THE VITAL SIGNS: TEMPERATURE, PULSE, RESPIRATIONS AND BLOOD PRESSURE Abbreviated: TPR BP or simply VS

THE VITAL SIGNS Take a moment and close your eyes and concentrate on your breathing, the heat of your body and the flow of blood through your blood vessels as your heart beats. These are the crucial, automatic processes that occur continuously to maintain your life. They are indeed vital to life—and thus called the Vital Signs

SIGNS VS. SYMPTOMS Symptoms can only be described / validated by the patient. Pain, nervousness, dizziness, fatigue Signs are able to be measured / observed by others besides the patient Vital signs, wound drainage, color of sputum, blood cell counts

The measurement of core body heat TEMPERATURE The measurement of core body heat

ROUTES TO MEASURE TEMPERATURE Axillary: Under the arm in the armpit Orally: By mouth Rectally: By rectum Tympanic: In the ear Temporal: through the skin of the temple

TYPES OF THERMOMETERS Digital Electronic: To be used for oral, rectal, and axillary Thermoscan - Digital: To be used for tympanic /temporal Mercury or glass: To be used for oral, rectal, and axillary. Rarely used anymore due to health risks r/t mercury and risk of sharps injury if broken

NORMS Orally: 97.6 - 99.6 degrees Fahrenheit Rectally: 98.6 - 100.6 degrees Fahrenheit Tympanic - manufacturers say to measure as for rectal Axillary: 96.6 - 98.6 degrees Fahrenheit Temporally: Manufacturers say to measure as axillary.

HOW SHOULD THERMOMETER BE USED? Tympanic: Special device with plastic covers, placed snugly in ear canal. Electronic: Oral, rectal & axillary routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary, always retain hold of thermometer. Mercury: same as electronic. Red ends are rectal; blue ends oral and axillary, always retain hold of thermometer.

DURATION FOR TAKING TEMPERATURES Tympanic: As long as it takes to push a button Temporal: Until the thermometer beeps Electronic: Until the thermometer beeps Mercury Oral: Three minutes Mercury Rectal: Three minutes Mercury Axillary: Ten minutes

BE CAREFUL ON RECTAL AND AXILLARY TEMPS Always hold the thermometer in place while measuring temperatures by these routes Always use lubricant with rectal temperatures Always remove clothing around axilla and maintain arm pressed to side of torso

READING THE THERMOMETER Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree Long lines indicate degrees Short lines indicate 0.2 of a degree Four short lines between each long line (0.2, 0.4, 0.6, 0.8) All other types give a digital display to the tenth of a degree.

PULSE The felt wave of blood created by the heart pumping, that travels along the arteries.

WHERE TO FIND PULSES Locations called “pulse points” Felt at areas where the artery is between finger tips and a bony prominence or section Felt with 2-3 fingers, but never the thumb

PULSE POINTS AND THEIR LOCATIONS Temporal Carotid Apical Brachial Radial Femoral Popliteal Post Tibial Dorsal Pedalis

HOW TO MEASURE? Measured in beats per minute Count the felt waves for 60 seconds Or, count the felt waves for 30 seconds – then multiply by 2

NORMS Pulse norms are 60 - 100 beats per minute Pulses between 90 - 100 are in a gray area - high normal Faster than 100 - tachycardia Slower than 60 – bradycardia Caveat: well trained athletes may have “normal” pulse rates of 45-60, depending on level of fitness

QUALITY OF PULSE Rhythm: regular or irregular Rate: Bradycardic, Within the normal limits, Tachycardic Strength: Thready, Weak, Strong, Bounding

WHAT AFFECTS PULSE RATES AND QUALITY Body Temperature Emotions Activity Level Health of the Heart / vascular volume

RESPIRATION The exchange of gases at the alveolar-cellular level that results from the mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

RESPIRATION Measured in breaths per minute Normal range is 12 - 24 breaths per minute Count for 1 full minute or for 30 sec. x 2 Greater than 24 is tachypnea Less than 12 is bradypnea Watch for rate, depth, listen for quality of breath (adventitious vs. vessicular sounds), and difficulty in breathing (SOB/labored)

METHOD OF MEASURING TPR If using a mercury thermometer, measure the pulse and respiration while waiting for the temperature If using another method of measuring the temperature, complete the temperature - then measure the pulse and respiration Keep your fingers on the pulse while measuring the respiration

BLOOD PRESSURE The measurement of the force of blood against artery walls. Measured using device called sphygmomanometer and a stethescope. Measured as a fraction in mm/Hg Upper number (numerator) called the Systolic blood pressure. Lower number (denominator) called the Diastolic blood pressure.

MEASURING BLOOD PRESSURE The last sound heard (diastolic blood pressure) – is the measure of the pressure in an artery when the heart (ventricles) relaxes between contractions. Normal Ranges SBP: 90-130, DBP: 60-80 Hypertensive: 140/90 and above Hypotensive: 80/50 and below Grey areas: between norms and hyper/hypo

CAUSES & S/S HYPOTENSION Causes may include: Medications Illness Injury dehydration Signs & symptoms may include: Dizziness / light-headedness Lethargy / fatigue / generalized weakness might faint

CAUSES & S/S HYPERTENSION Hypertension is called the silent killer because there are often no symptoms. Causes may include: family history / high salt diet / overweight emotional upset /physical pain illness / medications / fluid overload Some people might experience: Headache / Pressure in the head / Tinnitis General feeling of malaise

CAUSES OF HTN-(CON’T) Genetics: More prevalent in African Americans than other ethnicities Age: More prevalent in middle-aged and elderly people than younger people Body size: More prevalent in obese people than thinner people Lifestyle: More prevalent in heavy drinkers than moderate to non-drinkers Co-morbidities: People with diabetes, gout or kidney dx .

CHARTING Chart in order: temperature - pulse – respiration – blood pressure. Do not write T =, etc. Number for temp with no route designation=oral Write (Ax) after axillary temperatures Write (R) after rectal temperatures Write (Tymp.) for tympanic Write (Temporal) for temporal

ABBREVIATIONS QID - Four times a day SOB - Short of breath QS - Every shift QD - Every day PRN - As needed Ad Lib - At liberty (as desired) B/P - Blood Pressure VS - Vital Signs HTN-hypertension SOB - Short of breath TPR - Temperature, pulse, and respiration WNL-Within normal limits VSS-Vital signs stable P.O. - By mouth BID -Twice a day TID -Three times a day

TERMS Bradypnea - Slow breathing Eupnea - Normal breathing Orthopnea - Sitting upright to breath more easily Apnea - No breathing Hyperpnea - Fast, deep breathing Hypopnea- slow shallow breathing Tachypnea – Fast breathing Bradypnea - Slow breathing Dyspnea - Painful or difficult breathing Tachycardia - Pulse rate in excess of 100 bpm Bradycardia - pulse rate less than 60 bpm

TERMS Bounding pulse - excessively strong pulse Weak pulse – softer pulsation than normally felt Hypertensive – blood pressure 140/90 & above Hypotensive-blood pressure 80/50 & less Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is “a piece of thread” running or fluttering under the fingertips.