MEASURING VITAL SIGNS

1. MEASURING VITAL SIGNS UNIT 1 TPR

2. MEASURING VITAL SIGNS • TEMPERATURE • PULSE • RESPIRATION • (TPR) • (BLOOD PRESSURE) • Indicate how the body is functioning. • When within normal limits = homeostasis. • Accuracy in measuring and recording. • Patient’s treatment depends on this info.

3. BODY TEMPERATURE • The measure of body heat produced by the muscles and glands and by the oxidation of food • The balance between the heat produced and the heat lost • Measured with thermometer

7. Oral Cavity • Simplest, most common, convenient, and comfortable site • Avg. oral temp. is 98.6 F or 37 C • Use whenever possible, and when the patient has • Diarrhea • Rectal surgery • Fecal impaction

8. Rectal • The most accurate temp. reading is in the rectum • Normal rectal temp. is 99.6 F or 37.5 C • Rectal temp. is taken when patients • Are under 6 yrs. old • Have difficulty breathing • Are extremely weak • Are confused, unconscious, or senile • Are being given oxygen • Experience partial paralysis of the face caused by a stroke or accident

9. Aural • Also accurate, easy to use, and appropriate for patients listed under rectal • Probe is positioned in the aural canal of the ear • Normal aural temp. is 98.6 F or 37 C

10. Axillary • Taken in the armpit • Least accurate temp. • Normal axillary temp. is 97.6 F or 36.4 • Use this technique only when the temp. cannot be taken orally, aurally, or rectally

11. ALWAYS REPORT A TEMPERATURE THAT IS ABOVE NORMAL TO YOUR SUPERVISOR

12. FACTORS THAT INFLUENCE BODY TEMPERATURE INCREASE TEMPERATURE • Exercise • Digestion • Increased environmental temp • Illness • Infection • Excitement • Anxiety DECREASE TEMPERATURE • Sleep • Fasting • Exposure to cold • Certain illnesses • Decreased muscle activity • Mouth breathing • Depression

13. Human Temperature Variation EffectsHOT • 37°C (98.6°F) - Normal body temperature (which varies between about 36.12-37.5°C (96.8-99.5°F) • 38°C (100.4°F) - Sweating, feeling very uncomfortable, slightly hungry. • 39°C (102.2°F) - Severe sweating, flushed and very red. Fast heart rate and breathlessness. There may be exhaustion accompanying this. Children and people with epilepsy may be very likely to get convulsions at this point. • 40°C (104°F) - Fainting, dehydration, weakness, vomiting, headache and dizziness may occur as well as profuse sweating.

14. 41°C (105.8°F) - (Medical emergency) - Fainting, vomiting, severe headache, dizziness, confusion, hallucinations, delirium and drowsiness can occur. There may also be palpitations and breathlessness. 42°C (107.6°F) - Subject may turn pale or remain flushed and red. They may become comatose, be in severe delirium, vomiting, and convulsions can occur. Blood pressure may be high or low and heart rate will be very fast. 43°C (109.4°F) - Normally death, or there may be serious brain damage, continuous convulsions and shock. Cardio-respiratory collapse will likely occur. 44°C (111.2°F) or more - Almost certainly death will occur; however, patients have been known to survive up to 46.5°C (115.7°F).[

15. Heat Exhaustion and Heat Stroke Overview Heat exhaustion: This condition often occurs when people exercise (work or play) in a hot, humid place and body fluids are lost through sweating, causing the body to overheat. The person's temperature may be elevated, but not above 104°F. Heat stroke: This medical condition is life-threatening. The person's cooling system, which is controlled by the brain, stops working and the internal body temperature rises to the point where brain damage or damage to other internal organs may result (temperature may reach 105+°F).

16. Heat Exhaustion and Heat Stroke Causes Heat exhaustion is typically caused when people who are not well adjusted to heat exercise in a hot, humid environment. At high temperatures, the body cools itself largely through evaporation of sweat. When it is very humid, this mechanism does not work properly. The body loses a combination of fluids and salts (electrolytes). When this is accompanied by an inadequate replacement of fluids, disturbances in the circulation may result that are similar to a mild form of shock.

17. Heat stroke may often develop rapidly. • Medical conditions or medications that impair the body's ability to sweat may predispose people to this problem. • Heat stroke happens in the following two ways: • The classic form occurs in people whose cooling mechanisms are impaired. • The exertional form occurs in previously healthy people who are undergoing strenuous activity in a hot environment. • Infants and the elderly are more likely to have this problem, as are those who are taking antihistamines and certain types of medication for high blood pressure or depression.

