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SUR 111 LAB WEEK 2

SUR 111 LAB WEEK 2. Vital Signs. Vital Signs. Temperature Pulse Respiration Blood Pressure All are done initially before any surgical procedure to establish a baseline for the patient The baseline allows the caregivers to easily detect abnormalities during the surgical procedure.

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SUR 111 LAB WEEK 2

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  1. SUR 111LAB WEEK 2 Vital Signs

  2. Vital Signs • Temperature • Pulse • Respiration • Blood Pressure • All are done initially before any surgical procedure to establish a baseline for the patient • The baseline allows the caregivers to easily detect abnormalities during the surgical procedure

  3. Routine Procedure for all Vital Signs Assessment • Before coming in contact with any patient: • Wash your hands, performing the basic handwash • Assemble your needed supplies • Use clean gloves if necessary • Identify your self to the patient and tell them what you need to do • Identify the patient verbally and by their hospital identification armband

  4. Supplies Needed For VS Assessment • Clean Gloves • Thermometer • Thermometer probe covers • Watch with a Second Hand • Stethoscope • Sphygmomanometer • Black ink pen • Paper or chart

  5. Sphygmomanometer

  6. Temperature • Temperature controlled by the Hypothalamus in the brain which controls heat loss and heat production • Purpose: • Establish baseline • Determine if in normal range • Normal range 98 to 99.5°F or 36.6-37.5°C • Conversions: • C → F • C° x 9/5 + 32 (36°C x 9/5 = 64.2 + 32 = 96.2°F) • F → C • F° - 32 x 5/9 (98.6°F-32=66.6 x 5/9=37°C)

  7. Causes of Temperature Variations • Bacterial infections • Viral infections • Low physical activity • Increased physical activity • Age • Metabolism • Drugs/Medications • Exposure to cold or heat • Pregnancy • Stress • In the OR: it’s cold, the patient is exposed, prep solutions are cold, anesthesia drugs are being administered

  8. What to Call Variations • Normal = Normothermia • Below Normal = Hypothermia • Above Normal = Hyperthermia

  9. Types of Thermometers • Mercury (time for 3 to 5 minutes before reading) • Digital (requires turning on just before use) • Tympanic • Disposable strip • Places to Take Temperature: • Orally • Rectally (need lubricant) will place about 1 inch into anus • Axillary • Ear / Tympanic (plastic probe cover) • Skin • FYI: Esophageal and bladder temps monitor body core temp

  10. Temperature Procedure • Wash hands • Assemble supplies (put probe cover on) • Identify self, patient, explain what you’re going to do • Position the patient prn • Place probe depending on site • Hold probe prn • Time prn • Remove when reading complete • Remove sheath and discard • Wash your hands • Record reading and method used to take temperature • Disinfect device, return to storage location

  11. Pulse • With every beat of the heart, blood is pumped into the aorta, the force creates a pressure wave called the pulse or heartrate and is felt in various locations of the periphery • We can palpate or feel this pulse • Locations include the following: • Temporal, Carotid, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial arteries • Apically (apex of the heart)

  12. Pulse • Purpose: • Establish baseline • Determine if in normal range • Normal: Adult 60 – 100 Child (1 to 7 yrs) 80-120/minute Infant (<1 yr) 110-130/minute Birth 130-160/minute

  13. Pulse • Palpating each beat you feel for one full minute • If rhythm is regular may count for 30 seconds and multiply x two • Notice characteristics such as rhythm (regularity of the beat-note regular or irregular) and strength (weak, strong, bounding) • Below normal range is called bradycardia • Above normal range is called tachycardia

  14. Pulse Variations • Age • Infection • Level of activity • Pain • Medication (caffeine, alcohol, nicotine) • Stress or anxiety (patients in OR are anxious • Sleep deprivation

  15. Pulse Taking Procedure • Wash hands • Assemble supplies: watch with second hand, clean gloves prn, stethoscope if doing apical • Identify self, patient, explain what you’re going to do • Position the patient prn • Locate the site, using first two or three fingers (do not use the thumb) • Count pulse rate, note rhythm and strength or volume, • Wash hands • Record pulse, note regular or irregular, weak or strong or bounding • Clean supplies prn (stethoscope), return items to storage

