1. Day 1: TPR Day 2: O2 Sat, Pain, Medical Terminology
Vital Signs Intro
Day 1: TPR
Day 2: O2 Sat, Pain, Medical Terminology

2. BELL WORK 2-8-18 What are the components of vital signs?
What are the normal ranges?

3. Vitals Temp: 98.6 Pulse: 60-100 Respirations: 12-24
Blood Pressure: 120/80
O2 Sats: %

4. Standard for DM
26) Investigate cardiac diagnostic procedures both in-hospital and out- patient and identify the equipment required for these services.

5. Objectives
By the end of class, students will be able to: Identify the meaning of TPR List the normal ranges for TPR

6. THE VITAL SIGNS
Take a moment and close your eyes and concentrate on your breathing, the heat of your body and the flow of blood through your blood vessels as your heart beats.
These are the crucial, automatic processes that occur continuously to maintain your life.
They are indeed vital to life—and thus called the Vital Signs

7. VITAL SIGNS Temperature Pulse Respirations Blood Pressure
Pain is subjective but say it is the Fifth Vital Sign. Pulse Oximetry or O2 sat is an additional vital sign.

8. SIGNS VS. SYMPTOMS
Symptoms can only be described / validated by the patient.
Pain, nervousness, dizziness, fatigue
Signs are able to be measured / observed by others besides the patient
Vital signs, wound drainage, color of sputum, blood cell counts

9. The measurement of core body heat
TEMPERATURE
The measurement of core body heat

10. Temperature Body temperature regulated by hypothalamus
Important part of homeostasis
Physiologic factors affect temperature
Average body temperature—98.6
“Normal” 98.6
Usually over means infection/illness
Time of day affects temperature: temperature is lower in the am and higher in the pm
A patient’s temperature is a sign of homeostasis or infection or illness.

11. Factors Affecting Temperature
Increased temperature: illness, infection, exercise, environmental temperature
Decreased temperature: starvation, sleep, decreased muscle activity, mouth breathing,exposure to cold

12. Temperature Terminology
Hypothermia- low body temperature, below 95 degrees rectally. Death occurs if temperature is less than 93 degrees for a period of time.
Hyperthermia- high body temperature, over degrees. Fever is a temperature above degrees. Pyrexia is another term for fever. Febrile means “with fever”. Afebrile means “without fever”

13. Fever
Low-grade:
above 98.6° F (37° C) but lower than 100.4° F (38° C) for a period of 24 hours
Fever is an elevated temperature, usually greater than degrees Fahrenheit (orally). A person’s average body temperature is approximately 98.6 degrees Fahrenheit (orally).

14. ROUTES TO MEASURE TEMPERATURE
Oral: By mouth
Rectally: By rectum
Axillary: Under the arm in the armpit
Tympanic: In the ear

15. Documenting Temperature
To record temperatures write 98.0
If a temperature is oral/tympanic, there is no reason to indicate this, it is understood. If it is a rectal temperature, write ® beside the reading. If the reading is axillary, write (Ax) beside it.

16. TYPES OF THERMOMETERS
Digital Electronic: To be used for oral, rectal, and axillary
Thermoscan - Digital: To be used for tympanic
Mercury or glass: To be used for oral, rectal, and axillary. Will NOT see in facilities but patients may use at home. Red ends are rectal; blue ends oral and axillary.

17. NORMS Orally: 97.6 - 99.6 degrees Fahrenheit
(Best to wait 10 minutes after eating/drinking)
Rectally: degrees Fahrenheit (Usually Higher)
Tympanic - manufacturers say to measure as for rectal
Axillary: degrees Fahrenheit (Usually lower)

18. WHAT THERMOMETER SHOULD BE USED?
Tympanic: Special device with plastic covers.
Electronic: All routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary.
Mercury: All routes. Red ends are rectal; blue ends oral and axillary.

19. DURATION FOR TAKING TEMPERATURES
Tympanic: As long as it takes to push a button
Electronic: Until the thermometer beeps
Mercury Oral: Three minutes
Mercury Rectal: Three minutes
Mercury Axillary: Ten minutes

20. BE CAREFUL ON RECTAL AND AXILLARY TEMPS
Always hold the thermometer in place while measuring both temperatures
Always use lubricant with rectal temperatures
Always remove clothing around axilla

21. Let’s Practice: Put in Notebook
TEMPERATURE
1. Define Temperature
2. List the four ways to take a temperature.
3. What is a normal temperature?
Take your partners axillary temperature and record reading. TEMP:

22. Bell work 2-9-18 What is the average normal temperature?
What temperature would indicate infection?
What is another way or the word for having no fever?
What color is a rectal thermometer?
A temperature above what reading is considered hyperthermia?
A temperature below what reading is considered hypothermia?