18. Heat exhaustionsymptoms Often pale with cool, moist skin Sweating profusely Muscle cramps or pains Feels faint or dizzy May complain of headache, weakness, thirst, and nauseaCore (rectal) temperature elevated-usually more than 100°F-and the pulse rate increased

19. Heat stroke symptoms Unconscious or has a markedly abnormal mental status (dizziness, confusion, hallucinations, or coma) Flushed, hot, and dry skin (although it may be moist initially from previous sweating or from attempts to cool the person with water) May have slightly elevated blood pressure at first that falls later May be hyperventilating Rectal (core) temperature of 105°F or more

20. When to Seek Medical Care As with all other medical problems, a doctor should be called if you are not sure what is wrong, if you do not know what to do for the problem, or if the person is not responding to what you are doing for them. Call a doctor for heat exhaustion if the person is unable to keep fluids down or if their mental status begins to deteriorate. Symptoms of shortness of breath, chest pain, or abdominal pain may indicate that the heat exhaustion is accompanied by more serious medical problems.

21. Suspected heat stroke is a true, life-threatening medical emergency. Call for an ambulance and request information as to what to do until the ambulance arrives. A person with suspected heat stroke should always go to the hospital (or call for an ambulance) at once.

22. For heat exhaustion, a person should go to the hospital if any of the following are present: Loss of consciousness, confusion, or deliriumChest or abdominal pain Inability to drink fluids Continuous vomiting Temperature more than 104°F Temperature that is rising despite attempts to cool the person Any person with other serious ongoing medical problems

23. For mild cases of heat exhaustion Rest in a cool, shaded area. Give cool fluids such as water or sports drinks (that will replace the salt that has been lost). Salty snacks are appropriate as tolerated. Loosen or remove clothing. Apply cool water to skin. Do not use an alcohol rub. Do not give any beverages containing alcohol or caffeine.

24. Heat stroke (do not attempt to treat a case of heat stroke at home, but you can help while waiting for medical assistance to arrive.) Call 911 immediatelyMove the person to a cooler environment, or place him or her in a cool bath of water (as long as he or she is conscious and can be attended continuously). Alternatively, moisten the skin with lukewarm water and use a fan to blow cool air across the skin. Give cool beverages by mouth only if the person has a normal mental state and can tolerate it.

25. COLD • 37°C (98.6°F) - Normal body temperature (which varies between about 36-37.5°C (96.8-99.5°F) • 36°C (96.8°F) - Mild to moderate shivering (it drops this low during sleep). May be a normal body temperature. • 35°C (95.0°F) - (Hypothermia) is less than 35°C (95.0°F) - Intense shivering, numbness and bluish/grayness of the skin. There is the possibility of heart irritability. • 34°C (93.2°F) - Severe shivering, loss of movement of fingers, blueness and confusion. Some behavioral changes may take place. • 33°C (91.4°F) - Moderate to severe confusion, sleepiness, depressed reflexes, progressive loss of shivering, slow heart beat, shallow breathing. Shivering may stop. Subject may be unresponsive to certain stimuli.

26. Severe Hypothermia • 90º - 86ºF Shivering stops, exposed skin blue of puffy, muscle coordination very poor, inability to walk, confusion, incoherent/irrational behavior, but may be able to maintain posture and appearance of awareness • 86º - 82ºF Muscle rigidity, semiconscious, stupor, loss of awareness of others, pulse and respiration rate decrease, possible heart fibrillation • 82º - 78ºF Unconscious, heart beat and respiration erractic, pulse may not be palpable • 78º - 75ºF Pulmonary edema, cardiac and respiratory failure,death. Death may occur before this temperature is reached.

27. You may treat minor cold exposure at home with blankets and home care techniques. Call a doctor to ask about danger signs that might warrant immediate transportation to a medical facility.

28. Any person who is at risk for hypothermia and is suspected to have sustained a cold exposure should be brought to a hospital’s Emergency Department. Look for these danger signs of cold exposure: Intense shivering, stiffness, and numbness in the arms and legs, stumbling and clumsiness, sleepiness, confusion, and amnesia.

29. The adage that "a person is not dead until warm and dead" means that victims may appear dead because of cold exposure, but many of these people have made complete recoveries when rewarmed. All such victims in this situation need rapid transport to a hospital so that resuscitation attempts may be made.

30. Self-Care at Home The first priority is to perform a careful check for breathing and a pulse and initiate cardiopulmonary resuscitation (CPR) as necessary. If the person is unconscious, having severe breathing difficulty, or is pulseless, call 911 for an ambulance. Because the victim’s heartbeat may be very weak and slow, the pulse check should ideally be continued for at least 1 minute before beginning CPR. Rough handling of these victims may cause deadly heart rhythms.

