1. General Vital signs

2. Vital Signs Are important indicators of health Detect changes in normal body function May signal life-threatening conditions Provide information about responses to treatment

3. Vital Signs TemperaturePulseRespirations Blood Pressure

4. Vital sign Vital signs are physical signs that indicate an individual is alive, such as heart beat (pulse), (respiration)breathing rate, temperature,and blood pressure

5. Vital sign These signs may be observed, measured, and monitored to assess an individual's level of physical functioning.

6. Vital Signs Are Measured: –Upon admission –As often as required by the person’s condition –Before & after surgery and other procedures –After a fall or accident –When prescribed drugs that affect the respiratory or circulatory system –When there are complaints of pain, dizziness, shortness of breath, chest pain –As stated on the care plan

7. Vital sign All measurements are made while the patient is seated.

8. Vital sign Prior to measuring vital signs, the patient should have had the opportunity to sit for approximately five minutes.

9. When Measuring Vital Signs Usually taken with the person sitting or lying The person is at rest Always report: –A change from a previous measurement –Vital signs above or below the normal range –If you are unable to measure the vital signs

10. Vital sign Normal vital signs change with age, sex, weight, exercise tolerance, and condition.

11. Temperature Vital signs

12. TEMPERATURE The measurement of core body heat

13. Temperature Measurement of balance between heat lost and produced by the body. Measurement of balance between heat lost and produced by the body. –Heat is produced by: Metabolism of food Metabolism of food Muscle and gland activity Muscle and gland activity –Heat may be lost through: Perspiration, Respiration, Excretion Perspiration, Respiration, Excretion Measured with the Fahrenheit (F) Measured with the Fahrenheit (F) or Celsius or Centigrade (C) scales or Celsius or Centigrade (C) scales

14. Factors that  body temperature IllnessInfectionExerciseExcitement High temperatures in the environment Temperature is usually higher in the evening Factors that  body temperature Starvation or fasting Sleep Decreased muscle activity Exposure to cold in the environment Body Temperature

15. ROUTES TO MEASURE TEMPERATURE Oral: By mouth Rectally: By rectum Axillary: Under the arm in the armpit Tympanic: In the ear Temporal : Forehead

16. Temperature Sites Oral - by mouth – most common method –May be affected by hot or cold food, smoking, oxygen, chewing gum –Wait 15 minutes or use alternate site Rectal - in the rectum -most accurate site –Do not use if patient has rectal surgery or bleeding Axillary - under arm – less reliable site –Used when other sites are inaccessible –Do not use immediately after bathing

17. Temperature Sites Tympanic or aural - in the ear –Measures in 1 to 3 seconds Temporal Artery – temporal artery on the forehead Record route temperature was taken O - Oral R- Rectal T – Tympanic A – Axillary

18. Temperature Rectally temperatures taken rectally (using a mercury or digital thermometer) tend to be 1° (Fahrenheit) higher than when taken by mouth. This temperature is the most accurate because is an internal measurement.

19. Temperature Oral temperature can be taken by mouth using classic glass or digital thermometers.

20. Temperature Axillary temperatures can be taken under the arm. Temperatures taken by this route tend to be 1° (Fahrenheit) lower than those temperatures taken by mouth. This is the least accurate temperature measurement because is an external measurement

21. BE CAREFUL ON RECTAL AND AXILLARY TEMPS Always hold the thermometer in place while measuring both temperatures Always use lubricant with rectal temperatures Always remove clothing around axilla

22. Aural Temperature By ear a special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature.

23. BE CAREFUL ON RECTAL AND AXILLARY TEMPS Always hold the thermometer in place while measuring both temperatures Always use lubricant with rectal temperatures Always remove clothing around axilla

24. Types of Thermometers Clinical (glass) thermometer no longer contain mercury. –Come in oral and rectal. – Disposable covers are usually used. Electronic can be used for oral, rectal, or axillary and use disposable probe covers. Tympanic placed in auditory canal and uses disposable cover. Strips that contain special chemicals or dots that change colors can also be used.