23. PULSE Veins do not pulsate
The wave of blood created by the heart pumping, that travels along the arteries.

24. Pulse Wavelike pulsation of heartbeat in arteries
Palpate superficial artery with pads of three middle fingers
Veins do not pulsate
Counting a patient’s pulse is a method of determining the patient’s heart rate. Count the patient’s pulse for 1 minute.

25. Factors Affecting Pulse
Normal heart rate decreases with age
Newborn heart rate is higher than an adult’s heart rate
Athletic people will have decreased rate
Heart rate increases with exercise, emotion, stress, fear, and anxiety
Heart rate is affected by pregnancy, hyperthyroidism, and medications
Fever increases heart rate
Many factors affect pulse rate. Think of all the things that increase your heart rate and decrease your heart rate.

26. HOW TO MEASURE? Measured in beats per minute
Count the waves for 60 seconds
Or, count the waves for 30 seconds - multiply by 2

27. NORMS Pulse norms are 60 - 100 beats per minute
Pulses between are in a gray area - high normal
Faster than tachycardia
Slower than 60 - bradycardia

28. QUALITY OF PULSE Rhythm: regular or irregular
Rate: Within the normal limits
Strength: Strong, bounding, thready

29. TERMS Bounding pulse - Excessively strong pulse
Thready pulse - Pulse difficult to palpate because heart not beating heard enough

30. WHAT AFFECTS PULSE RATES AND QUALITY
Body Temperature
Emotions
Activity Level
Health of the Heart

31. FIND WHERE TO PULSES
At points where the artery is between finger tips and a bony area
Called pulse points
Felt with 2-3 fingers, but never the thumb

32. Pulse Sites Many pulse points in the body
Any area where pulse can be felt
May be done to evaluate circulation in body area
Count heart rate
Compressed to control bleeding
Pulse points can also be used to control bleeding in the event of an injury or accident.

33. PULSE POINTS AND THEIR LOCATIONS
Popliteal
Dorsal Pedalis
Posterior Tibial
Apical
Temporal
Carotid
Brachial
Radial

34. Temporal Temporal—located over temporal bone
The diagram in the book locates all pulse points in the body.

35. Carotid
Carotid—groove between the larynx and sternocleidomastoid muscle at side of neck

36. Brachial
Brachial—antecubital space of arm (the bend)

37. Pulse Points
Radial—distal part of forearm, inner aspect of wrist, base of thumb
The most common site to count a patient’s pulse is in the wrist area of the arm. This is the radial artery.

38. Popliteal
located behind knee

39. Dorsalis Pedis
Dorsalis pedis—top of the foot

40. Posterior Tibialis
Posterior tibialis—slightly inferior and posterior to the inside of the ankle

41. Apical Pulse
Apical pulse— auscultated with stethoscope, 5th intercostal space at the midclavicular line
PMI: point of maximal impulse
The apical pulse can be counted at the fifth intercostal space to the left of the sternum at the midclavicular line (MCL). This is also known as the point of maximal impulse, because it is where the heartbeat can be heard most easily. The apical pulse is always counted for 1 full minute.

42. Apical Pulse
Used with irregular heart beats, hardening of the arteries or weak or rapid pulses.
Usually easier to listen through stethoscope than feel with your fingers

43. Stethoscope Used to listen to internal body sounds
Ear plugs – bent forward
A two-sided chestpiece will typically have a diaphragm on one side and a deep cup-shaped side called the bell.
Make sure you disinfect between each patient

44. Let’s Practice PULSE 1. Define Pulse
2. What is considered a normal pulse range?
3. What is tachycardia? 4. What is bradycardia? List the ranges.
5. How long should you count the pulse? What if apical?
6. List the pulse points and find on a new partner.
6. Record the brachial and radial pulse.
7. Get a stethoscope and find your partners apical pulse. Record heart rate.

45. RESPIRATION
The mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

46. Respirations
Respiration is “the process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract”.
Normal adult respiratory rate is breaths per minute.
Respiratory rate should be counted for seconds just following pulse assessment.
Why following pulse? Act like you are continuing to check pulse. If patient knows you are assessing breathing, they may change their rate of breathing.
You are counting the number of times their chest rises and falls.

47. Documentation
Character or respirations should be noted. This refers to depth and quality. Deep, shallow, labored and difficult all refer to character.
Rhythm should also be addressed. This is regularity of respirations. Are they regular and even or irregular?
When you assess your partner you need to write these down.

48. Respirations Inspiration and expiration
Diaphragm is muscle involved with breathing
Only vital sign that can be easily controlled by a healthy adult
The medical assistant counts respirations by watching the patient’s chest rise and fall. Each inspiration and expiration count as one respiration.

49. Factors Affecting Respirations
Emotions
Severe pain
Physical exertion
Illness or condition that causes acidosis
Illness or condition that causes alkalosis
Fever
Many factors influence the rate of respirations. Remember the last time you got really nervous? Your respirations increased.

