1. Introduction to Vital Signs

2. Vital Signs
Various determinations that provide information regarding the condition of the patient.
Used to assess health of body

3. Other Important Measurements
Vital Signs
4 Major
Other Important Measurements
Temperature
Pulse
Respiration
Blood Pressure
Pain Scale
Color of Skin
Pupil Size
Pupil Reactivity
Level of Consciousness
Response to Stimuli

4. Body Temperature
A measurement of the balance heat lost and heat produced by the body.
Can be measured in mouth (oral), the rectum (rectal), the armpit (axillary), and the ear (aural)

5. Fahrenheit vs. Celsius- Conversion may be necessary.
Temp. Continued
Different readings can indicate disease
Most temperature is measured in degrees.
Fahrenheit vs. Celsius- Conversion may be necessary.

6. Pulse
The pressure of blood felt against the wall of an artery as the heart contracts and relaxes.
Rate= BPM (beats per minute)
Rhythm= regularity
Volume= strength
Apical Pulse: taken at the apex of the heart

7. Respirations Breathing rate of person Rhythm/Rate= regularity
Character= type

8. Blood Pressure
The force exerted by the blood against the arterial walls when the heart contracts or relaxes.

9. TEMPERATURE

10. The loss and production of HEAT!!!!!
Loss: perspiration, respiration, and excretion
Production: metabolism of food and muscle and gland activity
Why is temperature important?

11. Homeostasis Constant state of fluid balance Ideal health in human body
Chemical reactions regulated by body temperature
If temp is too high or too low the body’s fluid balance is affected

12. Variations in Temp Normal Range: 97-100 degrees Fahrenheit
Individual differences: bodily processes (slow/fast)
Time of the day: morning vs. evening
Body Sites:
Oral
Rectal
Axillary
Aural
Temporal

13. Oral By mouth Usually takes 3-5 minutes Most common Most comfy
Norm: 98.6

14. Rectal From the rectum Usually takes 3-5 minutes Most accurate
Most uncomfortable
Norm: 99.6

15. Axillary Under the armpit External reading Less accurate
Usually takes 10 minutes
Norm: 97.6

16. Aural Inside the ear Measures core temp.
Can be inaccurate if inserted incorrectly
Usually takes less than 2 seconds for a reading
No norm

17. Temporal Newest method Thermometer passed across the forehead
Measures temperature of blood in the temporal artery
Proving to be the most accurate

18. Changes in Body Temperature
Increases
Decreases
Hypothermia: low body temp (below 95) death usually occurs at below 93
Hyperthermia: high body temp (above 104) convulsions, brain damage or death can occur above 106
(Pyrexia) Fever: elevated body temperature (101 degrees)
Febrile= means you have a fever
Afebrile= means you do not have a fever

19. Types of Thermometers
Clinical: slender glass tube containing mercury or alcohol with red dye.
Electronic: registers temp. in about 60 secs. Used in a variety of facilities. Can be battery, solar or powered by an outlet
Tympanic: records aural temperatures. reads within 1-2 secs. Accuracy is key.
Temporal: measure temporal artery. Accurate. Easy to use. Non invasive.

20. Reading and Recording Temp
When recording the temperature to decrease errors always write?????????
If a reading is:
Rectal put a (R) beside the temp
Axillary put (Ax) beside the temp
Aural put (A) beside the temp

21. Cleaning Thermometers
Must be cleaned after each use
Procedures vary
Covers can be used in some cases.

22. Pulse

23. Defined as the pressure of the blood pushing against the wall of an artery as the heartbeats and rests
Feel throbbing of the arteries caused by contractions of the heart
More easily felt in arteries that lie close to the skin and can be pressed against a bone

24. Major Arterial/Pulse Sites
Temporal: side of the forehead
Carotid: side of the neck, used for CPR
Brachial: inner aspect of forearm at the antecubital space (crease of elbow), used for blood pressure
Radical: inner aspect of wrist, above thumb, most common site for measuring pulse
Femoral: inner aspect of upper thigh
Popliteal: behind knee
Dorsalis pedis: top of foot arch
Posterior Tibialis: behind the medial ankle bone

26. Pulse rate Noted as the number of beats per minute
Vary with individuals depending on age, sex, and body size
Adults: wide range of 60 to 100 beats per minute
Adult men: 60 to 70 beats per minute
Adult women: 65 to 80 beats per minute
Children over 7: 70 to 100 beats per minute
Children from 1 to 7: 80 to 110 beats per minute
Infants: 100 to 160 beats per minute

27. Pulse Rate Irregularities
Bradycardia: pulse rate under 60 beats per minute
Tachycardia: pulse rate over 100 beats per minute (except in children)
Any variations or extremes in pulse rates should be reported immediately.

28. Pulse Rhythm Should be noted along with rate
Refers to the regularity of the pulse, or the spacing of the beats
Described as regular or irregular
Arrhythmia
Irregular or abnormal rhythm
Usually caused by a defect in the electrical conduction pattern of the heart.

