Vital Signs

1. Vital Signs What are they and why are they so important?

2. Vital Signs • Important indicators that provide information about the basic body conditions of the patient • Four main vital signs: temperature, pulse, respirations, and blood pressure

3. Temperature • Definition – a measurement of the balance between heat lost and heat produced by the body

4. Temperature • Heat is produced by the metabolism of food and muscle, and gland activity • Heat is lost through perspiration, respiration, and excretion • Homeostasis (constant state of fluid balance) is the ideal state in the human body • Normal temperature range is 97 to 100 degrees Fahrenheit or 36.1 to 37.8 degrees Celsius

5. Temperature • Aseptic technique for handling • Oral measurement – mouth; 3-5 min • Rectal measurement – rectum; 3-5 min • Axillary measurement – armpit; 10 min • Aural measurement – ear; less than 2 sec

6. Temperature • Hypothermia – very low body temperature, below 95 degrees Fahrenheit measured rectally • Factors that lead to decreased body temperature: starvation or fasting, decreased muscle activity, mouth breathing, exposure to cold environmental temperatures and certain diseases • Hyperthermia – body temperatures exceeds 104 degrees Fahrenheit measured rectally • Factors that lead to increased body temperature: illness, infection, exercise, excitement, and high environmental temperatures

7. Temperature • Usually measured on Fahrenheit scale, but may see Celsius scale • Convert Fahrenheit to Celsius temperature, subtract 32 from the Fahrenheit temperature and then multiply the result by 5/9 or 0.5556. • Convert Celsius to Fahrenheit temperature, multiply the Celsius temperature by 9/5 or 1.8 and then add 32 to the total.

8. Temperature • Equipment used for measurement • Clinical thermometer – slender glass tube containing mercury, which expands when exposed to heat • Electronic thermometer – usually battery operated unit registering temperature in about 60 sec on digital display screen • Tympanic thermometer – specialized electronic thermometer measuring temperature in the auditory canal in 1 to 2 sec on display screen

9. Temperature • Conditions requiring modifications • Oral - eating, drinking, or smoking • Rectal – diarrhea • Axillary or groin – moisture or rubbing • Aural – incorrect positioning of pinna Recording or documenting - T • Cleaning equipment

10. Pulse • Definition- the pressure of the blood felt against the wall of an artery as the heart contracts and relaxes, or beats • Felt in arteries that lie fairly close to the skin and can be pressed against a bone by the fingers

11. Pulse • Pulse sites • Temporal – at side of forehead • Carotid – at neck • Brachial – at inner aspect of forearm at antecubital space • Radial – at inner aspect of wrist above thumb; most common site • Femoral – at inner aspect of upper thigh • Popliteal – behind knee • Dorsalispedis – at top foot arch

12. Pulse • Measured in number of beats per minute • Rate – number of beats per minute • Rhythm – regularity; regular or irregular • Volume – strength; strong, weak, thready, or bounding

13. Pulse • Pulse rates vary depending on age, sex, and body size • Adults – 60 – 90 bpm • Men – 60 – 70 bpm • Women – 65 – 80 bpm • Children over 7 years – 70 – 90 bpm • Children 1 to 7 years – 80 – 100 bpm • Infants – 100 – 160 bpm

14. Pulse • Bradycardia – pulse under 60 bpm • Tachycardia – pulse over 100 bpm • Arrhythmia – irregular or abnormal rhythm

15. Pulse • Factors that may change pulse rate • Increased – exercise, stimulant drugs, excitement, fever, shock, and nervous tension • Decreased – sleep, depressant drugs, heart disease, coma, and physical training • Document findings - P

16. Respirations • Definition- the process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract • One respiration consists of one inspiration and one expiration

17. Respirations • The breathing rate of the patient • Rate – number of respirations per minute = • Adults – 12 –20 rpm • Children – 16 – 25 rpm • Infants – 30 –50 rpm • Rhythm – regularity = regular or irregular • Character – type; depth and quality = deep, shallow, labored, difficult, stertorous, and moist

