Presentation on theme: "Introduction to Vital Signs"— Presentation transcript:
1 Introduction to Vital Signs
2 Vital Signs Various determinations that provide information regarding the condition of the patient. Used to assess health of body
3 Other Important Measurements
Vital Signs 4 Major Other Important Measurements Temperature Pulse Respiration Blood Pressure Pain Scale Color of Skin Pupil Size Pupil Reactivity Level of Consciousness Response to Stimuli
4 Body Temperature A measurement of the balance heat lost and heat produced by the body. Can be measured in mouth (oral), the rectum (rectal), the armpit (axillary), and the ear (aural)
5 Fahrenheit vs. Celsius- Conversion may be necessary.
Temp. Continued Different readings can indicate disease Most temperature is measured in degrees. Fahrenheit vs. Celsius- Conversion may be necessary.
6 Pulse The pressure of blood felt against the wall of an artery as the heart contracts and relaxes. Rate= BPM (beats per minute) Rhythm= regularity Volume= strength Apical Pulse: taken at the apex of the heart
7 Respirations Breathing rate of person Rhythm/Rate= regularity
Character= type
8 Blood Pressure The force exerted by the blood against the arterial walls when the heart contracts or relaxes.
9 TEMPERATURE
10 The loss and production of HEAT!!!!!
Loss: perspiration, respiration, and excretion Production: metabolism of food and muscle and gland activity Why is temperature important?
11 Homeostasis Constant state of fluid balance Ideal health in human body
Chemical reactions regulated by body temperature If temp is too high or too low the body’s fluid balance is affected
12 Variations in Temp Normal Range: 97-100 degrees Fahrenheit
Individual differences: bodily processes (slow/fast) Time of the day: morning vs. evening Body Sites: Oral Rectal Axillary Aural Temporal
13 Oral By mouth Usually takes 3-5 minutes Most common Most comfy
Norm: 98.6
14 Rectal From the rectum Usually takes 3-5 minutes Most accurate
Most uncomfortable Norm: 99.6
15 Axillary Under the armpit External reading Less accurate
Usually takes 10 minutes Norm: 97.6
16 Aural Inside the ear Measures core temp.
Can be inaccurate if inserted incorrectly Usually takes less than 2 seconds for a reading No norm
17 Temporal Newest method Thermometer passed across the forehead
Measures temperature of blood in the temporal artery Proving to be the most accurate
18 Changes in Body Temperature
Increases Decreases Hypothermia: low body temp (below 95) death usually occurs at below 93 Hyperthermia: high body temp (above 104) convulsions, brain damage or death can occur above 106 (Pyrexia) Fever: elevated body temperature (101 degrees) Febrile= means you have a fever Afebrile= means you do not have a fever
19 Types of Thermometers Clinical: slender glass tube containing mercury or alcohol with red dye. Electronic: registers temp. in about 60 secs. Used in a variety of facilities. Can be battery, solar or powered by an outlet Tympanic: records aural temperatures. reads within 1-2 secs. Accuracy is key. Temporal: measure temporal artery. Accurate. Easy to use. Non invasive.
20 Reading and Recording Temp
When recording the temperature to decrease errors always write????????? If a reading is: Rectal put a (R) beside the temp Axillary put (Ax) beside the temp Aural put (A) beside the temp
21 Cleaning Thermometers
Must be cleaned after each use Procedures vary Covers can be used in some cases.
22 Pulse
23 Defined as the pressure of the blood pushing against the wall of an artery as the heartbeats and rests Feel throbbing of the arteries caused by contractions of the heart More easily felt in arteries that lie close to the skin and can be pressed against a bone
24 Major Arterial/Pulse Sites
Temporal: side of the forehead Carotid: side of the neck, used for CPR Brachial: inner aspect of forearm at the antecubital space (crease of elbow), used for blood pressure Radical: inner aspect of wrist, above thumb, most common site for measuring pulse Femoral: inner aspect of upper thigh Popliteal: behind knee Dorsalis pedis: top of foot arch Posterior Tibialis: behind the medial ankle bone
25
26 Pulse rate Noted as the number of beats per minute
Vary with individuals depending on age, sex, and body size Adults: wide range of 60 to 100 beats per minute Adult men: 60 to 70 beats per minute Adult women: 65 to 80 beats per minute Children over 7: 70 to 100 beats per minute Children from 1 to 7: 80 to 110 beats per minute Infants: 100 to 160 beats per minute
27 Pulse Rate Irregularities
Bradycardia: pulse rate under 60 beats per minute Tachycardia: pulse rate over 100 beats per minute (except in children) Any variations or extremes in pulse rates should be reported immediately.
28 Pulse Rhythm Should be noted along with rate
Refers to the regularity of the pulse, or the spacing of the beats Described as regular or irregular Arrhythmia Irregular or abnormal rhythm Usually caused by a defect in the electrical conduction pattern of the heart.
