THE VITAL SIGNS: TEMPERATURE, PULSE, RESPIRATIONS AND BLOOD PRESSURE

1. THE VITAL SIGNS:TEMPERATURE, PULSE, RESPIRATIONS AND BLOOD PRESSURE Abbreviated: TPR BP or simply VS

2. THE VITAL SIGNS • Take a moment and close your eyes and concentrate on your breathing, the heat of your body and the flow of blood through your blood vessels as your heart beats. • These are the crucial, automatic processes that occur continuously to maintain your life. • They are indeed vital to life—and thus called the Vital Signs

3. SIGNS VS. SYMPTOMS • Symptoms can only be described / validated by the patient. • Pain, nervousness, dizziness, fatigue • Signs are able to be measured / observed by others besides the patient • Vital signs, wound drainage, color of sputum, blood cell counts

4. TEMPERATURE The measurement of core body heat

5. ROUTES TO MEASURE TEMPERATURE • Axillary: Under the arm in the armpit • Orally: By mouth • Rectally: By rectum • Tympanic: In the ear • Temporal: through the skin of the temple

6. TYPES OF THERMOMETERS • Digital Electronic: To be used for oral, rectal, and axillary • Thermoscan - Digital: To be used for tympanic /temporal • Mercury or glass: To be used for oral, rectal, and axillary. Rarely used anymore due to health risks r/t mercury and risk of sharps injury if broken

7. NORMS • Orally: 97.6 - 99.6 degrees Fahrenheit • Rectally: 98.6 - 100.6 degrees Fahrenheit • Tympanic - manufacturers say to measure as for rectal • Axillary: 96.6 - 98.6 degrees Fahrenheit • Temporally: Manufacturers say to measure as axillary.

8. HOW SHOULD THERMOMETER BE USED? • Tympanic: Special device with plastic covers, placed snugly in ear canal. • Electronic: Oral, rectal & axillary routes. Probes that are red in color for rectal temperatures; blue in color for oral and axillary, always retain hold of thermometer. • Mercury: same as electronic. Red ends are rectal; blue ends oral and axillary, always retain hold of thermometer.

9. DURATION FOR TAKING TEMPERATURES • Tympanic: As long as it takes to push a button • Temporal: Until the thermometer beeps • Electronic: Until the thermometer beeps • Mercury Oral: Three minutes • Mercury Rectal: Three minutes • Mercury Axillary: Ten minutes

10. BE CAREFUL ON RECTAL AND AXILLARY TEMPS • Always hold the thermometer in place while measuring temperatures by these routes • Always use lubricant with rectal temperatures • Always remove clothing around axilla and maintain arm pressed to side of torso

11. READING THE THERMOMETER • Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree • Long lines indicate degrees • Short lines indicate 0.2 of a degree • Four short lines between each long line (0.2, 0.4, 0.6, 0.8) • All other types give a digital display to the tenth of a degree.

12. PULSE The felt wave of blood created by the heart pumping, that travels along the arteries.

13. WHERE TO FIND PULSES • Locations called “pulse points” • Felt at areas where the artery is between finger tips and a bony prominence or section • Felt with 2-3 fingers, but never the thumb

14. Temporal Carotid Apical Brachial Radial Femoral Popliteal Post Tibial Dorsal Pedalis PULSE POINTS AND THEIR LOCATIONS

15. HOW TO MEASURE? • Measured in beats per minute • Count the felt waves for 60 seconds • Or, count the felt waves for 30 seconds – then multiply by 2

16. NORMS • Pulse norms are 60 - 100 beats per minute • Pulses between 90 - 100 are in a gray area - high normal • Faster than 100 - tachycardia • Slower than 60 – bradycardia • Caveat: well trained athletes may have “normal” pulse rates of 45-60, depending on level of fitness

17. QUALITY OF PULSE • Rhythm: regular or irregular • Rate: Bradycardic, Within the normal limits, Tachycardic • Strength: Thready, Weak, Strong, Bounding

