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, stress, and food intake
Treatment plans developed using vital sign measurements
Concentrate and attend to procedures
(discuss the Critical Thinking Box)

3. The Importance of Accuracy
Baseline shows patient’s overall well-being and deviation from patient baseline may indicate illness

4. 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

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

6. Temperature Body temperature measured in degrees
Body temperature influenced by several factors
There is no “normal” temperature

7. Temperature Average temperature for an adult is 98.6°F, or 37.0°C
Types of fevers
Continuous, remittent, intermittent, and relapsing
Fevers may indicate an infection
Types of thermometers: glass, disposable, digital, tympanic, and temporal artery

8. Temperature Recording temperature
Label as “F” for Fahrenheit or “C” for Celsius
Label if taken by methods other than oral
(R) for rectal
(A) for axillary
(Tym) for tympanic
(TA) for temporal artery

9. Temperature Measuring temperature Oral Aural Rectal Axillary
Temporal artery >>
(see Procedures 24-1 through 24-6 in the text)

10. Temperature Cleaning and storage of thermometers
Always separate oral and rectal glass thermometers
Rinse immediately after use, cleanse in mild soap and cool water solution, rinse, dry, then submerge in disinfectant solution for 30 minutes
Label storage containers
Clean digital, temporal artery, and tympanic thermometers according to manufacturer’s directions
Disinfect thermometers

11. Pulse Pulse rate consists of two phases of the heart action
Felt when compressing an artery
Pulse and heartbeat rate should be same

12. Pulse Pulse sites Radial Carotid Temporal Brachial Femoral Popliteal
Dorsalis pedis
Apical
Posterior tibial

13. Pulse Measuring a pulse
Note rate, rhythm, volume of pulse, and condition of the arterial wall
Rate is the number of beats felt for 1 minute
Pulse rates vary according to age, activities, general health, gender, emotions, pain, and medications
Arrhythmias may or may not indicate heart disease
(see Procedures 24-7 and 24-8 in the text)

14. Pulse Normal pulse rates Pulse abnormalities
Note, record, and alert physician to any abnormalities in any vital signs

15. Pulse
Watch the video

16. 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

17. Pulse Recording pulse rates Record after temperature
Report any unusual findings to the physician

18. Respiration
Respirations vary with age, activities, illness, emotions, and drugs
Normal respiration rate is a 1:4 ratio relationship to the pulse rate
Rate, rhythm, and depth of respiration are noted
See normal respiratory rates chart in the text

19. Respiration Watch the video
See normal respiratory rates chart in the text

20. Respiration Abnormalities Apnea Cheyne-Stokes Tachypnea Bradypnea
Orthopnea
Hypoventilation
Hyperpnea
Hyperventilation

21. Respiration Breath sounds can indicate respiratory problems
Rales and rhonchi
Wheezes
Stridor
Stertorous

22. Blood Pressure Components Recorded as a fraction: systole/diastole
The force exerted on the arterial walls during cardiac contraction
Diastole
The force exerted during cardiac relaxation
Recorded as a fraction: systole/diastole

23. Blood Pressure Factors that affect blood pressure Blood volume
Peripheral resistance
Vessel elasticity
Condition of heart muscle

24. Blood Pressure Equipment for measuring blood pressure
Auscultatory (listening) method uses a sphygmomanometer and stethoscope
Types of sphygmomanometers: mercury, aneroid, digital >>

25. Blood Pressure Measuring blood pressure
Korotkoff sounds are heard during blood pressure measurement
Phases of Korotkoff sounds
Phase I—first sound is the systolic reading
Phase II—more blood passes through the vessels
Procedure in text

26. Blood Pressure Measuring blood pressure Phases of Korotkoff sounds
Phase III—rhythmic tapping sound; cuff is 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
Procedure in text

27. Blood Pressure Measuring blood pressure Auscultatory gap
In some patients all sounds disappear between Phases I and II or III

28. Blood Pressure Recording blood pressure measurement
Normal blood pressure readings
Blood pressure abnormalities
Hypertension >140/90
Hypotension <90/60
See chart in text.

29. Height and Weight Not considered a vital sign
Many physicians prefer height and weight as part of yearly physical
Height measured with a measuring bar
Procedure 24-11

30. Height and Weight
Weight measured on a calibrated balance beam scale or digital scale
Significance of weight
Provides insight into metabolic, nutritional, and emotional problems
Desirable weights
Procedure 24-12
Case Study 24-1
Desirable weights – see charts in text

31. Measuring Chest Circumference
Take one measurement on deepest inspiration and one on deepest expiration and compare
Measure at disrobed patient’s nipple level
Record measurements for physician to make comparison