With Your Group, answer the following questions….

1. With Your Group, answer the following questions…. • 1. What areas of development do you feel were most affected in the main character in the movie Martian Child? • Give examples supporting your answers • 2. What milestones do you feel were not met? • 3. What do you feel led to his developmental delays? Explain

2. May 7, 2012 Why are Vital Signs essential for health care providers? (what do they help determine?)

3. Vital Signs

4. Define the following words….(without your books!!!!!) • Work with a partner to check your knowledge before we proceed. How do you think the following groups of terms relate and what do they mean? • Apical, Radial, Brachial, antecubital, stethoscope, intercostal space • Tympanic, Axillary, Rectal, Oral

5. What are they? • Vital signs: the most important measurements obtained for evaluating/assessing a client’s condition • Temperature, Blood Pressure, Pulse, Respirationsare indicators of patient status • Any drastic change can lead to DEATH • They are vital to life, hence the term VITAL SIGNS

6. Temperature (T) • Normal Adult Temp= 98.6 degrees Fahrenheit/ 37 degrees Celsius • Usual range 96.8 F to 100.4 F or 36 C to 38 C • Variables that affect temp: • Time of day (lower in morning) • Allergic reaction • Illness • Stress • Exposure to heat/cold

7. Where can you find it???? • Oral: in the mouth or under the tongue • Axillary: armpit (axilla) • Tympanic: ear canal • Rectal: through the anus, in the rectum • Alternative methods: surface of skin, through the blood

8. Types of Thermometers • 2 Types: electronic & glass • Electronic versions measure temp through a probe at the end of the thermometer • Ex: Tympanic Thermometers • Probe covers are used to prevent contamination • Glass versions contain mercury which rises until it matches the temperature • Round tip – for rectal temp (decreased risk of injury) • Long tip- oral temp (more surface area) • Security tip – thin, short tip for oral and rectal assessments • Handles are color coded for infection control

9. 5/8/2012 • Why are vital signs abbreviated?

10. PULSE (P) • A wave of blood flow created by heart contractions • You can palpate (feel) with 2 fingers or auscultate (listen for sounds) using a stethoscope or machine • Provides information about pulse rate and blood flow from left Ventricle to the assessment artery and its feeds • Pulse Sites: named according to nearby bones/structures • Most common: Radial, brachial, apical

11. Most common….. • Radial: best palpated on the inside of • the wrist (thumb side). Do not use your thumb! • Brachial: adults- antecubital space of the arm (bend of elbow); children- middle of the inside of upper arm • Apical: auscultated with stethoscope on chest wall • Found at apex of heart, to the left of sternum, under the 5th/6th intercostal space • Used on infants and young children or adults prior to administering drugs, or for apical-radial deficit

12. Evaluating 4 Characteristics: • 1. Pulse Rate: assess beats per minute, BPM/ bpm, counted for 15, 20, 30, 0r 60 seconds • Normal ranges vary according to age & gender • Pulse rate decreases with age, WHY? • Women tend to have faster rates then men • Fitness levels significantly affect rates as do illness or disease • Tachycardia is a faster than normal pulse rate • Caused by physical/mental stress, lack of oxygen (infection, pain, exercise, emotional stress of crying infant) • Bradycardia is a slower than normal pulse rate • Caused by physically fit athletes, heart meds, lack of Oxygen or BP

13. 5/9/12 • Review material • Guest speaker : Ben McAndrews

14. Evaluating 4 Characteristics: • 2. Pulse Rhythm: pattern of heartbeats which should be regular and evenly paced • Arrhythmia and dysrhythmia- irregular heartbeat • Must count pulse for full minute and average • Document as irregular • Caused by dysfunction, medications, lack of oxygen • May be normal for infants up until young adulthood • 3. Pulse Volume: strength of the pulse, measurement of the pulse as it presses against the arterial wall and fingertips during palpatation

15. Evaluating 4 Characteristics: • Described as: 0 Absent, unable to detect • Thready or weak, difficult to palpate and easily obliterated by light pressure from fingertips • Strong or normal, easily found and obliterated by strong pressure from fingertips • Bounding or full, difficult to obliterate with fingertips • Thready may indicate decreased circulation due to obstruction, low BP, or weak heart contractions • Bounding may indicate high BP or strong heart contractions

16. Evaluating 4 Characteristics: 4. Bilateral Presence: should be found on both sides of the body and have the same rate, rhythm, and volume. If found only on one side, document as unilateral

17. Activities • Pulse Sites Worksheet

18. Activities • Read pages 334-336 • Demonstrate procedure for taking Oral Temp • With a partner complete the activity • Use pages 334-339 as a guideline • While waiting for your turn, complete the packet on confidentiality and ethics. Answer questions on 1 separate sheet of paper with both of your names : ) • Match connections on T Conversion

19. 5/10/2012 List 3 things that affect one’s pulse.

