1. Vital Signs
Cadet training
21 Jan 2014

2. Objectives
Recognize common terminology and abbreviations used in documenting and discussing vital signs
Describe the instruments used to measure vital signs
Explain the procedure used to measure vital signs

3. Vital signs What are some examples of vital signs? Temperature
Respirations
Pulse
Blood pressure
Pupils
Ok, before we begin can anyone give me some examples of vital signs we may take for a patient?
Breathing (respiration)
Pulse
Skin
Pupils
Blood pressure
Pulse oximetry

4. Basic Vital Signs Vital signs are the physical “signs of life”
Outward signs that give clues to what is happening inside the body
Breathing (respiration)
Pulse
Skin
Pupils
Blood pressure
We aren’t able to get inside the patient’s body to see what is going on, but we can measure the vital signs. These are the physical “signs of life” - outward signs that give clues as to what is happening inside the patient’s body. They provide us with information about the patient’s overall condition – how are they doing? Are they sick or not sick?

5. Baseline vital signs Why do we take more than one set of vital signs?
What are some tools we can use to measure vital signs?
The first set of measurements we take are known as the baseline vital signs. We are able to compare the next set and the next set to this and we can track changes - or trends - in vital sign readings. For example, a blood pressure that continues to decrease and a heart rate that continues to increase would be significant findings in a patient who is losing blood.
A lot of vital signs can be measured with our senses (looking, listening, feeling), but some require equipment (ex. sphygmomanometer (BP cuff))
What are some tools we can use to measure vital signs?
- thermometer
- BP cuff
- pen light for pupils
- pulse oximetry

6. temperature

7. What is the normal body temperature?
A person’s body temperature varies depending on many things:
Gender
Recent activity
Food and fluid consumption
Time of day
Measured in Celsius or Fahrenheit
What is the normal body temperature?
We’ll start with temperature, which is a relatively easy vital sign to take and interpret.
Normal adult temperature is 98.6F or 37C
Normal range can be from 96.8F to 100.4F or 36C to 38C

8. Normal adult temperature is 98.6ºF, or 37ºC

9. What else can we tell from a patient’s skin?
Temperature
What else can we tell from a patient’s skin?
Skin temperature (cool, warm, hot)
Skin color (pale, blue-gray, red, yellow)
Skin condition (dry, moist, wet)
Just be touching a patient we can learn a lot about what is going on. We can take their skin temperature, but we can also note their skin color and their skin condition. Normally, skin is dry. Wet or mist skin (clammy) may indicate shock, cardiac problems, diabetic problems, and more. Skin that is both cool AND moist is often described as clammy.

10. Where can we measure temperature?
Febrile – body temperature above normal range
Afebrile – body temperature is normal
What could a fever mean?
Where can we measure temperature?
A fever is a common symptom of many medical conditions. It shows that the body is reacting to something that is happening to the body. A fever could be a sign of inflammation or infection, things like the flu, mono, malaria…inflammations like abscesses or boils, etc.
We can take a patient’s temperature in many different parts of the body…orally, axillary (armpit), rectally, tympanic (ear)
At Parkwood we use a thermometer that measures the tympanic temperature. DEMONSTRATE

11. Tympanic
Axillary

12. Skin Color and Condition

13. Respiratory rate

14. What is the goal of respiration? How do we measure respiratory rate?
Indication of how well the body is providing oxygen to the tissues.
How do we measure respiratory rate?
Looking, listening, or feeling movement of air
The goal of respiration is to provide oxygen to the body’s tissues. So the respiratory rate is an indication of how well the body is getting oxygen, which it needs to function.
Respiration means the actual process of moving oxygen and carbon dioxide across membrances, in out and out of the alveoli, capillaries, and cells. Respiration is the actual gas exchange process. Ventilation (breathing) is the mechanical process by which air is moved in and out of the lungs

15. Respiration

16. 1 inhalation + 1 exhalation = 1 respiration
Respiratory Rate
1 inhalation + 1 exhalation = 1 respiration
Respiratory rate is the number of breaths per minute
Measure: count breaths for 30 seconds, multiply by 2
Look, listen and feel for movement of air. You can also count with a stethoscope.

