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VITAL SIGNS

Learn how vital signs such as temperature, pulse, respiration, and blood pressure are crucial indicators of a patient's well-being. Discover how to assess vital signs accurately and understand their significance in patient care.

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VITAL SIGNS

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  1. VITAL SIGNS

  2. What is so VITAL about them????? What do they assess? What can they tell you? Why are they important? Are they objective or subjective? Think about how they can help you ANTICIPATE a patient’s outcome?

  3. VITAL SIGNS • TEMPERATURE • PULSE • RESPIRATION • BLOOD PRESSURE • PULSE OXIMETER T P R BP PULSE OX • VS are taken as an assessment, whenever ordered, or to help clarify a diagnosis. • VS are NEVER routine; you are recording measurements which reflect a patients well being and possible impending trouble with their vital organs.

  4. TEMPERATURE • Measurement of body heat. It is the balance between heat produced and heat lost. It is: • Fairly constant • Lower the closer to the body surface it is measured • Less stable in children • Affected by: • illness, medication, age, infection, pregnancy and dehydrations

  5. TEMPERATURE • Hyperthermia- • Hypothermia-

  6. TEMPERATURE Measured in 1 of 5 areas: • Rectal • Oral • Tympanic • Axillary • Temporal Scanner

  7. TEMPERATURE • ORAL • Normal: 98.6F/37 C • Range: • 97.6-99.0 • 36.5-37.5 • RECTAL • Normal: 99.6/37.9 • Range: • 98.6-100.6 • 37-38.1

  8. Types of Thermometers BATTERY OPERATED/IVACS

  9. TYMPANIC THERMOMETERS

  10. PULSE • Pressure of blood felt against wall of an artery as heart contracts/relaxes. • Measured to assess how well the cardiovascular system is meeting body’s needs. • Look at: • RATE ?? • RHYTHM ?? • FORCE ??

  11. PULSE • Where are the pulse sites in your body? (HAND OUT) • Temporal • Carotid • Brachial • Apical • Radial • Femoral • Popiteal • Posterior Tibial (Pedal)

  12. PULSE Count for 60 sec Count for 30 sec and multiply X2 • Shorter time counts = inaccurate data

  13. PULSE • Radial pulse- taken at wrist with 2 fingers over radial artery site

  14. APICAL PULSE • Pulse taken over apical site. Using your stethoscope you count the heart sounds FOR 1 FULL MINUTE.

  15. Important Pulse Terms TACHYCARDIA Too Fast! Greater than 100 BRADYCARDIA Too Slow….Lower than 50

  16. NORMAL PULSE RATES Birth- one year 120-160 Childhood 75-100 Adult 65-80

  17. PULSE PULSE DEFICIT Difference between the apical and radial pulse

  18. RESPIRATIONS Count for 60 sec Count for 30 sec and multiply X2 Respiration- 1 inspiration/1 expiration Normals: Adults: 16-20 Children: 18-30 Infants: 30-60

  19. RESPIRATIONS • Types of Respirations • 1. Stertorous- • 2. Tachypnea- • 3. Shallow- • 4. Cheyne-Stokes- • 5. Dyspnea- • 6. Apnea-

  20. CHARACTER OF RESPIRATIONS • Regular • Irregular • Shallow • Deep • Labored

  21. COUNTING RESPIRATIONS To count respirations, watch or feel the patient’s chest rise and fall. Try to observe WITHOUT patient’s awareness to prevent a change in the normal rate.

  22. Causes of Increased Respirations • Fever • Exercise • Stress • Disease • Medications

  23. BLOOD PRESSURE • Blood pressure- the force of blood exerted on inner walls of arteries as blood circulates • There is ALWAYS a certain amount of pressure in arteries because as the heart is pumping blood, it is constantly forcing it to circulate • Blood pressure depends on: • Volume: amount of blood in circulatory system • Force of heart beat • Condition of arteries (elasticity)

  24. BLOOD PRESSURE • Your heart is an AMAZING pump. It works reliably for decades, and it safely pumps blood around. Your blood vessels are the pipes. They take the output from the pump (heart) and distribute it though out the body. A blood pressure gauge is simply a way to measure the performance of the pump and pipes.

  25. BLOOD PRESSURE • Systolic: • Pressure exerted on artery walls when the heart is contracting • Top number • Always higher • 120

  26. BLOOD PRESSURE • Diastolic: Pressure exerted on artery walls when heart is relaxing Bottom number Always lower ___ 80

  27. BLOOD PRESSURE • Normal Blood Pressure • 120 • 80 Hypotension- low blood pressure Systolic less than 80 Hypertension- high blood pressure Systolic higher than 140 Diastolic higher than 90 Pulse Pressure- difference between systolic and diastolic pressure

  28. BLOOD PRESSURE • When the cuff is pumped up, the blood flow is actually cut off as the pressure is exerted by the cuff. As the pressure in the cuff is released, blood starts flowing again and you can hear the flow in the stethoscope. The number at which blood starts flowing (120) is the measure of the maximum output pressure of the heart (systolic). You continue releasing the pressure on the cuff and listen until there is no sound. That number (80) indicates the pressure in the system when the heart is relaxed (diastolic).

  29. BLOOD PRESSURE • Aneroid: • Mercury:

  30. BLOOD PRESSURE

  31. PULSE OXIMETER • Possibly considered the 5th vital sign. It is a rough measurement of the oxygen saturation of the blood. It allows nurses to get a good idea of how well the patient is breathing and oxygenating his blood. No nail polish! Why??

  32. Pulse Oximeter • Pages 620-622 in your textbook Pulse oximeter measures the level of saturation of the patient’s hemoglobin with oxygen. Hemoglobin is the part of the blood that carries oxygen to the cells to nourish them. It measures how full the hemoglobin molecules are with oxygen.

  33. VITAL SIGNS • Automatic vital sign machines

  34. VITAL SIGNS It is tempting to view VS as a routine & static piece of data but… • VS are fluid, dynamic, & ever-changing, just like our patients!

  35. VITAL SIGNS • Be accurate! • Be gentle! • Be observant!

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