Unit 102.2

1. Unit 102.2 Vital Signs Characteristics and Norms

2. Objectives • Describe the basic body functions that produce each vital sign. • Describe normal and abnormal characteristics, normal measures, methods and sites for measuring. • Discuss related terminology.

3. Vital Signs • Measurable, concrete indicators that pertain to and are essential for life • Vital signs are the signs of life! • They are: • Temperature • Pulse • Respirations • Blood Pressure

4. Temperature • measured degree of body heat • balance maintained between heat produced and heat lost by the body • can’t be changed at will • lower in morning • elevated more in evenings

5. Temperature • heat produced by oxidation of food • heat lost through • skin (perspiration) • lungs (breathing) • excretions ( urine, saliva)

6. Fever • an elevated temperature from normal • everyone has a temperature • ill people have a fever

7. Normal Temperature • Type: oral thermometer • Time: 3 minutes • 98.6 F or 37 C • easiest to obtain

8. Normal Temperature • Type: rectal thermometer • Time: 5 minutes • 99.6 F or 37.6 C • most accurate

9. Normal Temperature • Type: axillary placement of thermometer • Time: 10 minutes • 97.6 F or 36.4 C • most inaccurate

10. Normal Temperature • Type: Thermoscan • Time: 1 second • Ranges of 96.6 F - 99.7 F or 35.9 C - 37.6 C • very accurate when circumstances and technique are correct

11. Glass Thermometers • glass hollow tube (stem) with a bulb containing mercury, that expands and is read on scale on the stem • Fahrenheit 212 is boiling, 32 is freezing • scale measured in .20 (ea. little line represents .20) • Celsius (Centigrade) 100 is boiling, 0 is freezing • scale measured in .10 (ea. little line represents .10)

12. Basic Rules for Glass Thermometers • rinse off glass thermometer in cold water if stored in a disinfectant • shake mercury of glass thermometer down to 94F or 35C • use disposable sheath/cover over bulb end of thermometer inserted in mouth • no cold or hot food or drinks 15 min. prior to procedure & no smoking • Keep in place for 3-5 minutes.

13. Glass Thermometer If mercury falls between two lines, round up to next line for temperature reading

14. Glass Thermometer Celcius thermometers are graduated in increments of 0.1 therefore, each line represents 0.1 Celcius Mercury Thermometer

15. Glass Thermometer Fahrenheit thermometers are graduated in increments of 0.2 therefore, each line represents 0.2 Fahrenheit Mercury Thermometer

16. How to Read Glass Thermometer • hold the thermometer at eye level, rotate until you can see the column of mercury • observe the lines on the scale at the upper side of the mercury • read the whole number and the tenths when present

17. Key FactorsGlass Thermometers • guard against breaking a mercurythermometer. Mercury is hazardous material and requires special handling for disposal • if thermometer breaks in a patient’s mouth, give them soft bread to eat and notify the physician immediately • very few glass thermometers used today because of the above hazard

18. Oral Thermometers • always place protective sheath over oral thermometer • don’t use if patient can’t breathe through their nose • ask patient not to talk with thermometer in their mouth • place under the tongue • be sure patient has had nothing hot or cold & not smoked 15 min. prior • don’t use if patient can’t cooperate

19. Conversion between Celsius and Fahrenheit • C = (F-32) x 5/9 • F=C x 9/5 + 32

20. Other Thermometers • electronic or battery operated thermometers, cover probe with plastic sheath, reads and prints out in 10-45 seconds(oral & rectal units) • disposable patches for forehead • disposable plastic strip placed in mouth, turns colors according to degree of temperature • tympanic thermometers, for the ear with results in a second

21. Digital Oral Thermometer use according to the manufacture’s instructions lab practice

22. Thermoscan Tympanic (ear) thermometer. Use according to manufacture’s instructions lab practice Pull pinna up an Back before inserting

23. Tympanic Temperatures • reflects body core temperature • the eardrum shares same blood supply as hypothalmus • measures infrared heat of eardrum & surrounding tissue • scans eight (8) measurements per reading & displays highest as the temperature

24. External FactorsInfluencing Accuracy • lying on ear for extended period of time • ears covered with cap, scarf, ear muffs • exposure to extreme heat/cold • recent swimming/bathing • Wait 20 minutes if the above are factors to be considered

25. Key FactorsThermoscans • temperature should be taken in same ear for duration of an illness • ear must be free of obstructions to get an accurate reading (earwax, drainage, etc.) • if right ear is used, right hand should hold Thermoscan & visa versa on left • over age 1 year, pinna of ear should be pulled up and back • under 1 year, pinna of ear back only, NOT UP

