1. VITAL SIGNS

2. Vital Signs  Various factors that provide information about the basic body conditions of the patient.  4 Main VS Temperature Pulse Respirations Blood Pressure

3. Other Vital Signs  Pain Scale - 0 to 10  Pts are asked to rate their level of pain on the 0 – 10 scale  Skin color  Size of the pupil & reaction to light  Level of consciousness  Patients response to stimuli  Pulse oximetry reading

4. Pulse  The pressure of the blood felt against the wall of an artery as the heart contracts and relaxes Rate - # of beats per minute Rhythm – refers to regularity Volume – refers to strength

5. Pulse  Usually taken on the radial or carotid artery  Pulse is taken on an artery Temporal – sides of the forehead Carotid – sides of the neck Brachial – inner aspect of forearm at the antecubital space Radial – inner aspect of the wrist, above thumb Femoral – inner aspect of the upper thigh Popliteal – behind the knee Dorsalis pedis – top of the foot arch

6. Pulse  Bradycardia – pulse <60 bpm  Tachycardia – pulse >100 bpm (except in children)  Rhythm refers to the regularity of the pulse (the spacing of the beats) Regular Irregular - arrhythmia  Usually caused by a defect in the electrical conduction pattern

7. Pulse  Volume – strength or intensity Strong Weak Thready Bounding  Factors that alter pulse rate Increase pulse: exercise, stimulant drugs, excitement, fever, shock, nervous tension (stress) Decrease pulse: sleep, depressant drugs, heart disease, coma, physical training

8. Respirations  The process of taking in O 2 and expelling CO 2 from the lungs and respiratory tract  1 breath consists of 1 inspiration and 1 expiration (exhalation)  Normal range:12–20 breaths/minute in adults

9. Respiration  Character – depth & quality Deep Shallow Labored Difficult Stertorous (abnormal sounds like snoring) Moist  Regularity Regular Irregular

10. Respirations  Dyspnea – difficult or labored breathing  Apnea – absence of respirations  Tachypnea – RR >20 bpm  Bradypnea – RR <12 bpm  Orthopnea – severe dyspnea in which breathing is very difficult in any position other than sitting erect or standing

11. Respirations  Cheyne-Stokes Respirations – periods of dyspnea followed by periods of apnea; frequently noted in the dying pt  Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages  Wheezing – dyspnea with high pitched whistling or sighing sounds during expiration; caused by narrowing bronchioles and/or obstruction or mucus accumulation in the bronchi  http://familymedicine.osu.edu/products/physicalexam/exam/ http://familymedicine.osu.edu/products/physicalexam/exam/

12. Respirations  Cyanosis – a dusky, bluish discoloration of the skin, lips, and/or nail beds as a result of ↓ O 2 and ↑ CO 2 in the bloodstream  RR should be counted in a way that the pt is unaware of the procedure RR is partially voluntary controlled

13. Apical Pulse  Taken with a stethoscope at the apex of the heart Use diaphragm (flat, flexible disk) Actual heartbeat is heard & counted  Pulse Deficit – take the apical then the radial pulse, then subtract the radial from the apical = difference is the pulse deficit Occurs with pts with heart conditions Heart is weak & does not pump enough blood to produce a pulse

14. Temperature  A measurement of the balance between heat lost and heat produced  Heat is lost thru perspiration, respiration, & excretion (urine & feces)  Heat is produced by the metabolism of food; and by muscle and gland activity

15. Temperature  Homeostasis – constant state of fluid balance  The rates of chemical reactions in the body are regulated by body temp. If body temp is too high or too low the body’s fluid balance is affected

16. Temperature  Measured: OralO RectalR AxillaryAx Aural (ear) T  aka tympanic; in auditory canal  A low or high reading can indicate disease

17. Temperature  Normal range 96.6 to 100.6 F depending on route used Individuals have different body temps  Depends on the body’s processes Time of day  Lower in am, after resting  Higher in pm or after activity or food intake Parts of the body vary  O-98.6 R-99.6 Ax-97.6

18. Temperature  Factors that lead to ↑ body temp Illness, infection, exercise, excitement, environmental temp  Factors that lead to ↓ body temp Starvation/fasting, sleep, ↓ muscle activity, mouth breathing, environmental temp, certain diseases

19. Temperature  Hypothermia – body temp <95 o F rectally Death usually occurs if temp <93 o F rectally  Hyperthermia – body temp >104 o F rectally Prolonged exposure will cause brain damage or serious infection >106 o F will lead to convulsions, brain damage, or death

20. Temperature  Fever – elevated body temp >101 o F rectally Febrile – fever is present Afebrile - no fever is present, WNL (within normal limits)  Clinical Thermometer Glass with mercury or alcohol w/red dye  If breaks, mercury can evaporate & create toxic vapor, attacking CNS  Never vacuum or sweep to clean – use a mercury spill kit Red – rectal Blue – oral or axillary

21. Temperature  Factors that can alter temp in mouth Eating, drinking (hot or cold), smoking Wait at least 15 min before taking temp  Clean thermometers in disinfectant solution

22. Blood Pressure  BP – measurement of the pressure that the blood exerts on the walls of the arteries during the various stages of heart activity (contraction and relaxation)  BP is read in mm of Hg (mercury)  Sphygmomanometer is the medical name

23. Blood Pressure  Systolic BP Pressure occurs in the walls of the arteries when the left ventricle of the heart is contracting and pushing blood into the arteries Normal range 100 to 120 mm Hg

24. Blood Pressure  Diastolic BP The constant pressure in the walls of the arteries when the left ventricle of the heart is at rest, or between contractions. Blood has moved forward into the capillaries and veins, so the volume of blood in the arteries has decreased. Normal range 60 – 80 mm Hg http://familymedicine.osu.edu/products/ physicalexam/exam/ http://familymedicine.osu.edu/products/ physicalexam/exam/

25. Blood Pressure  Pulse Pressure The difference between Systolic BP and Diastolic BP Important indicator of the health and tone of the arterial walls Normal range 30 – 50 mm Hg  120/80 120 – 80 = 40 pulse pressure

26. Blood Pressure  Hypertension (HTN) – High BP; 140/90 or higher Causes: stress, anxiety, obesity, high Na intake, aging, kidney disease, thyroid deficiency, vascular conditions (arteriosclerosis) HTN not treated will lead to kidney failure, stroke, heart disease

27. Blood Pressure  Prehypertension- BP in the range of 120/80 - 139/89  Don’t have “high blood pressure” but at risk for developing HTN if lifestyle changes do not occur.

28. Blood Pressure  Hypotension – low BP; less than 90/60 May occur with heart failure, dehydration, depression, severe burns, hemorrhage, and shock  Orthostatic or Postural Hypotension Sudden drop in both SBP & DBP when a person changes positions Caused by the inability of blood vessels to compensate quickly to positional change SS ; lightheaded, dizziness, blurred vision

29. Blood Pressure  Factors that ↑ BP Excitement, anxiety, nervous tension Stimulant drugs Exercise & eating Smoking  Factors that ↓ BP Rest or sleep Depressant drugs Shock Excessive loss of blood Fasting (starvation)

31. As a class practice reading the computerized blood pressures http://familymedicine.osu.edu/products/ph ysicalexam/exam/ http://familymedicine.osu.edu/products/ph ysicalexam/exam/ After each reach reading discuss if BP is in normal range or not PRACTICE BLOOD PRESSURE