50. Characteristics of Respirations
Rate—number of respirations per minute, includes one respiration and one expiration; average rate for adults is 12– 20 breaths per minute
Rhythm—regular and even or irregular
Depth—normal, deep, or shallow
The characteristics of respirations include rate, rhythm, and depth. Depth of respirations is usually described with words such as “normal,” “ deep,” and “ shallow.”

51. RESPIRATION Measured in breaths per minute
Normal range is breaths per minute
Greater than 24 is tachypnea
Less than 12 is bradypnea
Watch for rate, depth, quality of breath, and difficulty in breathing

52. CHARTING Chart in order temperature - pulse - respiration.
Do not write T =, etc.
Write (Ax) after axillary temperatures
Write (R) after rectal temperatures

53. Temperature, Pulse, Respirations

54. O2 Saturation Measured in percent using a pulse oximeter
Normal Range % for healthy adults
Breathing room air contains 21% oxygen.
Anyone who is not achieving the critical blood oxygen saturation level of 90% may need oxygen

55. O2 Sat
Non invasive process involves inserting a finger (can be used on the ear or a toe as well) into the device where a red light calculates the redness of the blood pulsing through the finger. 

56. O2 Saturation
Oxygen saturation levels measure the degree to which the hemoglobin contained in the red blood cells (erythrocytes) has bonded with oxygen molecules. Oxygen is taken in by the lungs when we breathe in

57. PAIN PAIN is personal Everyone’s pain level will be different
How do we quantify it?

58. Pain Scales
Numeric: 1-10
Wong-Baker Faces

59. PAIN SCALE

60. How to assess Pain
Ask Patient: 1. Are you having any pain? Where is it located? If they say yes, proceed to next question 2. On a scale of 0 to 10 with O being no pain and 10 being the worst pain you can imagine, how much does it hurt right now? 3. What is the quality of your pain? Is it burning, stabbing, gnawing, shooting, cramping?

61. Descriptive Pain Words
Aching.
Cramping.
Fearful.
Gnawing.
Heavy.
Hot or burning.
Sharp.
Shooting.

62. How to assess pain
4. Does it radiate anywhere else? 5. What relieves your pain? 6. When does your pain start? How often does it occur? Has its intensity changed? How long does it last?

63. Let’s Practice RESPIRATIONS 1. What are respirations?
2. What is considered a normal respiration rate?
3. How long should you count a patient’s respirations?
4. Using the data you’ve obtained. How would you chart your “patient’s” TPR below? Example. Patient TPR is
5. What is an O2 sat? Write down Partner’s 02 sat.
7. Role play with partner asking about pain (be creative) Remember to write down number, but quality, radiation, what relieves it, when start? How long? Intensity. Chart in your notebook!

64. Bell Work
1. What is the normal beats per minute pulse range?
2. When would you take an apical pulse and for how long?
3. What is the normal Respirations?
4. What is the normal 02 Saturation?
5. How is pain measured?

65. Vital Sign Video

66. Vocabulary Terms
Write all terms and abbreviations from PowerPoint in Notebook

67. ABBREVIATIONS
SOB
TPR PO
BID
TID
QID QD
PRN
B/P VS
WNL

68. ABBREVIATIONS SOB - Short of breath QID - Four times a day
TPR - Temperature, pulse, and respiration
P.O. - By mouth
BID -Twice a day
TID -Three times a day
QID - Four times a day
QD - Every day
PRN - As needed
B/P - Blood Pressure
VS - Vital Signs
WNL – Within Normal Limits

69. ABBREVIATIONS Short of breath Temperature, pulse, and respiration
By mouth
Twice a day
Three times a day
Four times a day
Every day
As needed
Blood Pressure
Vital Signs
Within Normal Limits

70. TERMS Eupnea - Normal breathing
Orthopnea - Sitting upright to breath more easily
Apnea - No breath
Hyperpnea - Fast, deep breathing
Tachypnea - Fast, shallow breathing
Bradypnea - Slow breathing
Dyspnea - Painful or difficult breathing
Tachycardia - Pulse rate in excess of 100 bpm
Bradycardia - pulse rate less than 60 bpm

71. TERMS Eupnea Orthopnea Apnea Hyperpnea Tachypnea Bradypnea Dyspnea
Tachycardia
Bradycardia

72. TERMS Normal Breathing Slow breathing
Sitting upright to breath more easily
Fast, deep breathing
Fast, shallow breathing
Slow breathing
Painful or difficult breathing
Pulse rate in excess of 100 beats per minute
Pulse rate less that 60 beats per minute

73. TERMS Bounding pulse - excessively strong pulse
Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is a piece of thread running under the fingertips.

74. Palpate Practice

75. Vocabulary – Page 413 Apical pulse stethoscope Arrhythmia Tachycardia
Blood pressure
Bradycardia
Cyanosis
Diastolic
Homeostasis
Hypertention
Hyperthermia
Hypothermia