1. +. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Chapter 4 Vital Signs and Pain Assessment

2. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + "As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them."--John F. Kennedy

3. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Measurement of Vital Signs Temperature: indirect measure of body’s core temperature Pulse: measure of heart rate Respiration: measure of inspiration and expiration Blood pressure: peripheral measurement of cardiovascular function Use appropriate size. Pain: uncomfortable sensation and emotional experience associated with tissue damage 3

4. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Temperature Regulated by hypothalamus Pyrexia – (fever) – triggered by the production of prostaglandins Shivering – rapid contraction and relaxation of muscles reduces heat loss through the skin Vasodilation – increases heat loss through the skin 4

5. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Blood pressure Force of the blood against the wall of an artery as the ventricles contract and relax Systolic Force exerted when the ventricles contract Diastolic Force exerted by peripheral resistance when the heart is filling or relaxed 5

6. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Pain Acute pain is sudden, of short duration, and usually associated with surgery, injury, or acute illness. Chronic pain is persistent, lasting weeks or months, or longer; usually associated with prolonged disease. Nociceptors are free nerve endings activated to transmit pain impulses. 6

7. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Pain (Cont.) Response to pain is individualized because it is physiologic, behavioral, and an emotional phenomenon. Nonpain impulses (e.g., ice, massage) can compete with pain impulses for transmission along the spinal tracts to the brain and alter the perception of pain. 7

8. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Physical Examination Temperature Pulse rate Respiratory rate Blood pressure Assessing pain Infant and children pain scales 8

9. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Temperature Expected range – 97.2° to 99.9° F (36.2° to 37.7° C) Commonly performed: Oral Rectal Axillary Tympanic Forehead 9

10. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Pulse Rate Best palpated over carotid, brachial, radial, femoral, popliteal Count pulsations for 30 seconds (multiply x 2) Average adult pulse 60 to 100 Determine steadiness of the heart rhythm 10

11. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Respiratory Rate Count the number of breaths per minute Best to count after counting the pulse Count for 30 seconds and multiply x 2 Expected adult rate is 12 to 20 breaths per minute 11

12. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Blood pressure Measured when the patient is seated using the right arm Cuff size 12

13. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Blood pressure Check palpable systolic BP first Korotkoff sounds 13

14. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Assessment of Pain Subjective symptom that can be from many different conditions The pain experience and its characteristics and intensity are unique for each individual Assessment of the pain character and intensity 14

15. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Pain Scales Samples of self-reporting pain scales 15

16. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Assessing pain behaviors Guarding Facial mask of pain Vocalizations Body movements Vital sign changes Pallor Dry mouth 16

17. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. + Hypertension Most common disease in the world Defined as BP consistently above 140/90 Essential HTN poorly understood Secondary HTN underlying diseases – renal disease, renal artery stenosis, thyroid disorders, coarctation of the aorta, pheochromocytoma 17