17. Respiratory rate Rate Rhythm (regular vs. irregular)
Effort/Quality (labored vs. unlabored, deep vs. shallow)
Note: If patients are aware that you are counting their respirations, they may unintentionally alter their breathing.
Respiratory rate is the number of breaths a person takes per minute. We can measure this by looking, listening and feeling for a patient’s inhalation and exhalation. The number of breaths is important, but so is the rhythm and quality/effort of those breaths. Are they regular? Irregular? Are they labored or unlabored? Shallow? Deep? Are they trying to force air out or pursed lips?
Hyperventilation, dyspnea (difficult/painful breathing), tachypnea, hyperpnea
This says a lot about what is going on with a patient. They may be breathing at a normal rate, but working extra hard to do so. This is an important part of the respiratory rate vital sign.
There are other irregularities, like wheezing, gurgling, etc. that indicate what is occurring with the patient.

18. Normal respiratory rates depend a lot on age
Normal ranges:
Adults:
Adolescents: 12 – 20
Children: 15 – 30
Infants: 20 – 40
Newborns: 30 – 60

19. Blood pressure

20. Systolic and Diastolic
Blood Pressure
The force at which blood is pumped against the walls of the arteries
Measured in mmHg (milligrams of mercury)
Two different pressures:
Systolic and Diastolic
Blood pressure is the force at which blood is pumped against the walls of the arteries; it is measured in millimeters of mercury.
There are two pressure movements: systolic and diastolic.

21. 120/80 Blood pressure Systolic/Diastolic
Systolic: measure of pressure on the arteries when the heart contracts
Diastolic: measure of pressure on the arteries when the heart relaxes
Systolic/Diastolic
The systolic blood pressure is the measure of the pressure when the heart (left ventricle) contracts.
The diastolic pressure is the measure of the pressure when the heart is resting (relaxing) – this is the MINIMUM amount of pressure exerted against the artery walls at all times. Can’t go any lower than this. This will always be lower than the systolic pressure.
120/80

22. Blood pressure Hypertension: High blood pressure
Major contributor to heart attacks, strokes
Hypotension: Low blood pressure
Can be normal for some people
Can occur with shock, excessive bleeding, severe burns
Hypertension is high blood pressure; which is a common contributor to heart attacks and strokes
Hypotension is low blood pressure; this can be normal for some people; very low blood pressure can occur with many different conditions, including shock, excessive bleeding, severe burns

23. Blood pressure Measuring blood pressure Measuring blood pressure
Equipment: sphygmomanometer
1. Place cuff on the upper arm
2. Inflate cuff to about 180 – 200 mmHg
3. Release air slowly and listen for the first heartbeat (systolic pressure) and the last heartbeat(diastolic pressure)
4. Record results with systolic as top number and diastolic as bottom number (132/82)
Measuring blood pressure
- Place cuff on the upper arm above the brachial pulse site
- Inflate cuff about 30 mmHg above palpatory result or approximately 180 mmHg to 200 mmHg
- Release the air in cuff and listen for the first heartbeat (systolic pressure) and the last heartbeat (diastolic pressure)
- Record results with systolic as the top number and diastolic as the bottom number (i.e., 120/76)
Important: having the right size cuff is important; it should completely encircle the patient’s bare arm without overlapping; an improperly sized cuff will not give you an accurate reading (too small will give a higher reading than is true; too big will give a lower reading than is true)

25. Blood pressure Practice! Normal blood pressure readings: Patient
Systolic
Diastolic
Adult male
100 + age in years to age 40
60 – 85 mmHg
Adult female
90 + age in years to age 40
Adolescent
90 mmHg
2/3 systolic pressure
Child 1-10 years
80 + (2 age in years)
Infant 1-12 months
70 mmHg

