1. Medical Monday #1-Vital Signs

2. Vital Signs  Temperature  Pulse  Respiration  Blood pressure  Eye Exam

3. Vital Signs  Indicators of body function Assess body systems Signify changes taking place in body  Observations should also include Skin color & temp Behaviors Statements from resident (subjective)

4. Temperature  Balance of heat gained & heat lost  Hypothalamus is temp regulation center  Heat produced by Cellular activity ○ Infection elevates temp ○ Brain injury can increase or decrease temp Food metabolism Muscle activity ○ Exercise elevates temp Hormones External factors – heat, hot drinks, warm clothing Internal factors - dehydration

5. Temperature  Heat lost from body by Skin ○ Sweating ○ Increased blood flow to skin surface Lungs ○ Increased resp rate Elimination ○ Urine or feces

6. Temperature  Heat conserved by body through Reducing perspiration Decreasing flow of blood to skin Shivering ○ Increases muscle activity & produces heat

7. Temperature Norms  Adult 97 – 99 degrees Fahrenheit Oral – 98.6 Rectal – 99.6 Axillary – 97.6 Tympanic – 98.6

8. Temperature procedure  Wear gloves  Shake mercury down below 96  If smoked or had something to drink, wait 10 min  Insert thermometer, wait…. Oral – under tongue, 5 minutes Axillary – in armpit, 10 minutes Rectal – in rectum, 3 minutes

9. Contraindications for oral temps  Confused, disoriented  Restless  Unconscious  Coughing, unable to breathe through nose  Seizures  Oral/nasal oxygen  NG

10. Pulse  Force against the arterial walls that cause them to expand with each heartbeat  Count for one minute  Norm adult pulse is 60 –100 beats/min < 60 beats/min = bradycardia > 100 beats/min = tachycardia

11. Major pulse sites  Carotid – neck  Apical – left chest below nipple (need stethescope)  Brachial – inner aspect of elbow  Radial – thumb side of wrist  Femoral – groin  Popliteal – behind knee  Posterior tibialis – behind inner ankle  Dorsalis pedis – on top of foot

12. Factors that increase pulse  Exercise  Strong emotions – fear, anger, laughter, excitement  Fever  Pain  Shock  Hemorrhage

13. Factors that decrease pulse  Sleep/rest  Depression  Drugs – digitalis, morphine  Athletes in good physical condition may have a lower pulse, probably <60 beats/min. This is normal

14. Qualities of pulse  Rate – number of beats/min  Rhythm – regularity of pulse  Strength – force Weak or thready Bounding Strong

15. Respiration  Exchange of oxygen & carbon dioxide in lungs  1 respiration = 1 inhalation + 1 exhalation  Regulated by the medulla  Normal adult rate is 16 – 20 breaths/min  Normal breathing is quiet, effortless, & regular in rhythm

16. Qualities to observe for Resp  Rate  Rhythm  Depth – shallow, norm, deep  Effort involved to breathe  Discomfort it causes  Position resident adopts  Sounds that accompany it  Color of skin, mucous membranes, nailbeds – check for cyanosis

17. Abnormal breathing  Labored – struggles to breathe  Orthopnea- can breathe only when sitting or standing  Stertorous – snoring sounds when breathing (partial airway obstruction)  Abdominal – uses abd muscles  Shallow – uses only upper part of lungs  Dyspnea – painful or difficult breathing  Tachypnea – resp rate > 24 per min  Bradypnea – resp rate < 10 per min  Apnea – absence of breathing  Cheyne-Stokes – resp gradually increase in rate & depth & then become shallow & slow

18. Process of taking TPR  Take temperature first  Pulse second  Respirations last  When taking resp, keep fingers on pulse so that resident does not know you are counting resp  Document all together

19. Blood pressure  Pressure exerted against walls of blood vessels Systolic – highest reading ○ Pressure when heart contracting Diastolic – lower reading ○ Pressure when heart is at rest  Hear thumping sounds as blood flows through arteries Sounds correspond to numbers representing mm Hg on sphygmomanometer First sound heard is systolic Last sound heard is diastolic

20. Blood pressure  Normal adult reading 120/80  Normal systolic = 100 – 140  Normal diastolic = 60 – 90  Abnormal readings Hypertension – BP > 140/90 Hypotension – BP < 90/60

21. Factors increasing BP  Strong emotion  Exercise  Sitting or standing  Excitement  Pain  Decrease of vessel size  Digestion  Improperly placed or sized cuff

22. Factors decreasing BP  Rest/sleep  Lying down  Depression  Shock  Hemorrhage  Improperly sized cuff

23. Equipment for BP  Sphygmomanometer  Cuff  Stethescope  Cuff too narrow gives false high  Cuff below heart level will give false high  Cuff too large or improperly placed can give false low

24. Procedure for BP  Guidelines Measure BP at brachial artery Do not use injured arm, arm with IV, or casted Resident should be at rest Position arm level with heart Apply cuff to bare arm NOT over clothing Use appropriate size cuff Position sphygmomanometer at eye level