1. Vital Signs and Measurements
Chapter 24
Vital Signs and Measurements

2. The Importance of Accuracy
Vital signs may be altered by many factors
Anxiety, anger, food intake, apprehension, mood
Treatment plans developed using vital sign measurements
Obtain baseline
Concentrate and attend to procedures

3. Temperature
Heat production and heat loss maintain and regulate (via brain) body temperature
Body heat produced by actions of voluntary and involuntary muscles (produces energy)
Cellular metabolic activities produce heat

4. Temperature Body loses heat through five processes Convection
Conduction
Radiation
Evaporation
Elimination

5. Temperature
Body temperature measured in degrees and influenced by several factors
There is no “normal” temperature
“Average” temperature: adult 98.6°F or 37.0°C

6. Temperature Terms used to describe body temperature Afebrile Febrile
Fever (pyrexia)
Onset
Lysis
Crisis
Intermittent
Remittent
Continuous

7. Temperature
Phase-out of mercury thermometers and other mercury-containing equipment
Mercury toxicity
When thermometers break or are disposed of improperly, mercury can enter atmosphere
Even small mercury spills should be cleaned up as soon as possible

8. Temperature Types of thermometers Disposable strips Electronic/digital
Tympanic
Temporal artery
(See Procedure 24-3: Measuring a Temperature Using a Temporal Artery (TA) Thermometer)

9. Temperature Measuring temperature Oral Aural Rectal Axillary
Temporal artery >>
[FIGURE 24-4]
(See Procedure 24-1: Measuring an Oral Temperature Using an Electronic Thermometer)
(See Procedure 24-2: Measuring an Aural Temperature Using a Tympanic Thermometer)
(See Procedure 24-4: Measuring a Rectal Temperature Using a Digital Thermometer)
(See Procedure 24-5: Measuring an Axillary Temperature)

10. Temperature Recording temperature
Scale used for results designated F for Fahrenheit and C for Celsius
R for rectal
A for axillary
Tym for tympanic
TA for temporal artery
(See Procedures 24-1 through 24-6)
(See Procedure 24-6: Measuring an Oral Temperature Using a Disposable Oral Strip Thermometer)

11. Temperature Cleaning and storage of thermometers
Oral and rectal thermometers separated
Digital, electronic, tympanic, temporal artery thermometers cleaned according to manufacturer’s directions
Disinfect by wiping with mild disinfectant as instructed by manufacturer

12. Pulse Pulse rate consists of two phases of heart action
Felt when compressing an artery
Pulse and heartbeat usually identical

13. Pulse Pulse sites Radial Carotid Temporal Brachial Femoral Popliteal
Dorsalis pedis
Apical
[FIGURE 24-6]

14. Pulse Measuring and evaluating a pulse
Note rate, rhythm, volume of pulse, condition of arterial wall
Rate is number of pulsations felt for 1 minute
Pulse rates vary according to age, activities, general health, sex, emotions, pain, medications

15. Pulse Measuring and evaluating a pulse
Rhythm of pulse: time between pulsations and regularity of beat
Arrhythmias (abnormal rhythms) may indicate heart disease
Volume of pulse: strength of beat felt
Full, strong, hard, soft, thready, weak
Normal artery feels soft and elastic

16. Pulse Normal pulse rates Birth: 120–170 beats per minute
Infants: 100–150 beats per minute
1 year: 120–160 beats per minute
2 years: beats per minute
3 years: beats per minute
7–14 years: 50–90 beats per minute
Adults: 60–100 beats per minute

17. Pulse Pulse abnormalities Bradycardia Tachycardia
Pulse rate less than 60 beats per minute
Tachycardia
Pulse rate greater than 100 beats per minute
Premature ventricular contraction (PVC)
Pulsation felt before expected
Sinus arrhythmia
Variation of rhythm sometimes occurs during respiration

18. Pulse Recording pulse rates Record after temperature
Unusual findings recorded and reported to provider
(See Procedure 24-7: Measuring a Radial Pulse)
(See Procedure 24-8: Taking an Apical Pulse)