29 Pulse volume Noted along with rate and rhythm
Described by words such as strong, weak, thready, or bounding
30 Various factors will change the pulse rate
Increased or accelerated rates caused by exercise, stimulant drugs, fever, shock, nervous tension Decreased or slow rates caused by sleep, depressant drugs, heart disease, coma, and physical training
31 Basic principles for taking radial pulse
Position patient’s arm supported comfortably with palm of hand turned down Use tips of two or three fingers to locate pulse site on thumb side of wrist Count pulse for one full minute Note rate, rhythm, and volume of pulse Record all information!!!!!
32 Respirations
33 Measures the BREATHING of the patient
Process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract One respiration consists of one inspiration (breathing in) and one expiration (breathing out)
34 Normal respiratory rate
Adults: 12 to 20 breaths per minute Children: breaths per minute Infants: breaths per minute
35 Character of respirations
Should be noted along with rate Refers to the depth and quality of respirations Described by words such as deep, shallow, labored, moist, difficult or stertorous (abnormal sounds like snoring)
36 Rhythm of respirations
Should be noted along with rate and character Refers to the regularity or equal spacing between breaths Described as regular (or even) or irregular
37 Abnormal respirations
Dyspnea: difficult or labored breathing Apnea: absence of respirations, usually temporary Tachypnea: respiratory rate above 25 respirations per minute. Bradypnea: slow respiratory rate, usually below 10 respirations per minute Orthopnea: severe dyspnea in which breathing is very difficult in any position other than sitting erect or standing
38 Abnormal Respirations Continued…
Cheyne-Stokes: periods of dyspnea followed by periods of apnea; frequently noted in dying patient Rales: bubbling or noisy sounds caused by fluids or mucus in the air passages Wheezing Difficult breathing with a high pitched whistling or sighing sound during expiration Caused by narrowing of bronchioles (as seen in asthma) and/or an obstruction or mucus accumulation in the bronchi Cyanosis Dusky, bluish discoloration of the skin, lips, and/or nail beds Result of decreased oxygen and increased carbon dioxide in the bloodstream
39 Voluntary control of respirations
Respirations are partially under voluntary control Patients may breathe faster or slower when they are aware respirations are being counted Important to keep patient unaware of this procedure Do not tell a patient you are counting respirations Keep your hand on pulse site while measuring respirations Patient will think you are still counting pulse Will not be as likely to alter respiration Record all information
40 Blood Pressure
41 What exactly is Blood Pressure?????
The measurement of pressure of blood that is exerted on the walls of arteries during various stages of heart activity. Always read in millimeters (mm) of mercury
42 2 Different Pressures Systolic: occurs in the walls of the arteries when the left ventricle of the heart is contracting and pushing blood into the arteries Normal Range: mm Hg Diastolic: constant pressure in the walls of the arteries when the left ventricle of the heart is at rest, between contractions Normal Range: mm Hg
43 Pulse Pressure The difference between the systolic and diastolic pressure Indicator of normal health and tone of arterial walls Should be approximately 1/3 of the systolic pressure
44 Equipment Stethoscope and Sphygmomanometer Sphygmomanometer
Lines on the gauges represent 2 mm 3 different types Mercury, aneroid gauge and electronic Mercury has proven to be most accurate but OSHA discourages its use All cuffs must read zero when deflated before a measurement can be taken.
45 Accuracy Right cuff Clothing doesn’t constrict arm and blood flow
Gauge in correct position and applied correctly Gauge at heart level Place stethoscope over brachial artery at antecubital space Ear pieces should be pointed forward Tubing not tangled Cuff should be placed in the center of the upper arm and 1 inch above the antecubital space Control the valve Don’t over inflate the cuff Ideally you want the patient sit and wait 5 minutes before taking the measurement Size and placement of the sphygmomanometer cuff is important Too small will give an artificially high blood pressure Too large will give an artificially low blood pressure
46 Blood Pressure Terminology
Hypotension (low BP): <90 mm Hg/<60 mm Hg Heart failure, dehydration, depression, severe burns, hemmorhage & shock Orthostatic: postural hypotension that occurs when a person is moving from lying to sitting or standing PreHypertension: indicated when pressures are between mm Hg/80-89 mm Hg. Warning for high blood pressure Hypertension(High BP):140 mm Hg/ 90 mm Hg Stress, anxiety, obesity, high salt intake, aging, kidney diseases, thyroid deficiencies, and arteriosclerosis. Often called the “silent killer”
47 Factors Influencing BP
Force of the heart Resistance of arterial system Elasticity of arteries Volume of the blood in the arteries Patient positioning: lying sitting, standing Increased: excitement, stimulants, exercise, smoking and eating Decreased: rest/sleep, depressants, shock, blood loss, fasting
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