A R A V I N D E Y E C A R E S Y S T E M Vital Signs Dr. Banushree Physician

A R A V I N D E Y E C A R E S Y S T E M Vital Signs Pulse BP Temperature Respiration

A R A V I N D E Y E C A R E S Y S T E M Pulse It is the rhythmic expansion of the artery which occurs with each ventricular contraction

A R A V I N D E Y E C A R E S Y S T E M Following Statements are True / False Pulse rate is same for all agesFalse Only radial artery is used to feel pulse False Carotid pulse should never be felt bilaterally True Pulse gives a good idea about patients health. True

Resting Heart Rate Chart Resting heart rate Age or fitness levelBeats per minute (bpm) Babies to age 1100–160 Children ages 1 to 1060–140 Children age 10+ and adults60–100 Well-conditioned athletes40–60

A R A V I N D E Y E C A R E S Y S T E M Sites for Checking Pulse Temporal artery Facial Carotid Radial Femoral Dorsalis Pedis

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Method of checking radial pulse 3 fingers are used to feel the radial pulse on thumb side of wrist To palpate for 1 minute

A R A V I N D E Y E C A R E S Y S T E M Sites for checking pulse Temporal Artery Above outer side of outer canthus of eyes Carotids –Thumb to be used on inner side of sternomastoid muscle on either side of neck Brachial

A R A V I N D E Y E C A R E S Y S T E M Sites for checking pulse Femoral Artery –Feel in the Groin between anterior superior spine of illium and symphysis pubis Dorsalis pedis –On the in step of the foot

A R A V I N D E Y E C A R E S Y S T E M Characters of pulse Rate Rhythm Volume Tension

A R A V I N D E Y E C A R E S Y S T E M Rate Pulse rate more than 100 /mt is called tachycardia Common causes of techycardia – Excitement – Fever – Anemia – Thyrotoxicosis – Tachyarthythmias

A R A V I N D E Y E C A R E S Y S T E M Bradycardia Pulse rate less than 60 / mt is called bradycardia. Causes of bradycardia – Sleep – Old age – Atheletes – Hypothyrodism – Heart block

A R A V I N D E Y E C A R E S Y S T E M Rhythm Irregular pulse is seen in – Atrial Fibrillation – Ventricular Ectopics

A R A V I N D E Y E C A R E S Y S T E M Staging of Hypertension Normal – 120/80mmHg SystolicDiastolic High Normal Grade I H Grade II H 7 >160>100

A R A V I N D E Y E C A R E S Y S T E M Measurement of BP

BP Measurement

Measurement of BP Palpatory method Auscultatory method Step 1:Patient to rest for 5 minutes Step 2:Cuff is level with heart Step 3:Inflate cuff, palpate radial artery until 20-30mmHg above disapperance of pulse Step 4:Place stethscope over brachial artery in antecubital fossa and deflate cuff at rate of 2 to 5 mmHg/sec Step 5:listen for first sound (Korokoff phase1) – Systolic BP Disapperance of all sounds (Korokoff phase 5) Diastolic blood pressure

A R A V I N D E Y E C A R E S Y S T E M Why do need to do both palpation & Auscultation Severe HT has “Auscultatory Gap” which might be missed BP has to be measured by both methods

A R A V I N D E Y E C A R E S Y S T E M Common inaccuracies in BP recording Patient not relaxed Cuff not at heart level Rapid deflection Arm unsupported Inadequate cuff size

A R A V I N D E Y E C A R E S Y S T E M Cuff size Standard adult x 22.5cm Obese adult x 37.5cm Child- 5 x 18cm

A R A V I N D E Y E C A R E S Y S T E M Diagnosis of Hypertension Average of 3 BP measurements Investigations –Albumin deposits –Blood urea –Sr. Creatinine –Sr. Electrolytes

A R A V I N D E Y E C A R E S Y S T E M Complications of Hypertension

A R A V I N D E Y E C A R E S Y S T E M Complications of Hypertension

A R A V I N D E Y E C A R E S Y S T E M Temperature Taken by thermometer Normal body temperature is 37  C (Centigrade) (or) 98.6 F (Fahrenheit) Measured by 3 routes –Oral –Axilla –Rectal

A R A V I N D E Y E C A R E S Y S T E M

Thermometer

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Thermometer It is a delicate hollow tube with mercury Mercury expands when temperature goes up and shrinks when temperature goes down.

A R A V I N D E Y E C A R E S Y S T E M Precautions before Taking Temperature Always take temperature in sitting position Shake till mercury column is < 96F Avoid taking temperature if patient has consumed hot or cold liquids

A R A V I N D E Y E C A R E S Y S T E M

Oral Temperature Wash Hands Take thermometer out of container and wash with cold water Hold thermometer with thumb & first two fingers Keep under tongue

Axillary temperature Indications Unconscious patient Uncooperative patient Children Method –Place tip of thermometer in centre of axilla –To add one degree

A R A V I N D E Y E C A R E S Y S T E M Rectal Temperature Put lubricating jelly on tip of thermometer. Insert thermometer gently one inch into rectum. Minus one degree done Indications –Children –Unconscious patient Major surgery in face & neck

A R A V I N D E Y E C A R E S Y S T E M Temperature regulating centre – hypothalamus in brain Hypothermia –Temperature < 95  F Fever (pyrexia) –Temperature > 98.6  F Hyperpyrexia –Temperature > 106  F

A R A V I N D E Y E C A R E S Y S T E M Respiration Normal rate 16 – 20 times per/minute Method Hold wrist of patients over is chest Count number of times patients chest rises for 60sec

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