26. PUlse

27. Where can we feel pulses?
The pulse is the pressure wave generated by the contraction of the heart
Where can we feel pulses?
Carotid Popliteal
Femoral Posterior tibial artery
Radial Dorsalis pedis artery
Brachial
The pulse is the pressure wave generated by the contraction of the heart (left ventricle). The pulse directly reflects the rhythm, rate and realtive strength of the contraction of the heart as well as the volume of blood being pumped out of the heart.
Where can we feel pulses? Anywhere on the body where an artery
Carotid (either side of the neck in the groove between the trachea and the muscle mass)
Femoral (in the crease between the lower abdomen and the upper thigh (groin)
Radial (proximal to the thumb on the palmar surface of the wrist
Brachial (on the medial part of the arm; midway between the shoulder and the elbow between the biceps and tricep muscles)
Popliteal (in the crease behind the knee)
Posterior tibial artery (behind the ankle bone)
Dorsalis pedis (on the top of the foot on the big toe side)

29. Why do we not use our thumb to feel for a pulse?

30. Pulse Normal pulse rate ranges: For adults: Adult: 60-80 bpm
Adolescent: bpm
Child: bpm
Infant:
Newborn:
For adults:
Heart rate above 100 bpm is called tachycardia
Heart rate below 60 bpm is called bradycardia
The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Girls ages 12 and older and women, in general, tend to have faster heart rates than do boys and men.

31. pulse
Measuring pulse rate, quality, and regularity
Measure the rate by counting for 30 seconds and multiplying by 2
Rate, quality, and regularity, like with respirations, are important
Is it regular? Irregular?
Is it strong or weak?
Practice!
The pulse can help you gauge the patient’s condition. For example, a rapid pulse may indicated shock. Absence of a pulse means the heart has stopped breathing, the pressure is extremely low, or the artery has been blocked.
The quality of the pulse can be characterized as strong, or weak;

32. Pupils

33. Pupils
To assess pupils, we use a penlight and shine it into the patient’s eyes
We are looking for the size, equality, and reactivity
Size: pupils can be dilated (large) or constricted (small)
Equality: pupils should be the same size
Reactivity: pupils should both respond to light
Size: pupils that are dilated may indicated cardiac arrest, use of certain drugs like LSH, cocaine, etc. Pupils that are constricted may indicate a central nervous system disorder, narcotics, or a brightly lit environment.
Equality: pupils of unequal size may indicate a stroke, head injury, disease of the eye, etc. Some people normally have unequal pupils.
Reactivity: reactivity refers to the pupil changing in size in response to light shined in the eye; the pupils will constrict when light is shined in them; both pupils will have the same response even if the light is only shined in one of the eyes. This is called a consensual reflex.
If one or both pupils do not constrict to light shined in one eye, it is referred to as a fixed pupil. To assess the pupils, first note the size of each pupil; then shine the light in one eye and watch the response of both pupils. Is the response fast or sluggish? Do the return to the original size when you remove the light?

34. Pupils
Source:

35. unequal pupils

36. Other vitals? Pulse oximetry A percent - % Sp02 97 – 100% is normal
Read the patient, not the monitor
Capillary refill
2 seconds for infants, children, male adults
3 seconds for women
4 seconds for elderly
Pulse oximetry: pulse oximetry is the method of measuring oxygen saturation levels in the blood. We use a pulse oximeter which is clipped onto a patient’s finger, toe, earlobe, or nose. The pulse oximeter measures arterial blood oxygen saturation, so the probe has to be placed in an area where the light from the oximeter shines through arterial blood flow. The light shines through and detects the amount of hemoglobin in the blood that is saturated with oxygen and the amount that is not saturated with oxygen. The pulse oximeter provides a reading as a percent of hemoglobin saturated with oxygen. 97 – 100% is ideal. It is important to treat the patient and not the pulse oximeter reading.
Capillary refill: the time is takes for compressed capillaries to fill up again with blood is called capillary refill time. It is a great vital sign to use for infants and young children. To measure capillary refill, press firmly on the skin or nail bed. When you remove your finger, the compressed area will be white. Count the amount of time in seconds it takes to return to the original color. Normal capillary refill times vary based on age, temperature of the environment, etc. The upper limits for normal capillary refill times are 2 seconds for infants, children, and male adults; 3 seconds for women; and 4 seconds for the elderly. When it takes longer than these times, the circulation of blood through the capillaries may be inadequtea.

37. How much do you remember?
Why is it important to take more than one set of vital signs?
What are we looking and listening for when we count a patient’s breaths?
Where on the body can we feel pulses?
How do we record blood pressure?

38. Questions?