Vital SignsVital SignsVital SignsVital 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

1. Temperature

2. Pulse

3. Respiration

4. Blood Pressure

• Currently, Pain considered the 5th Vital Sign

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

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:1. Near hypothalamus (body’s temp regulator)

2. Not relying on contact, but on heat radiation

• Temporal Artery Temperature Scanner– Currently considered most accurate

PULSEdef: beat of heart as felt through wall of artery

• Characteristics :1. rate = frequency = beats per minute2. 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 fibrillationKey = 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 Ratesgenerally faster in women ( versus men) & short stature ( versus tall)BIRTH ----------------------- 120 - 160 beats/ minuteINFANTS ------------------- 110 - 130 CHILD (till age 7)----------- 80 - 110CHILD (after age 7) --------- 80 - 90ADULT ---------------------- 60 - 80

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

Respiration

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 per minute

infants ----------------- 30 - 40

children --------------- 20 - 30

adults ------------------ 14 - 20

Respiration• characteristics:

rate = number per minuterhythm = regular or irregulardepth = deep or shallow

• sounds :rales = any abnormal sound ; moist or dryronchi = like snoring; rattle in throatstridor = high pitched sound on inspirationstertor = snoring soundwheeze = high pitched whistling on expirationfriction rub = rubbing leather or sandpapergurgle = low pitched sound on expiration

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

BLOOD PRESSURE systolic = heart contraction phase

diastolic = heart relaxation phase

• diastolic pressure more important than systolicreasons: 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 - - - 60/30child -------- 100/60adult - - ----- 120/80 (adult = everyone over age 6)

140/90 = upper limit of normal

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 Vsounds 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

BLOOD PRESSURE

Causes of Hypertension Causes 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

- smoking those with no incr in CSF pres

- organ disease - diseases Renal, Heart, Liver adrenal insufficiency

- pain hypothyroidism

- diseases cancer

hyperthyroidism - sleep acromegaly

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