19. Respiration Exchange of gases oxygen and carbon dioxide
Involuntary act controlled by medulla oblongata of brain
Respiratory rate: number of respirations per minute
Varies with age, activities, illness, emotions, drugs

20. Respiration
Average respiration rate to pulse rate is 1:4, one respiration to four pulse beats
Respiratory rhythm: pattern of breathing
Depth of respiration: amount of air inspired and expired with each respiration

21. Respiration Respiration rate
Measured by counting breaths for 30 seconds and doubling amount
Important patients not be aware you are measuring their respirations
(See Procedure 24-9: Measuring the Respiration Rate)

22. Respiration Abnormalities Apnea Tachypnea Bradypnea Cheyne-Stokes
Orthopnea
Hypoventilation
Hyperpnea
Hyperventilation
Sleep apnea
Narcolepsy

23. Respiration Breath sounds
Presence or absence can indicate respiratory problems
Rales
Rhonchi
Wheezes
Stridor
Stertorous

24. Blood Pressure
Measures force of blood exerted on peripheral arteries during cardiac cycle or heartbeat
Systole: force exerted on arterial walls during cardiac contraction
Diastole: force exerted during cardiac relaxation
Recorded as fraction: systole/diastole

25. Blood Pressure Factors that affect blood pressure Blood volume
Peripheral resistance
Vessel elasticity
Condition of heart muscle
Genetics
Diet and weight
Activity
Emotional state

26. Blood Pressure Equipment for measuring blood pressure
Auscultatory (listening) method uses sphygmomanometer and stethoscope
An electronic sphygmomanometer can measure pulse and other vital signs simultaneously >>
[FIGURE 24-12]

27. Blood Pressure Equipment for measuring blood pressure
Pulse oximeter: non-invasive method for measuring amount of oxygen saturating hemoglobin molecules contained in red blood cell

28. Blood Pressure Measuring blood pressure
Korotkoff sounds heard during blood pressure measurement
Phases of Korotkoff sounds
Phase I—first sound is systolic reading
Phase II—more blood passes through vessels

29. Blood Pressure Measuring blood pressure Phases of Korotkoff sounds
Phase III—rhythmic tapping sound; cuff deflated
Phase IV—may be used to record diastolic pressure in children and those patients where a tapping sound is heard to zero
Phase V—blood flowing freely; sounds disappear; recorded as diastolic pressure

30. Blood Pressure Measuring blood pressure Auscultatory gap
In some patients all sounds disappear between Phases I and II or III
Easily missed; blood pressure measurement incorrect
Pulse pressure: difference between systolic and diastolic measurements
(See Table 24-1: Errors in Blood Pressure Measurement Procedures)

31. Blood Pressure Recording blood pressure measurement
On patient chart or EMR in fraction format
Normal blood pressure readings
Child 10 years: 100/65
Adolescent 16 years: 118/75
Adult: Systolic less than 120/diastolic less than 80
Prehypertension: 120–139/80–89
High blood pressure: Above 140/90
(See Procedure 24-10: Procedure for Measuring Blood Pressure)

32. Blood Pressure Blood pressure abnormalities
Hypertension: blood pressure consistently above normal
Primary or essential, secondary, benign, malignant, white coat
Hypotension: blood pressure consistently below normal
Less than 90/60
Usually result of various shock-like conditions
Orthostatic hypotension
(See Table 24-2: Blood Pressure Categories)

33. Height and Weight Height not considered vital sign
Many providers prefer height and weight measured as part of yearly physical
Height measured with measuring bar
[FIGURE 24-15B]
(See Procedure 24-11: Measuring Height)

34. Height and Weight
Weight measured on calibrated balance beam scale or digital scale
Occasionally, MA required to convert pound weight to kilogram weight
Significance of weight: provides insight into metabolic, nutritional, emotional problems
(See Procedure 24-12: Measuring Weight)

35. Measuring Chest Circumference
Done on patients with emphysema and as requirement for insurance and truck driver licenses
Two measurements taken: one on deepest inspiration; one on deepest expiration
Comparison made to ascertain chest capacity