31. The second priority is re-warming. Remove all wet clothes and move the person inside. The victim should be given warm fluids if he or she is able to drink, but do not give the person caffeine or alcohol. Cover the person’s body with blankets and aluminum-coated foils, and place the victim in a sleeping bag. Avoid actively heating the victim with outside sources of heat such as radiators or hot water baths. This may only decrease the amount of shivering and slow the rate of core temperature increase. Strenuous muscle exertion should be avoided.

32. Medical Terminology • afebrile – temp. is within normal range • febrile – temp. is elevated • hypothermia – temp. is below normal • pyrexia – above normal temp. • pyrogenic – any substance that produces fever

33. PULSE • Indicates the number of times the heart beats in 1 minute. • Pressure of the blood against the wall of the artery as the heart contracts and relaxes. • Indicates how well the blood is circulating through the body.

34. Place your fingers over an artery and squeeze gently against the bone • The pulse rate should be the same at all pulse points

36. Radial pulse is the most common site • Apical pulse • Taken at the apex of the heart when the heart is too weak to transmit a pulse that you can feel along the arteries • Place a stethoscope 2-3 inches to the left of the sternum, just below the nipple on the chest

37. PULSE CHARACTERISTICS must be noted • RATE: number of pulse beats per minute. • RHYTHM: regular, steady or skipped beats? • ARRHYTHMIA: uneven intervals between pulses or heartbeats? • FORCE OF BEAT (volume): weak, thready, or bounding? • ALWAYS COUNT THE PULSE FOR 1 FULL MINUTE

38. PULSE rate, rhythm & force • ALWAYS report a heartbeat < 60 or > 100. • > 100 = tachycardia • < 60 = bradycardia • irregular = arrhythmia • thready = weak, barely-felt pulse; thin, like a thread. • bounding = leaping, very strong, or forceful pulse.

39. FACTORS THAT AFFECT PULSE RATE INCREASE PULSE RATE • Exercise • Illness • Anxiety • Medication • Shock DECREASE PULSE RATE • High level of aerobic fitness • Depression • Medication

40. NORMAL PULSE RATES Age Rate 140 – 150 90 – 160 115 – 130 80 – 115 60 – 80 • Before birth • At birth • First year of life • Childhood years • Adult

41. Medical Terminology • arrhythmia – absence of rhythm • bradycardia – abnormally slow heartbeat • pulsation – rhythmic beat • tachycardia – abnormally fast heartbeat

42. RESPIRATION • The process of taking O2 into the body and expelling CO2 from the body • One inspiration/inhalation (breathing in) and one expiration/exhalation (breathing out) = one respiration • DO NOT tell patient you are counting respirations • Count pulse rate & respirations while you are taking the temperature

44. RESPIRATORY CHARACTERISTICS • Rate: number of respirations per minute. • Rhythm: regular or irregular? • Dyspnea: difficulty breathing? • Apnea: has breathing stopped? • Cheyne-Stokes: periods of labored respirations followed by apnea. • Rales: bubbling or rattling sounds caused by mucus in the air passages. • Always report any unusual or abnormal respirations to your supervisor.

45. Average respiratory rates, by age: • Newborns: Average 44 breaths per minute • Infants: 20-40 breaths per minute • Preschool children: 20-30 breaths per minute • Older children: 16-25 breaths per minute • Adults: 14-18 (12-20) breaths per minute

46. FACTORS THAT AFFECT RESPIRATION INCREASE RESPIRATION DECREASE RESPIRATION Relaxation Depression Head Injury Medication • Exercise • Anxiety • Respiratory disease • Medication • Pain • Heart disease (e.g., CHF)

48. Medical Terminology • apnea – not breathing • dyspnea – difficulty breathing • Cheyne-Stokes – labored respirations followed by apnea • rales – bubbling or rattling sounds caused by mucus in the air passages • tachypnea - abnormally fast respirations

49. BLOOD PRESSURE • The force of the blood pushing against the walls of the blood vessels. • Depends on the volume of blood in the circulating system, the force of the heartbeat, and the condition of the arteries. • When arteries lose their elasticity, they give more resistance, and the blood pressure increases.

50. BLOOD PRESSURE SYSTOLIC PRESSURE DIASTOLIC PRESSURE The least force exerted on the walls of the arteries by the heart. Occurs as the heart relaxes between contractions. • The greatest force exerted on the walls of the arteries by the heart. • Occurs when the heart is contracting.