Vital signs
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Vital Signs. What are they and why are they so important?. Vital Signs. Important indicators that provide information about the basic body conditions of the patient Four main vital signs: temperature, pulse, respirations, and blood pressure. Temperature.

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Vital Signs

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Vital signs

Vital Signs

What are they and why are they so important?


Vital signs1

Vital Signs

  • Important indicators that provide information about the basic body conditions of the patient

  • Four main vital signs: temperature, pulse, respirations, and blood pressure


Temperature

Temperature

  • Definition – a measurement of the balance between heat lost and heat produced by the body


Temperature1

Temperature

  • Heat is produced by the metabolism of food and muscle, and gland activity

  • Heat is lost through perspiration, respiration, and excretion

  • Homeostasis (constant state of fluid balance) is the ideal state in the human body

  • Normal temperature range is 97 to 100 degrees Fahrenheit or 36.1 to 37.8 degrees Celsius


Temperature2

Temperature

  • Aseptic technique for handling

  • Oral measurement – mouth; 3-5 min

  • Rectal measurement – rectum; 3-5 min

  • Axillary measurement – armpit; 10 min

  • Aural measurement – ear; less than 2 sec


Temperature3

Temperature

  • Hypothermia – very low body temperature, below 95 degrees Fahrenheit measured rectally

  • Factors that lead to decreased body temperature: starvation or fasting, decreased muscle activity, mouth breathing, exposure to cold environmental temperatures and certain diseases

  • Hyperthermia – body temperatures exceeds 104 degrees Fahrenheit measured rectally

  • Factors that lead to increased body temperature: illness, infection, exercise, excitement, and high environmental temperatures


Temperature4

Temperature

  • Usually measured on Fahrenheit scale, but may see Celsius scale

  • Convert Fahrenheit to Celsius temperature, subtract 32 from the Fahrenheit temperature and then multiply the result by 5/9 or 0.5556.

  • Convert Celsius to Fahrenheit temperature, multiply the Celsius temperature by 9/5 or 1.8 and then add 32 to the total.


Temperature5

Temperature

  • Equipment used for measurement

    • Clinical thermometer – slender glass tube containing mercury, which expands when exposed to heat

    • Electronic thermometer – usually battery operated unit registering temperature in about 60 sec on digital display screen

    • Tympanic thermometer – specialized electronic thermometer measuring temperature in the auditory canal in 1 to 2 sec on display screen


Temperature6

Temperature

  • Conditions requiring modifications

    • Oral - eating, drinking, or smoking

    • Rectal – diarrhea

    • Axillary or groin – moisture or rubbing

    • Aural – incorrect positioning of pinna

      Recording or documenting - T

  • Cleaning equipment


Pulse

Pulse

  • Definition- the pressure of the blood felt against the wall of an artery as the heart contracts and relaxes, or beats

    • Felt in arteries that lie fairly close to the skin and can be pressed against a bone by the fingers


Pulse1

Pulse

  • Pulse sites

    • Temporal – at side of forehead

    • Carotid – at neck

    • Brachial – at inner aspect of forearm at antecubital space

    • Radial – at inner aspect of wrist above thumb; most common site

    • Femoral – at inner aspect of upper thigh

    • Popliteal – behind knee

    • Dorsalispedis – at top foot arch


Pulse2

Pulse

  • Measured in number of beats per minute

    • Rate – number of beats per minute

    • Rhythm – regularity; regular or irregular

    • Volume – strength; strong, weak, thready, or bounding


Pulse3

Pulse

  • Pulse rates vary depending on age, sex, and body size

    • Adults – 60 – 90 bpm

      • Men – 60 – 70 bpm

      • Women – 65 – 80 bpm

    • Children over 7 years – 70 – 90 bpm

    • Children 1 to 7 years – 80 – 100 bpm

    • Infants – 100 – 160 bpm


Pulse4

Pulse

  • Bradycardia – pulse under 60 bpm

  • Tachycardia – pulse over 100 bpm

  • Arrhythmia – irregular or abnormal rhythm


Pulse5

Pulse

  • Factors that may change pulse rate

  • Increased – exercise, stimulant drugs, excitement, fever, shock, and nervous tension

  • Decreased – sleep, depressant drugs, heart disease, coma, and physical training

  • Document findings - P


  • Respirations

    Respirations

    • Definition- the process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract

      • One respiration consists of one inspiration and one expiration


    Respirations1

    Respirations

    • The breathing rate of the patient

      • Rate – number of respirations per minute =

        • Adults – 12 –20 rpm

        • Children – 16 – 25 rpm

        • Infants – 30 –50 rpm

      • Rhythm – regularity = regular or irregular

      • Character – type; depth and quality = deep, shallow, labored, difficult, stertorous, and moist