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

26. WHAT THERMOMETER SHOULD BE USED? Tympanic: Special device with plastic covers. Electronic: All routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary. Mercury: All routes. Red ends are rectal; blue ends oral and axillary.

27. 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)

28. Normal Body Temperature Oral 98.6 ( 97.6 - 99.6) Rectal 99.6 (98.6 - 100.6) Axillary 97.6 (96.6 - 98.6) Axillary 97.6 (96.6 - 98.6) Typmanic 98.6 (98.6 - 100.6) Typmanic 98.6 (98.6 - 100.6) Temporal 99.6 (98.6 - 100.6) Hypothermia – temperature below normal Hyperthermia – temperature above normal

29. Fever A fever is indicated when body temperature rises above 98.6° F orally or 99.8° F rectally.

30. Hypothermia Hypothermia is defined as a drop in body temperature below 95° F.

31. Respiration rate Vital signs

32. Respirations Process of breathing air into (inhalation) and out of (exhalation) the lungs. Oxygen enters the lungs during inhalation. Carbon dioxide leaves the lungs during exhalation. The chest rises during inhalation and falls during exhalation.

33. What is the respiration rate? The respiration rate is the number of breaths a person takes per minute.

34. RESPIRATION Measured in breaths per minute Normal range is 12 - 24 breaths per minute Greater than 24 is tachypnea Less than 12 is bradypnea Watch for rate, depth, quality of breath, and difficulty in breathing

35. Assessing Respiration Respirations is measured when the person is at rest. Rate may change is patient is aware that it is being counted. To prevent this, count respirations right after taking a pulse. Keep your fingers or stethoscope over the pulse site. To count respirations, watch the chest rise and fall.

36. Assessing Respiration Character and quality of respirations is also assessed: –Deep –Shallow –Labored or difficult –Noises – wheezing, stertorous (a heavy, snoring type of sound) –Moist or rattling sounds Dyspnea – difficult or labored breathing Dyspnea – difficult or labored breathing Apnea – absence of respirations Cheyne-Stokes – periods of dyspnea followed by periods of apnea; often noted in the dying patient often noted in the dying patient Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages the air passages

37. Respiratory Rate Try to do this as surreptitiously as possible. Observing the rise and fall of the patient's chest while you appear to be taking their pulse.

38. Respiratory Rate They should be counted for at least 30 seconds and multiply by 2

39. Respiratory Rate Respiration rates may increase with fever, illness,…. When checking respiration, also note whether a person has any difficulty breathing.

40. Pulse Vital signs

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

42. FIND WHERE TO PULSES At points where the artery is between finger tips and a bony area Called pulse points Felt with 2-3 fingers, but never the thumb

43. PULSE POINTS AND THEIR LOCATIONS TemporalCarotidApicalBrachialRadialFemoralPopliteal Dorsal Pedalis

45. Pulse The pressure of blood pushing against the wall of an artery as the heart beats and rests. Measure quality of pulse rate - beats per minute rhythm - regular or irregular strength or intensity - described as strong, weak, thready, bounding

46. 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

47. WHAT AFFECTS PULSE RATES AND QUALITY Body Temperature Emotions Activity Level Health of the Heart

48. Pulse rate Athletes, such as runners, may have heart rates in the 40's and experience no problems.

49. How to check your pulse The pulse can be found on the side of the lower neck. Carotid

50. Radial Pulse Place the tips of your index and middle fingers just proximal to the patients wrist on the thumb side, orienting them so that they are both over the length of the vessel.

51. Pulse: Quantity Measure the rate of the pulse (recorded in beats per minute). Count for 30 seconds and multiply by 2 (or 15 seconds x 4).

52. Pulse: Quantity If the rate is particularly slow or fast, it is probably best to measure for a full 60 seconds in order to minimize the error.

53. QUALITY OF PULSE Rhythm: regular or irregular Rate: Within the normal limits Strength: Strong, bounding, thready

54. 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 you fingers on the pulse while measuring the respiration

55. CHARTING Chart in order temperature - pulse - respiration. Do not write T =, etc. Write (Ax) after axillary temperatures Write (R) after rectal temperatures

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

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

58. TERMS Bounding pulse - excessively strong pulse 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 under the fingertips.