  16. Is the exchange of oxygen and carbon dioxide between the atmosphere and the body All cells in the body must have oxygen to function Respiration is controlled by the medulla oblongata and is involuntary Inspiration is inhaling Expiration is exhaling Respiration is counted as one for each inhalation and exhalation Respiration

  17. Respiration • Purpose: • Establish baseline • Determine if in normal range • Determine rhythm and depth • Normal: Adult 12-20/minute Child (1 to 7 yrs) 18-30/minute Infant (<1 yr) 30-60/minute • Normal = eupnea • Not breathing = apnea • Below normal = bradypnea • Above normal=tachypnea

  18. Respiration • Should be even or regular, not labored, silent, relaxed • Do not mention that you will be counting respiration as the pattern might be altered sue to their being self-conscious about it • Take after taking pulse, maintaining your pulse taking method, but look at the person’s chest • You’ll have to remember the pulse rate and respiration rate to record • Each complete breath (inhalation and exhalation is recorded as one) • Count for one full minute if breathing abnormal • If normal, may count for 30 seconds and multiply x two • Note rate, and regular, unlabored, and silent

  19. Respiration Variations • Age • Infection • Stress or anxiety • Medications • Exercise • Sleeping • Airway obstruction • Damage to respiratory system (medulla oblongata or lung disease)

  20. Respiration Procedure • Wash hands • Assemble supplies (watch with second hand) • Identify self, patient, and explain procedure prn • Position patient prn • Note rate, depth, rhythm and breath sounds (should be clear) • Wash your hands • Record rate and any irregularities • Return items to storage prn

  21. Blood Pressure • The force or pressure of blood against the sides of arterial wall, its container • Purpose: • Establish baseline • Determine abnormalities/deviations from the norm • Is expressed as two numbers: systolic and diastolic • Systolic = contraction of the heart • Diastolic = relaxation of the heart

  22. Blood Pressure • Normal Values: • Adult 130/85 (130=systolic/85=diastolic) • Measured in mm Hg • Adolescent 118/75 • Child (6-10) 100/65 • Child (< 6) 95/62 • Newborn 50-52/25-30 • Adult >140 S = hypertension > 90 D = hypertension • Below normal range called hypotension

  23. Blood Pressure Variations • Age • Sex • Race • Diurnal (lower in the morning than in the afternoon) • Weight • Exercise • Stress/anxiety

  24. Blood Pressure Monitoring • Can be assessed: • Manually • Automatically • Arm preferred lower third of upper arm with stethoscope over the brachial artery • Can use the thigh (reading will be higher) will wrap cuff around lower third of thigh and place stethoscope over the popliteal artery/ will require patient to be in prone position (on their stomach) • Intra-arterially (femoral or radial) with a catheter inserted into that artery, monitored by anesthesia machine

  25. Supplies Needed to Assess BP • Stethoscope • Sphygmomanometer (cuff’s bladder should be 40% of the circumference of the patient’s arm and length should be 80% of this circumference) • Cuff size (too small or too large) can alter the blood pressure reading

  26. Blood Pressure Procedure • Wash your hands • Equipment assembled (stethoscope, sphygmomanometer, clean gloves prn) • Identify self, patient, explain procedure • Position patient, expose site • Person should be sitting or lying down with the arm at the level of the heart • Try to take the BP in the left arm as that is closest to the heart • Apply cuff • Palpate brachial arterial pulse at antecubital area using first two fingers (do not use thumb)

  27. Blood Pressure Procedure • Inflate cuff 20 to 30 mm Hg above where pulse is no longer palpable • Place stethoscope over site where you palpated pulse, hold in place with first two fingers • Slowly release valve, listening carefully for “Korotkoff” sounds

  28. Korotkoff’s Korotkoff’s Sounds • Phase I Hearing initial tapping sound, you will record this as the systolic reading • Phase II Hear soft swishing sound as cuff deflates • Phase III Hear rhythmic tapping as more blood passes through the vessels • Phase IV Sound disappears (last sound heard is the diastolic reading)

  29. Blood Pressure Procedure • Continue to deflate cuff • Wash hands • Record results • Care for equipment and put back in storage area

  30. Summary • Vital Signs • Temperature • Pulse • Respirations • Blood Pressure

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