18. Respirations • Abnormal respirations • Dyspnea- difficult or labored breathing • Apnea – absence of breathing • Tachypnea – respiratory rate above 25 rpm • Bradypnea – respiratory rate below 10 rpm • Orthopnea – difficult breathing in any position other than sitting erect or standing

19. Respirations Abnormal respirations continued • Cheyne-Stokes respirations – periods of dyspnea followed by periods of apnea = frequently seen in dying patients • Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages

20. Respirations • Must be counted in such a way that patient is unaware of the procedure as respirations are partially under voluntary control • Leave hand on pulse site while counting respirations • Document findings - R

21. Blood Pressure • Definition– force exerted by the heart against the arterial walls when the heart contracts or relaxes • Read in millimeters (mm) of mercury (Hg)

22. Blood Pressure • Two types of measurements • Systolic – pressure in the walls of the arteries when the heart is contracting and pushing blood into the arteries • Reading shows greatest pressure • Normal reading is 120 mm Hg • Normal range is 100 to 140 mm Hg • Diastolic – constant pressure in the walls of the arteries when the heart is at rest or between contractions • Reading shows least pressure • Normal reading is 80 mm Hg • Normal range is 60 to 90 mm Hg

23. Blood Pressure • Pulse pressure – difference between systolic and diastolic pressure • Important indicator of health and tone of arterial walls • Normal range in adults 30 to 50 mm Hg

24. Blood Pressure • Hypertension – high blood pressure • Systolic greater than 140 mm Hg • Diastolic greater than 90 mm Hg • Causes – stress, anxiety, obesity, high-salt intake, aging, kidney disease, thyroid deficiency and vascular conditions

25. Blood Pressure • Hypotension – low blood pressure • Systolic less than 100 mm Hg • Diastolic less than 60 mm Hg • Causes – heart failure, dehydration, depression, severe burns, hemorrhage, and shock

26. Blood Pressure • Factors influencing blood pressure readings • Force of heartbeat • Resistance of the arterial system • Elasticity of the arteries • Volume of the blood in the arteries

27. Blood Pressure • Factors increasing blood pressure • Excitement, anxiety, nervous tension • Stimulant drugs • Exercise and eating • Factors decreasing blood pressure • Rest or sleep • Depressant drugs • Shock • Excessive loss of blood • Factors causing miscellaneous readings • Lying down • Sitting position • Standing position

28. Blood Pressure • Recorded as a fraction • Systolic is numerator = top number • Diastolic is denominator = bottom number • Sphygmomanometer instrument used to measure blood pressure = B/P cuff • Mercury – long column; 2mm marks • Aneroid – face scale; 2mm marks • Parts: cuff, bladder, control valve, bulb, tubing, measurement scale • Stethoscope: earpieces, diaphragm, bell and tubing • Document findings – B/P

29. Apical Pulse • Definition– pulse count taken at the apex of the heart with a stethoscope • Stethoscope amplifies the actual heart beat • Usually ordered on patients with irregular heartbeats, hardening of the arteries, or weak or rapid radial pulses, and infants • Two separate heart sounds are heard while listening to the heartbeat = “lubb-dupp” caused by closing of heart valves as blood flows through chambers of the heart • Each lubb-dupp counts as ONE heartbeat

30. Apical Pulse • Pulse deficit – heart condition in which heart is weak and does not pump enough to blood to produce a pulse or heart beats too fast and there is not enough time for the heart to fill with blood • The heart does not produce a pulse during each beat • Apical pulse rate is higher than the pulse rate at the other pulse sites on the body • Most accurate determination of pulse deficit calculated by two persons at the same time • Document findings - AP

31. Documentation • Graphing vitals • Graphic sheets used for recording vitals • Visual diagram of variations in patient’s vital signs • Must be neat, legible, and accurate • Correct errors carefully