20. Activities • Read pages 334-336 • Demonstrate procedure for taking Oral Temp • With a partner complete the activity • Use pages 334-339 as a guideline • While waiting for your turn, complete the packet on confidentiality and ethics. Answer questions on 1 separate sheet of paper with both of your names : ) • Match connections on T Conversion

21. 5/14/2012 What should you do prior to checking for vital signs? (many things)

22. RESPIRATION (R) • The act of breathing or the exchange of oxygen and carbon dioxide • When counting, count 1 inhalation and 1 exhalation as 1 respiration or complete breath • Respiratory Rate (RR)- most common assessment is to watch patient’s chest movement for 1 minute • Can also use a stethoscope to auscultate RR • Tell adults you are listening to their heart

23. 3 Characteristics of Respiration • 1. Rate of Respiration: # of breaths / minute (count for entire minute) • Normal= 12-20 breaths / minute • RR typically decreases with size and age • Increase in RR is called hyperventilation • Caused by physical/mental stress, increase body T, lack of oxygen or low BP • Decrease in RR is called hypoventilation • Caused by pain meds, alcohol, decrease in body T, severe lack of oxygen, and no BP

24. 3 Characteristics of Respiration • 2. Rhythm of Respiration: pattern should be regular • Cheyne-Stokes: abnormal respiration characterized by shallow breaths that increase to deeper breaths and then decrease to more shallow breaths. Then, apnea, or no breathing which lasts from 5-40 seconds • 3. Quality of Respiration: seen in volume and effort • Volume: amount of air taken in and expelled out of lungs (shallow or deep) • Effort: amount of work patient uses to breathe (muscle use in neck, chest, abdomen is a sign of dyspnea)

25. Practice Time • Find a partner of the same sex • Check their respiration rate for one minute • Use the stethoscope to listen for respiration • Front, back • Use the stethoscope to listen for heart rate

26. Pop Quiz • 1.) List the four characteristics of pulse. • 2.) List the three characteristics of respiration. • 3.) List the two factors that influence the quality of respiration. • 4.) Name the 3 most common pulse sites.

27. 5/15/2012 Which vital sign do you feel is most important to accurately determine? Why?

28. Stethoscope basics for EMT • http://www.youtube.com/watch?v=5SBRX6jq3GI

29. Blood Pressure (BP) • BP: amount of pressure or tension exerted on the arterial walls as blood pulsates through them • 2 pressures are measured • Systolic BP (SBP): pressure exerted on the arteries during the contraction phase of the heartbeat • Higher # because pressure should be higher in the blood vessels when the heart is contracting • Diastolic BP (DBP): the resting pressure on the arteries as the heart relaxes between contractions • BP is written as a fraction and measured in mm of mercury (Hg) (ex. 120/80)

30. Expected BP Values • Systolic readings between 100-140mm Hg. • Diastolic readings between 60-90mm Hg. • Hypertension: high BP • Hypotension: low BP • Body tries to raise BP • Signs of shock (lack of blood flow) may develop • Change in level of consciousness • Increase in heart rate and respirations • Weak, thready pulse, • Pale, sweaty skin

31. Types of sphygmomanometers… • Mercury: calibrated glass cylinder • Bottom of the miniscus, upper surface of liquid, forms point of reference as pressure rises • Aneroid: calibrated dial with a needle that points to numbers on the face of the dial • Needle moves as pressure changes • Electronic: digital display, usually includes the pulse rate and does not require a stethoscope

32. BP Sites Can be obtained at any artery at a pulse site Brachial: upper arm (most common for adult and older children) Radial: lower arm (infants or clients with very large upper arms) Popliteal: thigh, alternative to arms due to trauma, disease, medical tx to arms, mastectomy Dorsalis pedis & posterior tibial; lower leg (common on infants with automatic BP cuff)

33. BP Equipment & Steps • Sphygmomanometer: sphygmo (pulse), mano (pressure), meter (measure) • Instrument used to detect blood pressure (BP cuff) • 1. Place the cuff around extremity just above pulse site • 2. Place stethoscope on artery at pulse site • 3. Squeeze and release bulb, pushing air into the cuff to exert pressure on the artery • 4. Slowly release air from cuff • 5. Listen for sounds as mercury drops; note the number when you first hear the sounds and when you last hear sounds (or they become softer)

34. Measuring Blood Pressure http://www.youtube.com/watch?v=u6saTO8_o2g

35. BP Equipment & Steps • Sphygmomanometer: sphygmo (pulse), mano (pressure), meter (measure) • Instrument used to detect blood pressure (BP cuff) • 1. Place the cuff around extremity just above pulse site • 2. Place stethoscope on artery at pulse site • 3. Squeeze and release bulb, pushing air into the cuff to exert pressure on the artery • 4. Slowly release air from cuff • 5. Listen for sounds as mercury drops; note the number when you first hear the sounds and when you last hear sounds (or they become softer)

36. Case Study • 1.) Summarize the issue of concern • 2.) What is your legal obligation as a medical professional? • 3.) What would you do? • 4.) Would it be difficult for you to do this? (for example, would you wish you could do something differently but realize you cannot legally?)

37. Finish Case Studies

38. 5/16/2012 • How does lying down affect your blood pressure and why?

39. PLEASE TAKE A TEXTBOOK

40. Order of performance • Always perform least invasive first! Why? • Noninvasive: observation, actions that do not intrude • Invasive: invading someone’s personal space • Use this order if possible: • 1. Respiratory rate • 2. Pulse • 3. Temperature • 4. Blood Pressure • P and T are often taken together • If taking rectal T, conduct last

41. Documenting and Reporting • Look for section in chart/computer listed as VS (vital signs) or T P R BP. • If recording only numbers, be sure to document in this sequence. • For example: 98.6-72-16-145/69 • Always report findings to supervisor if: • VS results fall outside of normal range for Pt • VS result is significantly different from a previous result recorded • Complete Chapter 9 Review pg 352-353. # 1-12, 14

42. What’s next? • Review for Test on Thursday (TOMORROW!!) • Be prepared to perform a vital signs check on a client

43. THE END