29. Pulse volume Noted along with rate and rhythm
Described by words such as strong, weak, thready, or bounding

30. Various factors will change the pulse rate
Increased or accelerated rates caused by exercise, stimulant drugs, fever, shock, nervous tension
Decreased or slow rates caused by sleep, depressant drugs, heart disease, coma, and physical training

31. Basic principles for taking radial pulse
Position patient’s arm supported comfortably with palm of hand turned down
Use tips of two or three fingers to locate pulse site on thumb side of wrist
Count pulse for one full minute
Note rate, rhythm, and volume of pulse
Record all information!!!!!

32. Respirations

33. Measures the BREATHING of the patient
Process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract
One respiration consists of one inspiration (breathing in) and one expiration (breathing out)

34. Normal respiratory rate
Adults: 12 to 20 breaths per minute
Children: breaths per minute
Infants: breaths per minute

35. Character of respirations
Should be noted along with rate
Refers to the depth and quality of respirations
Described by words such as deep, shallow, labored, moist, difficult or stertorous (abnormal sounds like snoring)

36. Rhythm of respirations
Should be noted along with rate and character
Refers to the regularity or equal spacing between breaths
Described as regular (or even) or irregular

37. Abnormal respirations
Dyspnea: difficult or labored breathing
Apnea: absence of respirations, usually temporary
Tachypnea: respiratory rate above 25 respirations per minute.
Bradypnea: slow respiratory rate, usually below 10 respirations per minute
Orthopnea: severe dyspnea in which breathing is very difficult in any position other than sitting erect or standing

38. Abnormal Respirations Continued…
Cheyne-Stokes: periods of dyspnea followed by periods of apnea; frequently noted in dying patient
Rales: bubbling or noisy sounds caused by fluids or mucus in the air passages
Wheezing
Difficult breathing with a high pitched whistling or sighing sound during expiration
Caused by narrowing of bronchioles (as seen in asthma) and/or an obstruction or mucus accumulation in the bronchi
Cyanosis
Dusky, bluish discoloration of the skin, lips, and/or nail beds
Result of decreased oxygen and increased carbon dioxide in the bloodstream

39. Voluntary control of respirations
Respirations are partially under voluntary control
Patients may breathe faster or slower when they are aware respirations are being counted
Important to keep patient unaware of this procedure
Do not tell a patient you are counting respirations
Keep your hand on pulse site while measuring respirations
Patient will think you are still counting pulse
Will not be as likely to alter respiration
Record all information

40. Blood Pressure

41. What exactly is Blood Pressure?????
The measurement of pressure of blood that is exerted on the walls of arteries during various stages of heart activity.
Always read in millimeters (mm) of mercury

42. 2 Different Pressures
Systolic: occurs in the walls of the arteries when the left ventricle of the heart is contracting and pushing blood into the arteries
Normal Range: mm Hg
Diastolic: constant pressure in the walls of the arteries when the left ventricle of the heart is at rest, between contractions
Normal Range: mm Hg

43. Pulse Pressure
The difference between the systolic and diastolic pressure
Indicator of normal health and tone of arterial walls
Should be approximately 1/3 of the systolic pressure

44. Equipment Stethoscope and Sphygmomanometer Sphygmomanometer
Lines on the gauges represent 2 mm
3 different types
Mercury, aneroid gauge and electronic
Mercury has proven to be most accurate but OSHA discourages its use
All cuffs must read zero when deflated before a measurement can be taken.

45. Accuracy Right cuff Clothing doesn’t constrict arm and blood flow
Gauge in correct position and applied correctly
Gauge at heart level
Place stethoscope over brachial artery at antecubital space
Ear pieces should be pointed forward
Tubing not tangled
Cuff should be placed in the center of the upper arm and 1 inch above the antecubital space
Control the valve
Don’t over inflate the cuff
Ideally you want the patient sit and wait 5 minutes before taking the measurement
Size and placement of the sphygmomanometer cuff is important
Too small will give an artificially high blood pressure
Too large will give an artificially low blood pressure

46. Blood Pressure Terminology
Hypotension (low BP): <90 mm Hg/<60 mm Hg
Heart failure, dehydration, depression, severe burns, hemmorhage & shock
Orthostatic: postural hypotension that occurs when a person is moving from lying to sitting or standing
PreHypertension: indicated when pressures are between mm Hg/80-89 mm Hg. Warning for high blood pressure
Hypertension(High BP):140 mm Hg/ 90 mm Hg
Stress, anxiety, obesity, high salt intake, aging, kidney diseases, thyroid deficiencies, and arteriosclerosis.
Often called the “silent killer”

47. Factors Influencing BP
Force of the heart
Resistance of arterial system
Elasticity of arteries
Volume of the blood in the arteries
Patient positioning: lying sitting, standing
Increased: excitement, stimulants, exercise, smoking and eating
Decreased: rest/sleep, depressants, shock, blood loss, fasting