Bpressure%2Bsounds%26oq%3Dblood%2Bp res

Hypertension Nucleus – medical media 5 http://www.nucleusanimationlibrary.com/animation- preview?ccat=all&clang=English&animationid=76622

Activity – measure BP