26. Recommendation • Take tympanic temperature 3 times in the same ear and use the highest reading when: • *the patient is an infant less than 90 days old • *a child is less than 3 years & has a compromised immune system. A fever is critical in these situations, therefore one must be sure • *if you are an inexperienced user of the Thermoscan thermometer

27. When NOT to useThermoscan • *blood/drainage present in external ear canal • *ear is painful/swollen/red • *ear is plugged with earwax • *ear drops are being used • *facial deformities involving the ear • *when hearing aids are present (must wait 20 minutes after removing for an accurate temperature)

28. Rectal Temperature • use in young children and mentally disabled individuals who may bite • patients having difficulty breathing • confused patients • unconscious patients • patients on oxygen • the Thermoscan thermometer could be used for above situations & reduce risk of rectal tears

29. Key FactorsRectal Temperature • apply a lubricating jelly, K-Y, Vaseline, or even shortening (not a medicated jelly like Vicks) to approximately 1/2 of length • have adults lay on their side • infants lay on stomach or over parent’s knees • insert the thermometer gently • 1 1/2” into rectum • hold gently in place for 5 minutes

30. Key FactorsRectal Temperature • wipe from stem to bulb • wash thermometer with cool water and soap, rinse , dry and place in container with disinfectant • Rectal temperature is the most accurate temperature.

31. Key FactorsAxillary Temperature • use on infants with diarrhea and/or well infants • axillary area should be dry (DO NOT rub) • 10 minutes required for accurate reading • could be used for someone unable to tolerate or understand the concept of oral thermometers

32. Signs & Symptoms of Fever • Early Signs: • shivering • increased metabolism • increased pulse • feeling cold • goose bumps

33. Signs & Symptoms of Fever • Later Signs: • skin warm to the touch • flushed • dehydration • dry skin, sunken dull eyes, poor skin turgor • diaphoresis • profuse sweating, indicating hypovolemic shock • weakness • thirsty • rapid respirations

34. Documentation • when recording temperature on chart indicate: • the degree • whether it is Fahrenheit or Celsius • whether the left or right ear was used • what site was used. Oral is universal, if other sites used, an indicator must be shown • R for rectal • A for axillary • T with circle around it for tympanic

35. Pulse • a rhythmic beat or vibration detected by palpating an artery over a bony prominence that indicates the heart rate • should be the same at all arterial pulse sites

36. Pulse Sites • areas where you can compress an artery against a bone • Temporal • side of the head

37. Pulse Site • Carotid • neck

38. Pulse Site • Brachial (not shown) • distal upper arm, just above elbow, medial aspect • Radial • wrist, thumb side • Most common site for conscience adult patients

39. Pulse Sites • Apex • point of heart • Femoral • groin • Popliteal • behind knee • Dorsalis pedis • top of the foot

40. Normal Pulse Range • varies with age, gender, activity, physical conditions • General rule: The younger the patient the faster the heartbeat

41. Pulse RangesNormal • Prenatal • 120-160 • Infant • 115-130 • Child • 80-115 • Adult • 60-100

42. Tachycardia • Definition:pulse rate greater than 100 • Causes of tachycardia: • stimulant drugs • coffee, tea, soda • elevated temperature • pain • anxiety • shock • diseases like hyperthyroidism • digestion and exercise

43. Bradycardia • Definition: heart rate less than 60 • Causes of bradycardia: • poisons • sleeping pills, tranquilizers • resting or fasting • accidents or disease causing brain pressure • mental depression

44. Force of Pulse • How does the pulse force feel against your finger pressure? • Weak or thready (difficult to detect) • Strong (easily detected) • Bounding (very strong, so much so that your fingers feel as though they are being pushed off the artery)

45. Pulse Rhythm • Definition: Intervals between heart beats should be regularly spaced • when describing the rhythm on chart, note whether the rhythm is regular or irregular directly after the rate

46. Arrhythmia • Definition: Irregular heart beat

47. Apical Pulse • apex of heart is the pointed end of heart or its’ base • found at the 5th intercostal space at mid left chest just below left nipple • heard with a stethoscope • frequently used with infants or when a pulse is difficult to detect

48. Procedure Reminders • never use your thumb to detect & count pulse (thumb has own pulse) • Use a watch with a second hand and count pulse for 60 seconds • this may vary in some facilities. You may count for 30 seconds and multiply by 2, or 15 seconds and multiply by 4, etc. Know protocol • when an arrhythmia is detected, the pulse must be taken for 60 seconds

49. Respirations • the act of inhaling oxygen and exhaling carbon dioxide • Inspiration= breathing in • Expiration= breathing out

50. Normal RespirationsRates • Adult • 12-20 • Child/Infant • 20-30 • Newborn • 35-50