18. WHAT AFFECTS PULSE RATES AND QUALITY • Body Temperature • Emotions • Activity Level • Health of the Heart / vascular volume

19. RESPIRATION The exchange of gases at the alveolar-cellular level that results from the mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

20. RESPIRATION • Measured in breaths per minute • Normal range is 12 - 24 breaths per minute • Count for 1 full minute or for 30 sec. x 2 • Greater than 24 is tachypnea • Less than 12 is bradypnea • Watch for rate, depth, listen for quality of breath (adventitious vs. vessicular sounds), and difficulty in breathing (SOB/labored)

21. METHOD OF MEASURING TPR • If using a mercury thermometer, measure the pulse and respiration while waiting for the temperature • If using another method of measuring the temperature, complete the temperature - then measure the pulse and respiration • Keep your fingers on the pulse while measuring the respiration

22. BLOOD PRESSURE • The measurement of the force of blood against artery walls. • Measured using device called sphygmomanometer and a stethescope. • Measured as a fraction in mm/Hg • Upper number (numerator) called the Systolic blood pressure. • Lower number (denominator) called the Diastolic blood pressure.

23. MEASURING BLOOD PRESSURE • The last sound heard (diastolic blood pressure) – is the measure of the pressure in an artery when the heart (ventricles) relaxes between contractions. • Normal Ranges SBP: 90-130, DBP: 60-80 • Hypertensive: 140/90 and above • Hypotensive: 80/50 and below • Grey areas: between norms and hyper/hypo

24. CAUSES & S/S HYPOTENSION • Causes may include: • Medications • Illness • Injury • dehydration • Signs & symptoms may include: • Dizziness / light-headedness • Lethargy / fatigue / generalized weakness • might faint

25. CAUSES & S/S HYPERTENSION • Hypertension is called the silent killer because there are often no symptoms. • Causes may include: • family history / high salt diet / overweight • emotional upset /physical pain • illness / medications / fluid overload • Some people might experience: • Headache / Pressure in the head / Tinnitis • General feeling of malaise

26. CAUSES OF HTN-(CON’T) • Genetics: More prevalent in African Americans than other ethnicities • Age: More prevalent in middle-aged and elderly people than younger people • Body size: More prevalent in obese people than thinner people • Lifestyle: More prevalent in heavy drinkers than moderate to non-drinkers • Co-morbidities: People with diabetes, gout or kidney dx .

27. CHARTING • Chart in order: temperature - pulse – respiration – blood pressure. • Do not write T =, etc. • Number for temp with no route designation=oral • Write (Ax) after axillary temperatures • Write (R) after rectal temperatures • Write (Tymp.) for tympanic • Write (Temporal) for temporal

28. SOB - Short of breath TPR - Temperature, pulse, and respiration WNL-Within normal limits VSS-Vital signs stable P.O. - By mouth BID -Twice a day TID -Three times a day QID - Four times a day QS - Every shift QD - Every day PRN - As needed Ad Lib - At liberty (as desired) B/P - Blood Pressure VS - Vital Signs HTN-hypertension ABBREVIATIONS

29. Eupnea - Normal breathing Orthopnea - Sitting upright to breath more easily Apnea - No breathing Hyperpnea - Fast, deep breathing Hypopnea- slow shallow breathing Tachypnea – Fast breathing Bradypnea - Slow breathing Dyspnea - Painful or difficult breathing Tachycardia - Pulse rate in excess of 100 bpm Bradycardia - pulse rate less than 60 bpm TERMS

30. Bounding pulse - excessively strong pulse Weak pulse – softer pulsation than normally felt Hypertensive – blood pressure 140/90 & above Hypotensive-blood pressure 80/50 & less Thready pulse - Pulse rate difficult to palpate because the heart is not beating hard enough to produce a strong wave of blood. Feels as though there is “a piece of thread” running or fluttering under the fingertips. TERMS