March 24, 2010

With Your Group, answer the following questions.1. What areas of development do you feel were most affected in the main character in the movie Martian Child?Give examples supporting your answers2. What milestones do you feel were not met? 3. What do you feel led to his developmental delays? ExplainWhy are Vital Signs essential for health care providers? (what do they help determine?)December 21, 2011Vital Signs

Define the following words.(without your books!!!!!)Work with a partner to check your knowledge before we proceed. How do you think the following groups of terms relate and what do they mean?

Apical, Radial, Brachial, antecubital, stethoscope, intercostal space

Tympanic, Axillary, Rectal, Oral

What are they?Vital signs: the most important measurements obtained for evaluating/assessing a clients conditionTemperature, Blood Pressure, Pulse, Respirations are indicators of patient statusAny drastic change can lead to DEATHThey are vital to life, hence the term VITAL SIGNS

Temperature (T)Normal Adult Temp= 98.6 degrees Fahrenheit/ 37 degrees Celsius Usual range 96.8 F to 100.4 F or 36 C to 38 CVariables that affect temp:Time of day (lower in morning)Allergic reactionIllnessStressExposure to heat/cold

Where can you find it????Oral: in the mouth or under the tongueAxillary: armpit (axilla)Tympanic: ear canalRectal: through the anus, in the rectumAlternative methods: surface of skin, through the bloodTypes of Thermometers2 Types: electronic & glassElectronic versions measure temp through a probe at the end of the thermometerEx: Tympanic ThermometersProbe covers are used to prevent contaminationGlass versions contain mercury which rises until it matches the temperatureRound tip for rectal temp (decreased risk of injury)Long tip- oral temp (more surface area)Security tip thin, short tip for oral and rectal assessmentsHandles are color coded for infection control

1/2/2012Why are vital signs abbreviated?PULSE (P)

A wave of blood flow created by heart contractionsYou can palpate (feel) with 2 fingers or auscultate (listen for sounds) using a stethoscope or machineProvides information about pulse rate and blood flow from left Ventricle to the assessment artery and its feedsPulse Sites: named according to nearby bones/structuresMost common: Radial, brachial, apical

Most common..

Radial: best palpated on the inside of the wrist (thumb side). Do not use your thumb!Brachial: adults- antecubital space of the arm (bend of elbow); children- middle of the inside of upper armApical: auscultated with stethoscope on chest wallFound at apex of heart, to the left of sternum, under the 5th/6th intercostal spaceUsed on infants and young children or adults prior to administering drugs, or for apical-radial deficit

Evaluating 4 Characteristics:1. Pulse Rate: assess beats per minute, BPM/ bpm, counted for 15, 20, 30, 0r 60 secondsNormal ranges vary according to age & genderPulse rate decreases with age, WHY? Women tend to have faster rates then menFitness levels significantly affect rates as do illness or diseaseTachycardia is a faster than normal pulse rate Caused by physical/mental stress, lack of oxygen (infection, pain, exercise, emotional stress of crying infant)Bradycardia is a slower than normal pulse rateCaused by physically fit athletes, heart meds, lack of Oxygen or BP

Evaluating 4 Characteristics:2. Pulse Rhythm: pattern of heartbeats which should be regular and evenly pacedArrhythmia and dysrhythmia- irregular heartbeat Must count pulse for full minute and averageDocument as irregularCaused by dysfunction, medications, lack of oxygenMay be normal for infants up until young adulthood3. Pulse Volume: strength of the pulse, measurement of the pulse as it presses against the arterial wall and fingertips during palpatation

Evaluating 4 Characteristics:Described as:0 Absent, unable to detectThready or weak, difficult to palpate and easily obliterated by light pressure from fingertipsStrong or normal, easily found and obliterated by strong pressure from fingertipsBounding or full, difficult to obliterate with fingertipsThready may indicate decreased circulation due to obstruction, low BP, or weak heart contractionsBounding may indicate high BP or strong heart contractions

Evaluating 4 Characteristics:4. Bilateral Presence: should be found on both sides of the body and have the same rate, rhythm, and volume. If found only on one side, document as unilateral

ActivitiesPulse Sites Worksheet

ActivitiesRead pages 334-336Demonstrate procedure for taking Oral TempWith a partner complete the activityUse pages 334-339 as a guidelineWhile waiting for your turn, complete the packet on confidentiality and ethics. Answer questions on 1 separate sheet of paper with both of your names : )Match connections on T Conversion

1/3/2012 List 3 things that affect ones pulse.ActivitiesRead pages 334-336Demonstrate procedure for taking Oral TempWith a partner complete the activityUse pages 334-339 as a guidelineWhile waiting for your turn, complete the packet on confidentiality and ethics. Answer questions on 1 separate sheet of paper with both of your names : )Match connections on T Conversion

