V ITAL S IGNS AND O THER A SSESSMENT S URVEYS

D EFINITION Body temperature, pulse ( نبض ), respiration and blood pressure are the vital signs ( علامات حيوية ). They are indicators ( مؤشرات ) to distinguish ( تميّز ) between living and non living human being. These signs are used by nurses, paramedics and physicians to follow-up the patient's condition or to detect any variation in them.

PULSE Reflects the rate of the heart beat. Felt where an artery passes over a bone near the surface (superficial سطحي ) of the body. For a healthy adult, normal heart rate (HR) ranges between beats per min (bpm). Tachycardia تسارع انقباض القلب – greater than 100 bpm Bradycardia تباطؤ انقباض القلب – less than 60 bpm Pulse rate increases with bleeding, exercise, illness, injury, and emotions.

P ULSE S ITES To assess the peripheral pulses by palpation, apply (place) pads on the most distal aspects of the middle three fingers on its location, with moderate pressure. Apical pulse is usually evaluated by auscultation. صدغي سباتي عضدي فخذي شعاعي ( كعبري )

R ESPIRATION It is the means ( واسطة \ طريقة ) by which oxygen enters the blood through the lungs during breathing in (inspiration) and carbon dioxide is expelled during breathing out (expiration). For an adult, normal respiratory rate (RR) is breath/min Normal – eupnea Abnormal increase – tachypnea Abnormal decrease – bradypnea Absence of breathing – apnea

TEMPERATURE Average body temperature is 37 C° Body temperature ranges from 36 to 38 C°. It is measured by a thermometer ( ميزان حرارة ). If temperature < 38 hyperthermia. If temperature > 36 hypothermia. C = (Fahrenheit temperature - 32 ) x 5/9 F = (Celsius temperature x 9/5 ) + 32

S ITES OF TEMPERATURE ASSESSMENT SiteDescriptionTime to attain Oral Posterior sublingual pocket (under tongue) No hot or cold drinks or smoking 20 min prior to temp. Must be awake & alert. Not for small children (bite down) Leave in place 2-3 minutes.

S ITES OF TEMPERATURE ASSESSMENT SiteDescriptionTime to attain Axillary Bulb in center of axilla Lower arm position across chest Non invasive – good for children. Less accurate (no major blood vessels nearby) Leave in place 5-10 minutes. Measures 0.5 C lower than oral temperature.

S ITES OF TEMPERATURE ASSESSMENT SiteDescriptionTime to attain Rectal Side lying on left side with upper leg flexed, insert lubricated bulb (1- 11/2 inch adult) (1/2 inch infant) When unsafe or inaccurate by mouth (unconscious, disoriented or irrational) Left side lying position – right leg flexed Left leg straight Leave in place 2-3 minutes. Measures 0.5 C higher than oral temperature

S ITES OF TEMPERATURE ASSESSMENT SiteDescriptionTime to attain Ear Close to hypothalamus – sensitive to core temperature changes. Adult - Pull pinna up & back Child – pull pinna down & back Rapid measurement Easy to assess Cerumen إفرازات الأذن الصمغية impaction distorts reading Otitis media التهاب الأذن المتوسطة can distort reading 2-3 seconds

B LOOD PRESSURE (BP) It means the force required by the heart to pump blood into the arteries. It is measured in systolic and diastolic pressure. Systolic is the pressure exerted by the contraction of the ventricles - higher value. Diastolic is the pressure when the ventricles at rest – lower value Normal B.P.: 120/80 mmHg Hypertension : High blood pressure if BP < 140/90 mmHg. Hypotension : Low blood pressure if BP > 100/60 mmHg.

PUPILS Check the pupils for size, equality and reactivity to light (both pupils constricted). Examine both eyes.

COLOUR Color of the skin and mucous membrane, (e.g., conjunctiva ملتحمة العين, inside of the lips).

LEVEL OF CONSCIOUSNESS This is used during cardiac arrest, head injuries and any comatose patient to assess responsiveness Terms Used to Describe Level of Consciousness Alert متنبه يقظ : Follows commands in a timely fashion. Lethargic نوامي كسول : Appears drowsy, may drift off to sleep during examination. Stuporous ذهولي : Requires vigorous stimulation (shaking, shouting) for a response. Comatose غيبوبي : Does not respond appropriately to either verbal or painful stimuli.

H OW TO ASSESS LEVEL OF CONSCIOUSNESS (LOC) مستوى الوعي The Glasgow Coma Scale (GCS) provides a more objective way to assess the patient’s LOC. It evaluates best eye response, best motor response, and best verbal response on a scale of 3 to 15. Fifteen (highest score) indicates that the patient is awake, alert, oriented, and able to follow simple commands. Three (lowest score) indicates that the patient does not respond to any stimulus and has no motor or eye response, reflecting a very serious neurologic state with poor prognosis.

A GCS of 8 or less indicates severe head injury (comatose state) A GCS of 9-12 moderate head injury A GCS of is obtained when the head injury is minor.

ABILITY TO MOVE If the patient is conscious and if spinal or neck injury is suspected assess the patient's ability to move his upper and lower extremities.