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Vitals. Adapted from Mosby’s Guide to Physical Examination, 5 th Ed. Ch. 3 . Vitals . Pulse Respiration Blood pressure Temp Height & weight (infants and children). Pulse. Apical pulse 5 th intercostal space in the midclavicular line Femoral pulse

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Vitals

Vitals

Adapted from Mosby’s Guide to Physical Examination, 5th Ed.

Ch. 3


Vitals1

Vitals

  • Pulse

  • Respiration

  • Blood pressure

  • Temp

  • Height & weight (infants and children)


Pulse

Pulse

  • Apical pulse

    • 5th intercostal space in the midclavicular line

  • Femoral pulse

    • use a point halfway from the pubic tubercle to ASIS as a guide


Pulse1

Pulse


Respiration

Respiration

  • Infants – rise and fall of the abdomen facilitates counting

    • Rate

    • Regularity and rhythm

    • Depth

    • Difficulty; use of accessory muscles


Respiration1

Respiration


Blood pressure

Blood Pressure

  • Cuff size (children)

    • Width should cover ~2/3 of the upper arm or thigh

      Too wide - underestimate BP

      Too narrow - artificially high BP

http://store.datascope.com/Assets/product_images/0998-00-0003-21,22_s164_jpg.jpg


Temperature

Temperature

  • Tympanic thermometers are becoming increasingly popular

    • Accuracy depends on correct technique

      • Must read tympanic membrane which shares blood supply with the hypothalamus


Temperature young infants

Temperature – Young Infants

  • Traditional routes may be more accurate

    NOTE: axillary temp correlates well with core temp of newborns

    • due to the infant’s small body mass and uniform skin blood flow


Height infant

Height - Infant

Infant measuring mat

OR

Mark on a sheet of headrest paper


Height child

Height - Child

“Stature measuring device”

(or height chart)

  • child is able to stand without support

  • approx. 24 months old


Weight

Weight

  • Infant platform scale

    • More accurate

      (ounces or grams)

    • Child may sit or lie

    • Place paper or blanket under the child

      • “weigh it out”


Growth and measurement

Growth and Measurement

Adapted from Mosby’s Guide to Physical Examination, 5th Ed. Ch. 5

MacGregor, 2000


Newborn

Newborn

  • Most babies born to the same parents weigh within 6oz of each other at birth

    • Lower birth weight: consider an undisclosed congenital abnormality or intrauterine growth retardation


Vitals

Average Weight

  • 5 lb, 8 oz – 8 lb, 13oz (term newborn)

    Expected growth

  • Double birth weight by 4-5 months

  • Triple birth weight by 12 months

    NOTE: on average formula-fed babies are heavier after the 1st 6 months than breast-fed babies


Vitals

Average Length

  • 18-22 in (45-55cm) long at birth

    Expected Growth

  • Length increases by 50%in the 1st year of life


Growth

Growth

  • Infancy

    • Growth of the trunk predominates

    • Fat increases until 9 months of age

      • What happens at 9 months?

  • Childhood

    • Legs are the fastest growing body part

    • Weight is gained at a steady rate

    • Fat increases slowly until 7 yrs of age when a prepubertal fat spurt occurs before the true growth spurt


Growth1

Growth

  • Adolescence

    • Trunk and legs elongate

    • About 50% of the ideal weight is gained

    • Skeletal mass and organ systems double in size


Gender differences

Gender Differences


Measurement

Measurement

Infant

  • Length

  • Weight

  • Head circumference

  • Chest circumference

    Child

  • Height

  • Weight


Recumbent length

Recumbent Length

  • Measurement of choice for infants birth to 24-36 months


Recumbent length1

Recumbent Length

  • Tear a length of headrest paper

  • Lay the child on top of the paper

  • Mark the top of the child’s head

  • Ask mother to hold child in place

  • Extend leg and mark under the heel (foot dorsiflexed)


Recumbent length2

Recumbent Length

  • Measure to the nearest 0.5 cm or ¼ in.

  • Chart on appropriate growth curve for sex and age

    • Identify the infant’s percentile

    • Note any change or variation from the population standard or the child’s norm


Standing height

Standing Height

  • Child stands erect

    • Heels, buttocks and shoulders against the wall

    • Looking straight ahead

      • Outer canthus of the eye should line up with the external auditory canal

  • Slide the headpiece onto the crown


Standing height1

Standing Height

  • Use once the child is walking well

  • Usually about 24-36 months

  • Stature is recorded to the nearest ¼ in (0.5 cm)


Infant scale oz or g

Infant scale (oz or g)

  • Distract the infant and balance the scale

  • Read the weight to the nearest ½ oz (10g) when the infant is most still

  • Chart on appropriate growth curve for sex and age

    • Identify the infant’s percentile

    • Note any change or variation from the population standard or the child’s norm


Head circumference

Head Circumference

  • Measure the infant’s head at every “health visit” until 2 years of age

    • Yearly from 2-6 years of age

      Newborn:13-14 in (33-35 cm)

      NOTE: By 2, the head is 2/3 its adult size


Head circumference1

Head Circumference

  • Measure the largest circumference with the tape snug

    • Occipital protuberance to the supraorbital prominence


Head circumference2

Head Circumference

  • Nearest 1/4 in (0.5 cm)

  • Repeat to check the accuracy of your measurement

  • Chart on appropriate growth curve for sex and age

    • Identify the infant’s percentile

    • Note any change or variation from the population standard or the child’s norm


What if

What if…?

  • Head circumference increases rapidly

    • Rises above percentile curves

      ~> Increased intracranial pressure

  • Head circumference grows slowly

    • Falls off percentile curves

      ~> Microcephaly


Chest circumference

Chest Circumference

  • Measure around the nipple line to the nearest 1/4 in (0.5 cm)

    • Firmly but not tight

      enough to cause

      an indentation in the skin


Head vs chest circumference

Head vs. Chest Circumference

Newborn to 5 months

  • Head may be equal or exceed the chest by 2 cm

    5 months to 2 years

  • Chest should closely approximate the head circumference

    2 years +

  • Chest should exceed head circumference


Growth development abnormalities

Growth/ Development Abnormalities

What might you detect by recording height, weight, head & chest circumference?

  • Failure to thrive

  • Craniosynostosis

  • Hydrocephalus

  • Turner’s syndromeetc.


Failure to thrive

Failure to Thrive

  • Failure of an infant to grow at “normal rates”

  • May be related to:

    • Chronic disease

    • Congenital disorder (brain, heart, kidney)

    • Inadequate calories and protein

    • Improper feeding methods

    • Intrauterine growth retardation

    • Emotional deprivation


Failure to thrive1

Failure to Thrive

  • An emotionally deprived infant will not grow

    • Growth hormone levels will be low

      Once the child is given attention, growth hormone will be produced and the child will grow.


Craniosynostosis

Craniosynostosis

www.emedicine.com/neuro/topic80.htm

Early closure of suture(s)

Associated with:

  • small head circumference (microcephaly)

  • rigid sutures

www.emedicine.com/neuro/topic80.htm


Hydrocephalus

Hydrocephalus

Excess CSF accumulates between the brain and the dura or within the ventricular system

Resultant increased ICP leads to:

  • head enlargement

  • widening of sutures and fontanels

  • lethargy, irritability, weakness

  • “setting sun eyes”


Turner syndrome

Turner Syndrome

  • Abnormality of sex chromosomes

  • Characteristics include:

    • Short stature

    • Absence of sexual development

    • Webbed neck

    • Shield-shaped chest

    • Hypoplastic axillary nipples

    • Increased carrying angle

    • Congenital abnormalities or heart or urinary tract


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