1. Vital Signs Mrs. Jessica Dean, RN, BSN

2. Daily Objectives: 1.List the four main vital signs: temperature, pulse, respirations, blood pressure 2.Recognize common terminology and abbreviations used in documenting and discussing vital signs. 3.Compare the methods and contraindications of measuring oral, tympanic, axillary, and rectal temperatures

3. Vital Signs Vital signs: various determinations that provide information about the basic body conditions of the patient Four main vital signs 1.Temperature 2.Pulse 3.Respiration 4.Blood pressure

4. 5 th vital sign Degree of pain frequently regarded as the fifth vital sign – Patients are asked to rate their level of pain on a scale of 1 to 10 – 1 indicates minimal pain and 10 indicates severe pain

5. Other important vital signs: Color of the skin Size of the pupils in the eyes and their reaction to light Level of consciousness Patient’s response to stimuli

6. Health assistant may have responsibility of measuring and recording vital signs – Not able to reveal information to the patient – Physician will decide if information should be told to patient

7. Accuracy is essential – Abnormal vital signs are often the first indication of a disease or an abnormality – Never guess or report an inaccurate reading

8. Report any abnormality or change in vital sign to your supervisor immediately If you have difficulty obtaining a correct reading for any vital sign, ask another individual to check the reading

9. Temperature: the balance between heat lost and heat produced by the body

10. Heat Heat is lost through perspiration, respiration, and excretion Heat is produced by the metabolism of food and muscle and gland activity Homeostasis: constant state of fluid balance, ideal health state in the human body

11. If body temperature is too high or low, the body’s fluid balance is affected.

12. Temperature Range 97-100 degrees F 36.1-37.8 degrees C

13. Body temperature variations Individual differences Time of day Parts of the body where temp is taken

14. Oral Temperature Oral- mouth Leave in place 3-5 minutes Normal 98.6 Range: 97.6- 99.6 degrees F Most common, convenient, and comfortable method for obtaining a temperature

15. Rectal Temperature Rectal= Rectum Leave in place 3-5 minutes MOST ACCURATE of all methods Normal temp= 99.6F Range 98.6-100.6 degrees F

16. Axillary Temperature Axillary= armpit May also be taken in the groin area Hold in place for 10 minutes External temperature, less accurate Normal 97.6F Range 96.6-98.6F

17. Aural Temperature Aural= ear Detects and measures thermal, infrared energy radiating from the tympanic membrane (eardrum) No normal range= core body temp Most record in less than 2 seconds Fast and convenient method

18. Temporal temperatures Temporal= temple Measures the temperature in the temporal artery to provide an accurate measurement of blood temperature Easy to use and produces very accurate results

19. Daily Objectives: 1.Identify the different types of thermometers 2.Define fever, hypothermia, and hyperthermia and the effects on the human body 3.Accurately assess an oral temperature using a clinical thermometer.

20. Increased Body Temp Illness Infection Exercise Excitement High environmental temperature

21. Decreased Body Temperature Starvation or fasting Sleep Decreased muscle activity Exposure to cold temperature Certain diseases

22. Hypothermia Hypothermia: low body temperature Below 95 degrees F, rectally Caused by prolonged exposure to cold Death usually occurs at 93 degrees F for a period of time

23. Fever Fever: elevated body temperature Above 100.4F, rectally Usually caused by infection or injury

24. Hyperthermia Hyperthermia: body temperature exceed 104 degrees, rectally Caused by prolonged exposure to hot temperatures, brain damage, serious infections Body temp above 106F leads to convulsions and death

25. Clinical Thermometers Slender glass tube containing mercury Expands when exposed to heat – Glass oral thermometer Long, slender bulb or blue tip – Security oral thermometer Shorter, rounder bulb marked with blue tip – Rectal thermometer Short, stubby, rounded bulb, marked with red tip

26. Thermometers Oral thermometer Security oral thermometer Rectal

27. Thermometers, cont Electronic Thermometers – Registers the temp in a few seconds – Disposable covers are used – Can be used orally, rectally, axillary, and/or groin temperature Blue= oral Red= rectal

28. Thermometers, cont Tympanic thermometers – Record temperature aurally – Read within 1-2 seconds

29. Thermometers, cont Plastic or paper thermometer – Contain special chemical dots or strips that change color when exposed to specific temperatures – Used and then discarded

30. Electronic and tympanic are easy to read because of digital displays Glass clinical thermometers take some practice – Read at the point where mercury line ends – Each short line represents.2 of a degree

31. Writing temperature Always write with little number for the tenth degree If oral, doesn’t need to be indicated If rectal, place (R) beside recording If axillary, place (Ax) beside recording If Tympanic, place (T) beside recording

32. Eating or drinking hot or cold liquids and/or smoking can alter the temperature in the mouth No eating, drinking, smoking for 15 minutes prior to taking temperature

33. Follow agencies policy for cleaning and caring for thermometer It is NOT your job to tell the patient the temperature reading. That is the physician's responsibility!

