Vital Signs

1. Vital Signs Pat Rutherford HSTE Hart County High School 2009

2. Temperature • Measurement of balance of heat loss and heat produced • Abbreviation T

3. Homeostasis • Constant state of fluid balance • Body reacts to chemicals and influences temperature

4. Sites to measure T • Rectal - rectum • Mouth - oral • Axillary - armpit • Aural – ear • Temporal – forehead

5. Factors that affect body temp • Individual people differ – metabolic rates • Time of day • Body Sites • Activities

6. Causes of increase T • illness • infection • exercise • excitement • environment

7. Cause of decrease • starvation of fasting • ↓muscle activity • mouth breathing • exposure to cold • certain disease

8. Methods to Measure Temp Oral • Most comfortable and common • Questions pt about eating, drinking or smoking prior to temp • Leave in place 3-5 minutes if using merciless thermometer Digital– leave until beeps usually  one minute Electronic – records within 2 – 4 seconds

9. Continued • Tympanic – record aural readings, placed in the ear canal uses inferred reading of the tympanic membrane. Must be used correctly for accuracy • Temporal – measure the temporal artery

10. Terminology related to temp • Hypothermia – low body temp ↓ 95° • Hyperthermia – high body temp 104° F • Fever – an elevated (↑) temp usually 101°F • Pyrexia – another term for fever

11. How to read a glass thermometer • The long line represents a whole number ex 98° • The short line represents .2 ° (2 tenths) of a degree

12. Normal Ranges • Oral = 98.6° F (+ or - 1°) 37° C • Rectal = 99.6° F (+ or - 1°) 37.6° C • Axillary =97.6° F (+ or - 1°) 36.4° C

13. Guidelines for Obtaining a Oral Temperature • Standard Precautions – wipe with alcohol or facility guideline before and after use; cover tip/probe; check glass thermometer prior to use, make sure the line is below 96° careful when shaking down not to hit objects close by. Use cool water when rinsing to prevent from breaking glass and destroying contents inside of the thermometer • Record and Report

14. Supplies for Temperature • Oral thermometer • Plastic sheath • Holder of with disinfectant • Tissues or dry cotton balls • Watch with second hand • Soapy cotton balls • Gloves • Paper and pen

15. Pulse • Pulse is defined as the pressure of the blood pushing against the wall of an artery as the heartbeats and rests • Feel throbbing of the arteries caused by contractions of the heart • More easily felt in arteries that lie close to the skin and can be pressed against a bone.

16. Major arterial or pulse sites in the body • Temporal: side of the forehead • Carotid: side of the neck, used for CPR • Brachial: inner aspect of forearm at the antecubital space (crease of elbow), used for blood pressure • Radial: inner aspect of wrist, above thumb, most common site for measuring pulse • Femoral: inner aspect of upper thigh

17. Pulse sites continued • Popliteal: behind knee • Dorsalis pedis: top of foot arch • Apex of the heart – inferior tip of the heart. Not a pulse site, but a location to hear the heart rate accurately using a stethoscope. This is called an apical pulse • Posterior tibialis – behind the ankle

18. TEMPORAL Carotid Apex 4 Brachial 5 Radial Femoral Popiiteal Dorsalis pedis Posterior tobialis

19. Three items to note when obtaining a pulse • Rate • Rhythm • Volume

20. Pulse rate • Noted as the number of beats per minute • Vary with individuals depending on age, sex, and body size • Adults: wide range of 60 to 90 beats per minute • Adult men: 60 to 70 beats per minute • Adult women: 65 to 80 beats per minute • Children over 7to 12: 70 to 90 beats per minute • Children from 1 to 7: 80 to 110 beats per minute • Infants: 100 to 160 beats per minute

21. Related Terms • Bradycardia: pulse rate under 60 beats per minute • Tachycardia: pulse rate over 100 beats per minute (except in children)

22. Pulse Rhythm • Should be noted along with rate • Refers to the regularity of the pulse, or the spacing of the beats • Described as regular or irregular • Arrhythmia • Irregular or abnormal rhythm • Usually caused by a defect in the electrical conduction pattern of the heart.

23. Pulse Volume • Refers to the strength of the force • Noted along with rate and rhythm • Described by words such as strong, weak, thready, or bounding

24. Various factors will change the pulse rate • Increased or accelerated rates caused by fever, shock, nervous tension, exercise, stimulant drugs and other similar factors • Decreased or slow rates caused by sleep, depressant drugs, heart disease, coma, and physical training and other similar factors

25. Basic principles for taking radical pulse • Position patient’s arm supported comfortably with palm of hand turned down • Use tips of two or three fingers to locate pulse site on thumb side of wrist • Count pulse for one full minute • Note rate, rhythm, and volume of pulse

26. Record all information • Include rate, rhythm, and volume • Example: Date, Time, P 82 strong and regular, your signature and title

28. Respiration • Measures the breathing of the patient • Process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract • One respiration consists of one inspiration (breathing in) and one expiration (breathing out)

29. Normal Respiratory Rate • Adults: 14 to 18 breaths per minute • Wider adult range: 12-20 breaths per minute • Children: 16-25 minutes • Infants: 30-50 per minute

30. Character of respirations • Should be noted along with rate • Refers to the depth and quality of respirations • Described by words such as deep, shallow, labored, moist, difficult, stertorous (abnormal sounds like snoring), and moist

31. Rhythm of respirations • Should be noted along with rate and character • Refers to the regularity or equal spacing between breaths • Described as regular (or even) or irregular

32. Abnormal respirations • Dyspnea: difficult or labored breathing • Apnea: absence of respirations, usually temporary • Tachypnea: respiratory rate above 25 respirations per minute. • Bradypnea: slow respiratory rate, usually below 10 respirations per minute • Orthopnea: severe dyspnea in which breathing is very difficult in any position other than sitting erect or standing • Cheyne-Strokes: periods of dyspnea followed by periods of apnea; frequently noted in dying patient • Rales: bubbling or noisy sounds caused by fluids or mucus in the air passages • Wheezing • Difficult breathing with a high pitched whistling or sighing sound during expiration • Caused by narrowing of bronchioles (as seen in asthma) and/or an obstruction or mucus accumulation in the bronchi • Cyanosis • Dusky, bluish discoloration of the skin, lips, and/or nail beds • Result of decreased oxygen and increased carbon dioxide in the bloodstream

33. Voluntary control of respirations • Respirations are partially under voluntary control • Patients may breathe faster or slower when they are aware respirations are being counted • Important to keep patient unaware of this procedure • Do not tell a patient you are counting respirations • Keep your hand on pulse site while measuring respirations • Patient will think you are still counting pulse • Will not be as likely to alter respiration

34. Record all information • Include rate, character, and rhythm • Example: Date, Time, R 18 deep and regular, Your signature and title • Report any abnormalities immediately to your supervisor