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Vital Signs

Vital Signs. Accuracy is very important Things one can do to achieve most accurate measurements Maintain a positive attitude Explain the procedure to the patient VS Temperature Pulse Respiration Blood Pressure. Currently, Pain considered the 5 th Vital Sign.

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Vital Signs

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  1. Vital Signs

  2. Accuracy is very important • Things one can do to achieve most accurate measurements • Maintain a positive attitude • Explain the procedure to the patient • VS • Temperature • Pulse • Respiration • Blood Pressure

  3. Currently, Pain considered the 5th Vital Sign

  4. TEMPERATUREBody Temperature = regulated in hypothalamus is balance between : * heat production via cell metabolism & muscle movement & * heat loss via skin (85%) , lungs , urine, & feces • Norms: • Oral = 97.6 F to 99.6 F ( avg: 98.6 F) takes 3 min • Rectal = 99.6 F takes 5 min • Axillary = 97.6 F takes 10 min • Tympanic (aural) = same as oral instantly • Diurnal variation : lowest in early morning highest in early evening • Age variation : very old & very young show 1 degree higher • Centigrade vs Fahrenheit C = (F-32 x 5/9) F = (Cx 9/5) + 32 98.6 F = 37 C

  5. Temperature TERMS • Fever = Febrile = Pyrexia ( def of fever(morbidity) = > 100.4 F ) • Afebrile = no fever • Hyperthermia = higher than normal temperature • Hypothermia = lower than normal temperature • Tympanic Thermometry = use of special instrument(Thermoscan) that takes infrared snapshot of eardrum & converts reading into Fahrenheit temp • MOST ACCURATE METHOD • Reasons: • Near hypothalamus (body’s temp regulator) • Not relying on contact, but on heat radiation

  6. Temporal Artery Temperature Scanner • Currently considered most accurate

  7. PULSEdef: beat of heart as felt through wall of artery • Characteristics : 1. rate = frequency = beats per minute 2. rhythm = time interval between each pulse noted as------ regular or irregular • If irregular do APICAL PULSE (with stethoscope) • This checks for “pulse deficit” (difference between radial & apical pulse) • Apical usually slower e.g. atrial fibrillation Key = If irregular also record apical pulse to see if pulse deficit 3. volume = refers to strength of pulsations e.g. strong, weak, feeble, etc. 4. condition of arterial wall = texture of artery normal = soft & elastic • Pulse Rates generally faster in women ( versus men) & short stature ( versus tall) BIRTH ----------------------- 120 - 160 beats/ minute INFANTS ------------------- 110 - 130 CHILD (till age 7)----------- 80 - 110 CHILD (after age 7) --------- 80 - 90 ADULT ---------------------- 60 - 80

  8. PULSE • Different Sites (see next slide) • Temporal = in front of ear • Carotid = in neck at ant edge of sternocleidomastoid • Apical =apex of heart ; fifth intercostal space at left midclavicular line • Brachial = inner aspect of bend at elbow • Radial = wrist ( thumb side) • Femoral = mid-groin • Popliteal = behind the knee • Dorsalis pedis = upper surface of foot between ankle & toes • Terms • Thready = faint, weak • Bounding = strong; usually indicates increase volume

  9. Respiration

  10. RESPIRATION • def: - external respiration = exchange of gases that occurs in lungs - internal respiration = exchange of gases that occurs in tissues • relationships: ratio of resp : pulse = 1:4 • Respiratory Rates newborn ---------------30 - 60 respirations perminute infants ----------------- 30 - 40 children --------------- 20 - 30 adults ------------------ 14 - 20

  11. Respiration • characteristics: rate = number per minute rhythm = regular or irregular depth = deep or shallow • sounds : rales = any abnormal sound ; moist or dry ronchi = like snoring; rattle in throat stridor = high pitched sound on inspiration stertor = snoring sound wheeze = high pitched whistling on expiration friction rub = rubbing leather or sandpaper gurgle = low pitched sound on expiration

  12. Respiration • Terms • apnea = no breathing • bradypnea = slow breathing • tachypnea = fast breathing • eupnea = normal breathing • dyspnea = difficulty in breathing • hyperventilation (hyperpnea) = increase rate & depth • hypoventilation (hypopnea) = decrease rate & depth • orthopnea = breathing only possible sitting or standing ( hard to breath lying FLAT) • Cheyne - Stokes respiration = gradual decrease; then apnea ; then gradual increase; then apnea ---in coma, brain dysfunction, terminal

  13. BLOOD PRESSUREsystolic = heart contraction phasediastolic = heart relaxation phase • diastolic pressure more important than systolic reasons: 1. it indicates the pressure to which the blood vessel walls are constantly subjected & their “elastic rebound” 2. it reflects peripheral resistance e.g. if patient has sclerosed walls both the peripheral resistance & diastolic are increased • PULSE PRESSURE = difference between systolic & diastolic • normal = 40 • excessive (> 50) due to: anxiety , aortic insufficiency, arteriosclerosis, etc. • MAP = mean arterial pressure • Used when recording a single number as BP • MAP = diastolic pressure + pulse pressure/ 3 • Standards: newborn - - - 60/30 child -------- 100/60 adult - - ----- 120/80 (adult = everyone over age 6) 140/90 = upper limit of normal

  14. BLOOD PRESSURE • Korotkoff Sounds = sounds heard when taking BP • Phase I first heard; faint; systolic • Phase II swishing quality • Phase III sounds become crisper & louder • Phase IV sound become muffled; fainter • Phase V sounds disappear; diastolic • Terms • Benign Hypertension = slow onset; without symptoms • Essential (Primary) Hypertension = idiopathic; no obvious cause;most common • Malignant Hypertension = rapid onset; ominous course • Secondary Hypertension = when cause is known • Orthostatic (Postural) Hypotension = when change position (flat- to- sit /stand) • Toxemia of Pregnancy = pre-eclampsia; eclampsia

  15. BLOOD PRESSURE Causes of HypertensionCauses of Hypotension - “highs” = exercise, stress, anxiety -cardiac failure - rigid blood vessels - decrease volume = hemorrhage - increase peripheral resistance - shock - increase weight = increased pressure - dehydration on CV system - nervous system diseases = only - smokingthose with no incr in CSF pres - organ disease - diseases Renal, Heart, Liver adrenal insufficiency - pain hypothyroidism - diseases cancer hyperthyroidism - sleep acromegaly

  16. BLOOD PRESSURE • Sphygmomanometer • mercury • aneroid • wide cuff for the obese; pediatric cuff for children • Parts: pressure indicator, cuff, inflation bulb, pressure control valve • Auscultation method & palpation method • Hypertension is the leading cause of morbidity & mortality in the United States for men and women !!! • Classify the degree of hypertension ( based on diastolic) • mild - - - - 90 to 100 • moderate ----100 to 110 • severe ------- > 110

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