34. Daily Objectives: 1.Identify the sites for assessing the pulse. 2.Recognize the normal and abnormal values and characteristics of pulse

35. Pulse Pulse: the pressure of the blood pushing against the wall of an artery as the heart beats and rests

36. Pulse, cont More easily felt in arteries that lie fairly close to the skin and can be pressed against a bone by the fingers

37. Arterial Sites Temporal-side of the forehead Carotid- at the neck Brachial- inner aspect of forearm at the antecubital space (crease of elbow) Radial-wrist area Femoral- inner aspect of the upper thigh Popliteal- behind the knee Dorsalis Pedis- top of the foot arch

38. Pulse sites Usually taken over the radial artery

39. Pulse Rate Measured as the number of beats per minute Vary among individuals, depending on age, sex, and body size

40. Pulse Rate, cont Adults: 60-90 beats per minute (bpm) – Adult men: 60-70 bpm – Adult female: 65-80 bpm Children over 7: 70-90 bpm Children 1-7: 80-110 bpm Infants: 90 to 160 bpm

41. Pulse Rate, cont Bradycardia: rates under 60 bpm Tachycardia: rates over 100 bpm (except in children)

42. Pulse Rhythm: regularity of the pulse, or the spacing of the beats – Regular or irregular Volume: strength or intensity of the pulse – Strong, weak, thready, or bounding

43. http://depts.washington.edu/physdx/heart/de mo.html http://depts.washington.edu/physdx/heart/de mo.html

44. Factors Increasing Pulse Rate Exercise Stimulant drugs Excitement Fever Nervous tension

45. Factors Decreasing Pulse Rate Sleep Depressant drugs Heart disease Coma

46. Apical Pulse Apical Pulse: taken with a stethoscope at the apex of the heart Actual heart beat is heard and counted Taken in children due to rapid pulse and difficult to count radially

47. Daily Objectives 1.Recognize the normal and abnormal values and characteristics of respirations for infants, children, and adults. 2.Recognize common terminology and abbreviations used in documenting and discussing respirations.

48. Respirations Respirations: process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract

49. Respirations, cont One respiration consists of one inspiration and one expiration

50. Respiratory Rate Adults: 12-20 breaths per minute Children: 16-25 breaths per minute Infants: 30-50 breaths per minute

51. Respiratory Rate, cont Character: the depth and quality of respirations – Deep, shallow, labored, difficult, stertorous (snoring), moist Rhythm: the regularity of respiration or equal spacing between breaths – Regular or irregular

52. Abnormal Respirations Dyspnea: difficult or labored breathing Apnea: absence of respirations

53. Abnormal Respirations Cheyne-Stokes respirations: periods of dyspnea followed by periods of apnea, frequently seen in the dying patient Rales: bubbling or noisy sounds caused by fluids or mucus in the air passages

54. Respirations Count in a way that the patient is unaware of the procedure Do not tell the patient you are counting respirations

55. http://www.wilkes.med.ucla.edu/lungintro.ht m http://www.wilkes.med.ucla.edu/lungintro.ht m

56. Daily Objectives 1.Identify the sites for assessing the blood pressure 2.List the effects of high and low blood pressure on the body 3.Recognize normal and abnormal values and characteristics of blood pressure for adults, children, and infants

57. Blood Pressure Blood Pressure: measurement of the pressure that the blood exerts on the walls of the arteries during the various stages of heart activity. Sphygmomanometer: instrument used to measure blood pressure

58. Blood Pressure Two types of blood pressure – Systolic: occurs in the walls of the arteries when the heart is contracting and pushing blood into the arteries – Diastolic: the constant pressure in the walls of the arteries when the heart is at rest or between contractions

59. Systolic Pressure Normal reading= 120 millimeters mercury (120 mm Hg) Normal range= from 100 to 140 mm Hg Noted as the reading on the sphygmomanometer gauge when the first sound is heard