59. Blood pressure Vital signs

60. Definition of Blood Pressure The measurement of the force of blood against artery walls. 1. Force comes from the pumping of the heart 2. If arteries are hardened or narrowed, this force might be increased to pump the blood throughout the body.

61. Measurement Measurement is done by listening for two sounds with a stethoscope the first sound and the change in sound/or in some instances the last sound the first sound and the change in sound/or in some instances the last sound 1. The first sound is called the systolic blood pressure – it measures the pressure in an artery when the heart is contracting 2. The change in sound/or last sound heard is the diastolic blood pressure - it measures the pressure in an artery when the heart relaxes between contractions.

62. Measurement cont. The units of measurement are millimeters of mercury 1. the top number/systolic is charted first, then the diastolic as in systolic/diastolic 2. 120/80 is an example of a blood pressure and this would be in millimeters of mercury or mm Hg.

63. Blood pressure values HYPERYENSION High blood pressure, or hypertension, is defined in an adult as a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher Blood pressure is measured in millimeters of mercury (mm Hg). HYPOTENSION Someone whose B/P is < 90-100/60 is said to be hypotensive 1. Someone with hypotension may have symptoms of dizziness, light-headedness, might faint

64. Blood pressure values Normal range of B/P = 90-100/60 - 140/90 AHA Recommendation Blood pressure Normal Prehypertension Hypertension Mm/Hg Systolic (top 140 number) Diastolic (bottom number) 90

65. Position of the Patient Sitting position Arm and back are supported. Feet should be resting firmly on the floor Feet not dangling. Feet not dangling.

66. Position of the arm The measurements should be made on the right arm whenever possible. The measurements should be made on the right arm whenever possible. Patient arm should be resting on the desk

67. Position of the arm Palm is facing up. Palm is facing up. The arm should remain somewhat bent and completely relaxed

68. In order to measure the Blood Pressure (Cuff Position) Patient's arm slightly flexed at elbow Push the sleeve up, wrap the cuff around the bare arm

69. In order to measure the Blood Pressure (Cuff Position) Cuff applied directly over skin (Clothes artificially raises blood pressure ) Position lower cuff border 2.5 cm above antecubital Center inflatable bladder over brachial artery

70. In order to measure the BP Feel for a pulse from the artery coursing through the inside of the elbow (antecubital fossa).

71. In order to measure the BP Wrap the cuff around the patient's upper arm Close the thumb- screw.

72. In order to measure the BP With your left hand place the stethoscope head directly over the artery you found. Press in firmly but not so hard that you block the artery.

73. Technique of BP measurement Use your right hand to pump the squeeze bulb several times and Inflate the cuff until you can no longer feel the pulse to level above suspected SBP

74. Technique of BP measurement If you immediately hear sound, pump up an additional 20 mmHg and repeat

75. Technique of BP measurement Listen for auditory vibrations from artery "bump, bump, bump" (Korotkoff)

76. In order to measure the BP Systolic blood pressure is the pressure at which you can first hear the pulse.

77. In order to measure the BP Diastolic blood pressure is the last pressure at which you can still hear the pulse

78. In order to measure the BP Avoid moving your hands or the head of the stethescope while you are taking readings as this may produce noise that can obscure the Sounds of Koratkoff.

79. In order to measure the BP If you wish to repeat the BP measurement you should allow the cuff to completely deflate, permit any venous congestion in the arm to resolve and then repeat a minute or so later.

80. Blood pressure The minimal SBP required to maintain perfusion varies with the individual. Interpretation of low values must take into account the clinical situation.

81. Blood pressure for adult Physician will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of hypertension and initiating treatment.

82. Hypertension High blood pressure greater than 140/90

83. Blood pressure may be affected by many different conditions Pre eclampsia in pregnant women Psychological factors such as stress, anger, or fear Eclampsia

84. Blood pressure may be affected by many different conditions Various medications "White coat hypertension" may occur if the medical visit itself produces extreme anxiety