Vital Signs

1. Vital Signs

2. Vital Signs • Outward signs of what is occurring inside the body • Also give valuable information about the patient’s condition • They are taken on every patient you assess.

3. What are the vital signs? • Pulse • Blood pressure (BP) • Respirations • Skin Condition • PupillaryRespons • Capillary refill (for children < 6yo)

4. Vital signs – take them when? • Initial set of vial signs are called baseline vital signs • Must be repeated periodically • Observe trends!

5. Pulse • The “waves” felt as blood is pumped by the heart • Measures the heart rate and quality • Feel for the pulse and an artery near the skin surface • Most often measured at the radial artery.

6. Pulse Rates • Normal pulse rate • 60-100 beats per minute (bpm) at rest • >100 bpm – tachycardia • <60 bpm – bradycardia Regular Pulse Measure over 15 seconds x 4 or 30 seconds x 2 Irregular pulse Measure for a full minute

7. Abnormal Pulses • Tachycardia • Temporary tachycardia • Fear • Activity • Some medication • Sudafed is a common culprit!

8. Abnormal pulses • Bradycardia • Seasoned athletes may normally have pulses from 40-50 bpm • Some medications may depress pulse rate • Beta blockers A pulse consistently under 50 or greater than 120 is a problem!

9. Pulse Quality • Normal/full • Weak/thready • Strong/bounding • Regular vs irregular • Regularly irregular vs. irregularly irregular

10. Reporting pulse • A complete pulse measurement must include: Rate, strength, regularity • For example: • Pulse rate of 120, thready and regulary irregular

11. Respiratory Rate • Often overlooked, yet it’s an early and EASY tipoff that the respiratory system is impaired. • Normal respiratory rate in an adult • 12-20 breaths per minute • One respiration cycle is one inhalation and one exhalation • Can measure for 30 seconds X 2 • Best to measure for a full minute

12. Respiratory Rate - Terms • Bradypnea: < 12 breaths per minute • Tachypnea: > 20 breaths per minute • Apnea: absence of breathing • Hyperpnea: Very deep respiration • Hyperventilation: Hyperpnea and tachypnea • Cheyne-Stokes: alternating between apnea and tachypnea • Hypoxia: Inadequate oxygenation

13. Quality of Respirations • Deep • Shallow • Labored • Normal

14. Blood Pressure

15. Blood pressure is the force of blood against the arterial walls. Responsible for the flow of blood. Blood pressure is the result of: - The pumping action of the heart. - Resistance of the blood vessels. - Volume of blood.

16. Blood pressure also depends on: • Distance from the heart. Would B/P in the legs be lower or higher than in the arm?

17. Systolic Phase-Systole Ventricles Contract Blood flows to the body Pumping Action of the Heart

18. Diastolic Phase – Diastole Heart relaxes Pumping Action of the Heart

19. Sex and age of the patient. Exercise, eating, emotions Stimulants Obesity Arteriosclerosis Diabetes Pain Heredity factors Some drugs Blood Pressure is Elevated by:

20. Blood Pressure is lowered by: • Fasting • Rest • Depressants • Weight loss • Loss of blood or shock • Diuretics

21. Blood Pressure is: • Recorded as an improper fraction. 120/80 • Numerator equals systolic pressure, the first sound you will hear. • Denominator equals diastolic pressure, the last sound you will hear.

22. Blood Pressure Sounds are: • Auscultated through a stethoscope • Sounds are correlated with the readings on a sphygmomanometer. • Blood pressure is recorded in millimeters of mercury. (mm Hg)

23. Blood Pressure Variations • Determine baseline - From medical record - From systolic palpated pressure • Hypertension – High blood pressure • Hypotension – Low blood pressure • Orthostatic hypotension – decrease in B/P with position change from supine to erect.

24. Equipment

25. Stethoscope

26. Stethoscope

27. Aneroid Sphygmomanometer • Use the proper size cuff • Undersized cuff artificially raises blood pressure • Oversized cuff artificially lowers blood pressure

28. The "ideal" cuff should have a bladder length that is 80% and a width that is at least 40% of arm circumference (a length-to-width ratio of 2:1).

29. Mercury Sphygmomanometer

30. Ideally have the patient seated and their arm at heart level. Make sure that they do not have any tight clothing which may constrict their arm. Positioning for BP

31. Palpate in the antecubital fossa for the point of maximal pulsation of the brachial artery. Locate the brachial pulse

32. Cuff applied directly over skin (not through clothes) Clothes artificially raises blood pressure Center inflatable bladder over brachial artery Position lower cuff border 1 inch above antecubital space Positioning of Blood Pressure Cuff

33. The examiner should assess the estimated systolic pressure. To do this, palpate the patient’s radial pulse. Now inflate the cuff until you feel the exact point when the pulse disappears. The point on the manometer at this moment represents the estimated systolic pressure. Estimation of systolic pressure

34. Place your stethoscope over the brachial artery area. Now inflatean extra 30mmHg worth of pressure above the estimate systolic pressure (e.g. if the estimate systolic pressure was 120mmHg – inflate the cuff to 150mmHg). Assessment of systolic & diastolic pressure

35. Korotkoff Sounds

36. Now slowly release the pressure in the cuff by using the valve. • The pressure should be reduced at a rate of 2-3mmHg per second. The point where consecutive tapping noises (i.e. Korotkoff phase 1) occur you should read off the pressure on the manometer – i.e. the systolic pressure.

37. When the consecutive heart beat sounds finally disappear (i.e. Korotkoff phase 5), read off the measurement on the manometer. This represents the diastolic pressure.

38. Trouble-shooting • False high reading - Cuff too small - Cuff too loose - Slow cuff release - Column or dial not at eye level - Anxiety or recent exercise

39. False low reading - Incorrect position of arm…be sure to position at the level of the heart - Failure to notice auscultatory gap: Sounds fade out for 10 to 15 mm Hg then return – Inaudibility of low volume sounds – Column or dial not at eye level

40. Blood pressure values • Systolic normal range 90 – 140 mm Hg • Diastolic normal range 60 – 90 mm Hg • Pulse pressure: difference between systolic & diastolic pressure, approximately 40 mm Hg

41. Blood pressure readings… Use same arm for readings • Do not take B/P on arm with: – An IV – Paralysis – Injury – A – V shunt – Edema

42. Temperature • Body temperature (T) is one of the first assessments done. • Temperature Ranges • Normal adult temperature is 98.6ºF, or 37ºC. • Normal range can be from 96.8ºF to 100.4ºF, or 36ºC to 38ºC.

43. Temperature (cont.) • Temperature Ranges (cont.) • Temperatures can vary due to: • Time of day. • Allergic reaction. • Illness. • Stress. • Exposure to heat or cold.

44. Temperature (cont.) • Temperature Sites • Oral – within the mouth or under the tongue. • Axillary – in the armpit. • Tympanic – in the ear canal. • Rectal – through the anus, in the rectum. • Other sites include on the skin or in the blood.

45. Temperature (cont.) • Types of Thermometers • Electronic Thermometers • Measure temperature through a probe at the end of the device. • Hold as close as possible to the area where you wish to measure the temperature.

46. Temperature (cont.) • Types of Thermometers (cont.) • Glass Thermometers • Mercury rises in a glass tube until its level matches the temperature. • Bulb shapes • Long tip – for oral use. • Security tip – for oral and rectal use. • Rounded tip – for rectal.