Case Study1.) Summarize the issue of concern2.) What is your legal obligation as a medical professional?3.) What would you do?4.) Would it be difficult for you to do this? (for example, would you wish you could do something differently but realize you cannot legally?)1/4/2012What should you do prior to checking for vital signs? (many things)Finish Case Studies

RESPIRATION (R)The act of breathing or the exchange of oxygen and carbon dioxideWhen counting, count 1 inhalation and 1 exhalation as 1 respiration or complete breathRespiratory Rate (RR)- most common assessment is to watch patients chest movement for 1 minuteCan also use a stethoscope to auscultate RRTell adults you are listening to their heart3 Characteristics of Respiration1. Rate of Respiration: # of breaths / minute (count for entire minute)Normal= 12-20 breaths / minuteRR typically decreases with size and ageIncrease in RR is called hyperventilationCaused by physical/mental stress, increase body T, lack of oxygen or low BPDecrease in RR is called hypoventilationCaused by pain meds, alcohol, decrease in body T, severe lack of oxygen, and no BP

3 Characteristics of Respiration2. Rhythm of Respiration: pattern should be regularCheyne-Stokes: abnormal respiration characterized by shallow breaths that increase to deeper breaths and then decrease to more shallow breaths. Then, apnea, or no breathing which lasts from 5-40 seconds3. Quality of Respiration: seen in volume and effortVolume: amount of air taken in and expelled out of lungs (shallow or deep)Effort: amount of work patient uses to breathe (muscle use in neck, chest, abdomen is a sign of dyspnea)

Practice TimeFind a partner of the same sexCheck their respiration rate for one minute Use the stethoscope to listen for respirationFront, backUse the stethoscope to listen for heart rate1/5/2012Which vital sign do you feel is most important to accurately determine? Why?http://www.youtube.com/watch?v=5SBRX6jq3GI

Blood Pressure (BP)BP: amount of pressure or tension exerted on the arterial walls as blood pulsates through them2 pressures are measuredSystolic BP (SBP): pressure exerted on the arteries during the contraction phase of the heartbeatHigher # because pressure should be higher in the blood vessels when the heart is contractingDiastolic BP (DBP): the resting pressure on the arteries as the heart relaxes between contractionsBP is written as a fraction and measured in mm of mercury (Hg) (ex. 120/80)

Expected BP ValuesSystolic readings between 100-140mm Hg.Diastolic readings between 60-90mm Hg. Hypertension: high BPHypotension: low BPBody tries to raise BPSigns of shock (lack of blood flow) may developChange in level of consciousnessIncrease in heart rate and respirationsWeak, thready pulse, Pale, sweaty skin

Types of sphygmomanometersMercury: calibrated glass cylinder Bottom of the miniscus, upper surface of liquid, forms point of reference as pressure risesAneroid: calibrated dial with a needle that points to numbers on the face of the dialNeedle moves as pressure changesElectronic: digital display, usually includes the pulse rate and does not require a stethoscope

BP SitesCan be obtained at any artery at a pulse siteBrachial: upper arm (most common for adult and older children)Radial: lower arm (infants or clients with very large upper arms)Popliteal: thigh, alternative to arms due to trauma, disease, medical tx to arms, mastectomyDorsalis pedis & posterior tibial; lower leg (common on infants with automatic BP cuff)

BP Equipment & StepsSphygmomanometer: sphygmo (pulse), mano (pressure), meter (measure)Instrument used to detect blood pressure (BP cuff)1. Place the cuff around extremity just above pulse site2. Place stethoscope on artery at pulse site3. Squeeze and release bulb, pushing air into the cuff to exert pressure on the artery4. Slowly release air from cuff5. Listen for sounds as mercury drops; note the number when you first hear the sounds and when you last hear sounds (or they become softer)

http://www.youtube.com/watch?v=u6saTO8_o2g

1/6/2012How does lying down affect your blood pressure and why?PLEASE TAKE A TEXTBOOK

Order of performance Always perform least invasive first! Why? Noninvasive: observation, actions that do not intrudeInvasive: invading someones personal spaceUse this order if possible:1. Respiratory rate2. Pulse3. Temperature4. Blood PressureP and T are often taken togetherIf taking rectal T, conduct last

Documenting and ReportingLook for section in chart/computer listed as VS (vital signs) or T P R BP. If recording only numbers, be sure to document in this sequence.For example: 98.6-72-16-145/69Always report findings to supervisor if:VS results fall outside of normal range for PtVS result is significantly different from a previous result recorded Complete Chapter 9 Review pg 352-353. # 1-12, 14

Whats next?Case Study 2Review for Test on MondayTHEEND