Vital Signs: Body Temperature, Pulse, Respiration, Blood Pressure, and Pulse Oximetry

1. Chapter 2 The Physical Examination and Its Basis in Physiology

2. Vital Signs • Body temperature (T) • Pulse (P) • Respiration (R) • Blood pressure (BP) • Pulse oximetry (SpO2)

3. Table 2-1. Average Range for Vital Signs According to Age Group

4. Body Temperature

6. Four Common Types of Fever • Intermittent • Remittent • Relapsing • Constant

7. Box 2-1 Clinical Signs of Hypothermia • Below normal body temperature • Decreased pulse and respiratory rate • Severe shivering (initially) • Patient indicating coldness or presence of chills • Pale or bluish cool, waxy skin • Hypotension

8. Box 2-1 Clinical Signs of Hypothermia (Cont’d) • Decreased urinary output • Lack of muscle coordination • Disorientation • Drowsiness or unresponsiveness • Coma

9. Box 2-2 Common Therapeutic Interventions for Hypothermia • Remove wet clothing • Provide dry clothing • Place patient in a warm environment (e.g., slowly increase the room temperature) • Cover patient with a warm blanket or electric heating blanket

10. Box 2-2 Common Therapeutic Interventions for Hypothermia (Cont’d) • Apply warming pads (increase temperature slowly) • Cover patient’s head with a cap or towel • Supply warm oral or intravenous fluids

11. Table 2-2 Factors Affecting Body Temperature(see text for full discussion) • Age • Environment • Time of day • Exercise • Stress • Hormones

12. Body Temperature Measurements • The measurement of body temperature establishes an essential baseline for clinical comparison. • To ensure reliability of a temperature reading: • Select correct equipment • Choose the most appropriate site • Use the correct technique or procedure

13. Body Temperature Measurements (Cont’d) • The four most commonly used sites are the: • Mouth • Rectum • Ear (tympanic) • Axilla • Additional sites • Esophagus • Pulmonary artery

14. Core Temperature Sites • Rectum • Ear (tympanic) • Esophagus • Pulmonary artery

15. Table 2-3 Body Temperature Measurements:Summary of Body Temperature Sites, Advantages and Disadvantages, and Equipment Used

16. Pulse • Rate • Rhythm • Strength

17. Table 2-1. Average Range for Vital Signs According to Age Group.

18. Figure 2-2. The nine common pulse sites.

19. Box 2-3 Scale to Rate Pulse Quality 0: Absent or no pulse 1+: Weak, thready, easily obliterated with pressure; difficult to feel 2+: Pulse difficult to palpate; may be obliterated by strong pressure 3+: Normal pulse 4+: Bounding, easily palpated, and difficult to obliterate

20. Respiration

21. Table 2-1. Average Range for Vital Signs According to Age Group.

22. Common Breathing Patterns

23. Eupnea.Normal range and rhythm; 12 to 20 breaths/min in regular rhythm and of moderate depth for an adult. Volume Time (15 seconds)

24. Bradypnea. Regular rhythm of fewer than 12 breaths/min. Volume Time (15 seconds)

25. Tachypnea.Regular rhythm of more than 20 breaths/min for an adult. Volume Time (15 seconds)

26. Apnea. Absence of breathing that leads to respiratory arrest and death. Volume Apnea Time (15 seconds)

27. Hypoventilation. Decreased rate and depth, decreasing alveolar ventilation and leading to an increased PaCO2. Volume Time (15 seconds)

28. Hyperventilation. Increased rate and depth, which increases alveolar ventilation and leads to a decreased PaCO2. Volume Time (15 seconds)

29. Cheyne-Stokes. Respirations become faster and deeper, then slower and shallower with a period of apnea. Apnea Volume Time (15 seconds)

30. Kussmaul’s.Increased rate and depth of breathing. Usually associated with diabetic ketoacidosis as a compensatory mechanism to eliminate excess carbon dioxide. Volume Time (15 seconds)

31. Biot’s.Fast, deep respirations with abrupt pauses. Apnea Volume Time (15 seconds)

32. Blood Pressure

33. Table 2-1. Average Range for Vital Signs According to Age Group.

34. Blood Pressure • The arterial blood pressure is the force exerted by the circulating volume of blood on the walls of the arteries • Systolic blood pressure • Diastolic blood pressure

35. Blood Pressure (Cont’d) • Function of: • Blood flow generated by ventricular contraction • Resistance to blood flow by the vascular system • BP = V × R .

36. Blood Flow • Blood flow is equal to cardiac output • Cardiac output (CO) is equal to: • Volume of blood ejected from the ventricles during each heartbeat (stroke volume [SV]), multiplied by the heart rate (HR) • CO = SV × HR • Average CO is about 5 L/min .

37. Blood Flow Abnormalities • Hypertension • Blood pressure is chronically above normal • Hypotension • Blood pressure falls below 90/60 mm Hg • Orthostatic hypotension • When blood pressure quickly drops as the individual rises to an upright position or stands

38. Pulsus Paradoxus • ↓ Blood pressure during inspiration • ↑ Blood pressure during expiration

39. Oxygen Saturation • Often considered the fifth vital sign

40. Table 2-6. Spo2 and Pao2 Relationship for the Adult and Newborn

41. Table 2-7 Signs and Symptoms of Inadequate Oxygenation • Central Nervous System • Apprehension (early) • Restlessness or irritability (early) • Confusion or lethargy (early or late) • Combativeness (late) • Coma (late)

42. Table 2-7 Signs and Symptoms of Inadequate Oxygenation (Cont’d) • Respiratory • Tachypnea (early) • Dyspnea on exertion (early) • Dyspnea at rest (late) • Use of accessory muscles (late) • Intercostal retractions (late) • Takes a breath between each word or sentence (late)

43. Table 2-7 Signs and Symptoms of Inadequate Oxygenation (Cont’d) • Cardiovascular • Tachycardia (early) • Mild hypertension (early) • Arrhythmias (early or late) • Hypotension (late) • Cyanosis (late) • Skin is cool or clammy (late)

44. Table 2-7 Signs and Symptoms of Inadequate Oxygenation (Cont’d) • Other • Diaphoresis (early or late) • Decreased urinary output (early or late) • General fatigue (early or late)

45. Systematic Examination of the Chest and Lungs • Inspection • Palpation • Percussion • Auscultation

46. Lung and Chest Topography • Thoracic cage landmarks • Imaginary lines • Lung borders and fissures

47. Thoracic Cage Landmarks

48. Figure 2-3. Anatomic landmarks of the chest.

49. Imaginary Lines

50. Figure 2-4. Imaginary vertical lines on the chest.