    Respirations2

    Respirations

    • Abnormal respirations

      • Dyspnea- difficult or labored breathing

      • Apnea – absence of breathing

      • Tachypnea – respiratory rate above 25 rpm

      • Bradypnea – respiratory rate below 10 rpm

      • Orthopnea – difficult breathing in any position other than sitting erect or standing


    Respirations3

    Respirations

    Abnormal respirations continued

    • Cheyne-Stokes respirations – periods of dyspnea followed by periods of apnea = frequently seen in dying patients

    • Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages


    Respirations4

    Respirations

    • Must be counted in such a way that patient is unaware of the procedure as respirations are partially under voluntary control

    • Leave hand on pulse site while counting respirations

    • Document findings - R


    Blood pressure

    Blood Pressure

    • Definition– force exerted by the heart against the arterial walls when the heart contracts or relaxes

      • Read in millimeters (mm) of mercury (Hg)


    Blood pressure1

    Blood Pressure

    • Two types of measurements

      • Systolic – pressure in the walls of the arteries when the heart is contracting and pushing blood into the arteries

        • Reading shows greatest pressure

        • Normal reading is 120 mm Hg

        • Normal range is 100 to 140 mm Hg

      • Diastolic – constant pressure in the walls of the arteries when the heart is at rest or between contractions

        • Reading shows least pressure

        • Normal reading is 80 mm Hg

        • Normal range is 60 to 90 mm Hg


    Blood pressure2

    Blood Pressure

    • Pulse pressure – difference between systolic and diastolic pressure

      • Important indicator of health and tone of arterial walls

      • Normal range in adults 30 to 50 mm Hg


    Blood pressure3

    Blood Pressure

    • Hypertension – high blood pressure

      • Systolic greater than 140 mm Hg

      • Diastolic greater than 90 mm Hg

      • Causes – stress, anxiety, obesity, high-salt intake, aging, kidney disease, thyroid deficiency and vascular conditions


    Blood pressure4

    Blood Pressure

    • Hypotension – low blood pressure

      • Systolic less than 100 mm Hg

      • Diastolic less than 60 mm Hg

      • Causes – heart failure, dehydration, depression, severe burns, hemorrhage, and shock


    Blood pressure5

    Blood Pressure

    • Factors influencing blood pressure readings

      • Force of heartbeat

      • Resistance of the arterial system

      • Elasticity of the arteries

      • Volume of the blood in the arteries


    Blood pressure6

    Blood Pressure

    • Factors increasing blood pressure

      • Excitement, anxiety, nervous tension

      • Stimulant drugs

      • Exercise and eating

    • Factors decreasing blood pressure

      • Rest or sleep

      • Depressant drugs

      • Shock

      • Excessive loss of blood

    • Factors causing miscellaneous readings

      • Lying down

      • Sitting position

      • Standing position


    Blood pressure7

    Blood Pressure

    • Recorded as a fraction

      • Systolic is numerator = top number

      • Diastolic is denominator = bottom number

    • Sphygmomanometer instrument used to measure blood pressure = B/P cuff

      • Mercury – long column; 2mm marks

      • Aneroid – face scale; 2mm marks

      • Parts: cuff, bladder, control valve, bulb, tubing, measurement scale

      • Stethoscope: earpieces, diaphragm, bell and tubing

    • Document findings – B/P


    Apical pulse

    Apical Pulse

    • Definition– pulse count taken at the apex of the heart with a stethoscope

      • Stethoscope amplifies the actual heart beat

      • Usually ordered on patients with irregular heartbeats, hardening of the arteries, or weak or rapid radial pulses, and infants

      • Two separate heart sounds are heard while listening to the heartbeat = “lubb-dupp” caused by closing of heart valves as blood flows through chambers of the heart

      • Each lubb-dupp counts as ONE heartbeat


    Apical pulse1

    Apical Pulse

    • Pulse deficit – heart condition in which heart is weak and does not pump enough to blood to produce a pulse or heart beats too fast and there is not enough time for the heart to fill with blood

      • The heart does not produce a pulse during each beat

      • Apical pulse rate is higher than the pulse rate at the other pulse sites on the body

      • Most accurate determination of pulse deficit calculated by two persons at the same time

    • Document findings - AP


    Documentation

    Documentation

    • Graphing vitals

      • Graphic sheets used for recording vitals

      • Visual diagram of variations in patient’s vital signs

      • Must be neat, legible, and accurate

      • Correct errors carefully


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