1. Vital Signs aka Cardinal Signs
MED106

2. Signs
Vital or Cardinal: temperature, pulse, respiration and blood pressure. TPR and BP
Anthropometric signs – height, weight, fat composition, chest circumference

3. Factors That May Influence VS
Accuracy is essential
VS can be affected by physical and emotional factors
Many patients are apprehensive during an office visit, which can alter their VS
Medical Assistant should help patient to relax as much as possible

4. Normal Ranges Blood Pressure Age Group Pulse Respirations (mm Hg)
Newborn /30-62
Toddlers /48-78 (1-3 yr)
Preschool / (4-6 yr)
School age / (7-11 yr)
Adolescent / (12-16 yr)
Adult /60-90

5. Body Temperature/Fever
Body temperature is the balance between the heat lost and the heat produced by the body, measured in degrees.
The increase in body temperature is thought to be the body's defensive reaction to inhibit the growth of some bacteria and viruses.
Continuous fever rises and falls only slightly during the 24-hour period. It remains above the patient's average normal range and is called continuous because that is exactly what the pattern shows.
Intermittent fever comes and goes, or it spikes then returns to average range.
Remittent fever has great fluctuation but never returns to the average range. It is a constant fever with fluctuating levels.

6. Temperatures Considered Febrile
Rectal or aural (ear) temperatures over 100.4° F (38° C)
Oral temperatures over 99.5° F (37.5° C)
Axillary temperatures over 98.6° F (37° C)
Fever of unknown origin (FUO) is a fever over 100.9° F (38.3° C) for 3 weeks in adults and 1 week in children without a known diagnosis.
Formulas for conversion from one system to the other
C = (F – 32) x 5/9
F = 9 × C + 32

7. Rectal and Oral Readings
Rectal temperatures, when taken accurately, are approximately 1° F or 0.6° C higher than oral readings.
Axillary temperatures are approximately 1° F or 0.6° C lower than accurate oral readings.

8. Aural (Ototemp) Temperature
Advantages:
Accurate—reflection of blood temp surrounding the hypothalamus
Not affected by open mouth, hot or cold drinks, etc.
Decreased risk of spreading communicable diseases
Do not use in the presence of:
Bilateral otitis externa
Impacted cerumen

9. Types of Thermometers
Digital
Tympanic
Disposable
Axillary
Rectal

10. Pulse
Pulse reflects the palpable beat of the arteries as they expand with the beat of the heart.
With every beat, the heart pumps an amount of blood (stroke volume) into the aorta.
An artery close to the body surface can be pushed against a bone for the pulse to be felt.
Patient should be in a comfortable position, with artery to be used at same level as or lower than the heart, with the limb relaxed and supported.

11. Pulse Sites
The most common sites are at the following arteries: temporal, carotid, apical, brachial, radial, femoral, popliteal, and dorsalis pedis.
Apical pulse used with:
Infants and children
Adults with difficult radial pulse to palpate
Patients taking cardiac drugs
Arrhythmia—bradycardia, tachycardia, pulse deficit

12. Characteristics of Pulse and Three-Point Scale
When you take a pulse, note four important characteristics: (1) rate, (2) rhythm, (3) volume of the pulse, and (4) condition of the arterial wall.
Record the number of beats in 1 minute, and assess the rate, rhythm, volume, and elasticity.
Three-Point Scale for Measuring Pulse Volume
3+, full, bounding
2+, normal pulse
1+, weak, thready

13. Respiration
One complete inspiration and expiration is called a respiration.
During inspiration, diaphragm contracts, lungs expand and fill with air.
During expiration, diaphragm returns to normal, elevated position and lungs exhale waste air.
Breathing is both an involuntary and voluntary process:
Elevated blood carbon dioxide levels activate the respiratory control center in the brain to stimulate respiration.
Can be controlled to a certain extent.

14. Respiratory Rate Characteristics
Rate: number of respirations per minute
Rhythm: breathing pattern
Depth: amount of air being inhaled and exhaled
Patients self-consciously alter their breathing rates when they are being watched.
Therefore count the respirations while appearing to count the pulse.
Keep your eyes alternately on the patient's chest and your watch while you are counting the pulse rate, and then, without removing your fingers from the pulse site, determine the respiration rate.

15. Respirations Terms Dyspnea COPD Bradypnea Apnea Tachypnea Hyperpnea
Hyperventilation
Orthopnea
Rales
Rhonchi
Stertorous
Cyanosis

16. Blood Pressure
Blood pressure reflects the pressure of the blood against the walls of the arteries.
Blood pressure is read in millimeters of mercury, abbreviated mm Hg.
Blood pressure is recorded as a fraction, with the systolic reading in the numerator (top), and the diastolic reading in the denominator (bottom) (for example, 130/80).

17. Systolic/Diastolic BP
The systolic measurement is the pressure of blood against the artery walls when the heart has just finished pumping (contracting).
The diastolic measurement is the pressure of blood against the artery walls between heartbeats, when the heart is relaxed and filling with blood.
Korotkoff sounds - produced by the vibrations of the arterial wall

18. Factors That Affect Blood Pressure
Volume: Amount of blood in the arteries
Peripheral resistance of blood vessels: Relationship of the lumen or diameter of the vessel and the amount of blood flowing through it
Vessel elasticity: Vessel's capability to expand and contract to supply the body with a steady flow of blood
The condition of the heart muscle, or myocardium, is of primary importance to the volume of blood flowing through the body.

19. Hypertension
Risk factors include cigarette smoking, diabetes mellitus, hyperlipidemia, male gender, postmenopausal status, obesity, stress, and family history.
Fifty million Americans have hypertension that requires treatment.
Treatments include medications and lifestyle changes such as weight loss, limitation of alcohol intake, smoking cessation, aerobic exercise, and a diet low in fat and sodium and high in fiber.
Schedule regular follow-up visits every 3-6 months, depending on severity

20. Hypertension Diagnosis
LEVEL
SYSTOLIC
DIASTOLIC
High blood pressure
140 or above
90 or above
Pre-hypertension
120 to 139
80 to 89
Normal adult (age 18 or older) blood pressure
119 or below
79 or below

21. Hypotension
Hypotension: Abnormally low blood pressure, caused by shock, both emotional and traumatic; hemorrhage; central nervous system disorders; and chronic wasting diseases.
Persistent readings of 90/60 mm Hg or below are usually considered hypotensive.

22. Causes for BP Errors
The limb being measured is not at the same level as the heart.
The rubber bladder was not completely deflated before starting.
The pressure in the cuff is released too rapidly.
The patient is nervous, uncomfortable, or anxious.
The patient drank coffee or smoked cigarettes within 30 minutes of the elevation.
The cuff is improperly applied.
The cuff is too large, too small, too loose, or too tight.
The cuff is not placed around the arm smoothly.
The bladder is not centered over the artery, or it bulges out from the cover.
The examiner did not wait 1 to 2 minutes between measurements.
Defective instruments were used.