60. Diastolic Pressure Normal reading= 80 mm Hg Normal range= from 60 to 90 mm Hg Noted as the reading on the sphygmomanometer gauge when the sound stops or becomes very faint

61. Recording Blood Pressure Recorded as a fraction Systolic reading is top number or numerator Diastolic is bottom number or denominator Example: Systolic of 120 and diastolic of 80 is 120/80

62. Prehypertension Warning that high blood pressure will develop unless steps are taken to prevent it Indicated by pressure readings – Systolic: 120-139 – Diastolic: 80-89 Treatment: – Proper nutrition – Regular exercise program

63. Hypertension ( high blood pressure) Indicated when pressures are greater than 140mm Hg systolic and 90mm Hg diastolic Often called the “silent killer” because many individuals do not have any signs or symptoms of disease If not treated, can lead to stroke, kidney disease, and/or heart disease

64. Hypotension (low blood pressure) Indicated when pressures are less than 90mm Hg systolic and 60 mmHg diastolic Occurs with heart failure, dehydration, depression, severe burns, hemorrhage, and shock – Orthostatic hypotension: sudden drop in both systolic and diastolic pressure when move from lying to a sitting or standing position

65. Factors influencing blood pressure readings Force of the heartbeat Resistance of the arterial system Elasticity of the arteries Volume of the blood in the arteries

66. Factors increasing blood pressure Excitement Anxiety Nervous tension Stimulant drugs Exercise eating

67. Factors decreasing blood pressure Rest Sleep Depressant drugs Shock Excessive loss of blood

68. Factors causing miscellaneous readings Lying down (usually lower) Sitting position Standing position (usually highest)

69. Daily Objectives: Identify and Demonstrate correct techniques for assessing blood pressure.

70. Types of sphygmomanometers Two main types are used – Mercury sphygmomanometer – Aneroid sphygmomanometer

71. Mercury sphygmomanometer Contains a long column of mercury Each line on gauge represents 2 mm of mercury Must be placed on a flat, level surface Level of mercury should be at zero when viewed at eye level if manometer is calibrated correctly

72. Aneroid sphygmomanometer Does not have a column of mercury- just round gauge Calibrated in millimeters of mercury Each line on gauge represents 2mm of mercury pressure Gauge should be positioned at eye level for correct readings

73. Factors to follow for accurate readings (American Heart recommendations) Patient should sit quietly for at least 5 minutes before the blood pressure is taken Two separate readings should be taken and averaged Minimum wait of 30 seconds between readings

74. Factor to follow, cont Size and placement of sphygmomanometer cuff – Cuff contains a rubber bladder Bladder fills with air as cuff is inflated Applies pressure to arteries to stop blood flow – Cuffs that are too narrow or too wide cause inaccurate readings Width of cuff should be approximately the same diameter of patient’s arm Small cuff results in falsely high reading Large cuff may cause falsely low reading

75. Patient should be seated or lying comfortably Arm must be fee of any constricting clothing and cuff should be applied to bare arm Deflated cuff should be placed on arm with the center of rubber bladder directly over the brachial artery Lower edge of the cuff should be 1 to 1.5 in above the antecubital area (bend of the elbow) – Forearm should be supported on a flat surface – Area of the arm covered by the cuff should be at heart level

76. Palpatory Systolic pressure Should be determined to avoid overinflation of cuff Position cuff correctly on arm Locate radial pulse and keep fingers on pulse Inflate the cuff until radial pulse disappears Inflate the cuff 30mm Hg above this point Slowly release the pressure on the cuff while watching the gauge Note the reading on the gauge when radial pulse is felt again= palpatory systolic pressure

77. Deflate the cuff completely to 0mm Hg Wait 30-60 seconds to allow blood flow to resume completely Ask the patient to raise the arm and flex the fingers to promote blood flow When you are ready to measure blood pressure, inflate the cuff to 30mm Hg above the palpatory systolic pressure

78. Place the stethoscope bell/diaphragm correctly – Place bell/diaphragm directly over the brachial artery at the antecubital area – Hold it securely but with as little pressure as possible

79. Make sure the earpieces of the stethoscope are pointed forward while they are placed in the ears to ensure accurate sound Record all information

80. Blood Pressure Demonstration http://www.merlot.org/merlot/viewMaterial.htm?id=80803