Vital SignsVital Signs“signs of life”“signs of life”

What are vital signs?What are vital signs?

**TemperatureTemperature- body temp- body temp

**Pulse RatePulse Rate- wave of blood,from - wave of blood,from contraction of heart.contraction of heart.

**Respiratory RateRespiratory Rate- number of breaths - number of breaths (respirations) per minute.(respirations) per minute.

**Blood PressureBlood Pressure- amount of pressure exerted on - amount of pressure exerted on vessel walls as blood pulsates. 2 pressures vessel walls as blood pulsates. 2 pressures

measured. measured.

Vital SignsVital Signs

Abbreviations for documenting (charting)

“T”- temperature

“P”- pulse

“R”- respirations

“BP”- blood pressure

Abbreviations for documenting (charting)

“T”- temperature

“P”- pulse

“R”- respirations

“BP”- blood pressure

TemperatureTemperature

Reading Sites:

Oral- within mouth, under tongue

Axillary- in armpit, aka axilla

Tympanic- in ear canal

Rectal- through anus, in rectum

Reading Sites:

Oral- within mouth, under tongue

Axillary- in armpit, aka axilla

Tympanic- in ear canal

Rectal- through anus, in rectum

TemperatureTemperature

Thermometer types:

Electronic- measure temperature through probe at end of device (or) infrared capture.

Glass- contains mercury which rises to appropriate level to indicate reading temperature.

Thermometer types:

Electronic- measure temperature through probe at end of device (or) infrared capture.

Glass- contains mercury which rises to appropriate level to indicate reading temperature.

TemperatureTemperature

Fahrenheit to Celsius conversion

C°= Degrees Celsius

Water freezes at 0°C

F°= Degrees Fahrenheit

Water freezes at 32°F

Fahrenheit to Celsius conversion

C°= Degrees Celsius

Water freezes at 0°C

F°= Degrees Fahrenheit

Water freezes at 32°F

TemperatureTemperature

°F to °C- Deduct 32, then multiply by 5, then divide by 9

°C to °F- Multiply by 9, then divide by 5, then add 32

°F to °C- Deduct 32, then multiply by 5, then divide by 9

°C to °F- Multiply by 9, then divide by 5, then add 32

Temp-Conversion EX.Temp-Conversion EX.

96.8°F-32*5÷9= 36°C

36°C*9÷5+32= 96.8°F

96.8°F-32*5÷9= 36°C

36°C*9÷5+32= 96.8°F

TemperatureTemperature

Normal adult temperature range considered 98.6°F

Most range from 96.8°F to 100.4°F (36.0°C to 38.0°C).

Normal adult temperature range considered 98.6°F

Most range from 96.8°F to 100.4°F (36.0°C to 38.0°C).

TemperatureTemperature

Many factors affect body temperature:

Exposure to (heat/cold)

Time of day- normally cooler in AM

Illness, Stress, Allergic Reaction,etc.

Many factors affect body temperature:

Exposure to (heat/cold)

Time of day- normally cooler in AM

Illness, Stress, Allergic Reaction,etc.

TemperatureTemperature

When temperature is above 100.4F (38.0C), the patient is febrile- “with fever”.

When temperature is within normal range (96.8F to 100.4) the patient is afebrile- “without fever”

When temperature is above 100.4F (38.0C), the patient is febrile- “with fever”.

When temperature is within normal range (96.8F to 100.4) the patient is afebrile- “without fever”

Pulse RatePulse Rate

Pulse- wave of blood flow created by contraction of the heart

Pulse Rate- number of times the heart beats in one minute (60 seconds).

BPM-beats per minute

Pulse- wave of blood flow created by contraction of the heart

Pulse Rate- number of times the heart beats in one minute (60 seconds).

BPM-beats per minute

Pulse SitesPulse Sites

TextText

*Table 9-1 on page 326*Table 9-1 on page 326

Pulse SitesPulse Sites

TemporalTemporal-side of head-side of headCarotidCarotid-neck-neckApicalApical-just below left nipple (listen)-just below left nipple (listen)BrachialBrachial-inside elbow-inside elbowRadialRadial-wrist-wristFemoralFemoral-groin-groinPoplitealPopliteal- behind knee- behind kneePedalPedal-top of foot-top of foot

Pulse RhythmPulse Rhythm

Pulse Rhythm- should be regular, “evenly paced”. Can be irregular- “dysrhythmia”

If irregular, pulse should always be counted entire minute for average pulse rate.

Irregular heart (pulse) rate is sometimes normal condition in infants, through young adulthood.

Pulse Rhythm- should be regular, “evenly paced”. Can be irregular- “dysrhythmia”

If irregular, pulse should always be counted entire minute for average pulse rate.

Irregular heart (pulse) rate is sometimes normal condition in infants, through young adulthood.

Pulse- Bilateral?Pulse- Bilateral?

Bilateral- “both sides”

pulses should be found “equal bilaterally”

If found only on one side of body at a pulse point it is referred to as “unilateral”.

Bilateral- “both sides”

pulses should be found “equal bilaterally”

If found only on one side of body at a pulse point it is referred to as “unilateral”.

Pulse Volume“Strength of Pulse”

Pulse Volume“Strength of Pulse”

Measure of the force against the arterial wall and your fingertips as you palpate.

See Chart on next slide

Described often as:

Absent, Thready/Weak, Strong/Normal, Bounding/Full

Measure of the force against the arterial wall and your fingertips as you palpate.

See Chart on next slide

Described often as:

Absent, Thready/Weak, Strong/Normal, Bounding/Full

Pulse Volume“Chart”

Pulse Volume“Chart”

0 Absent, Unable to detect

1 Thready/Weak, difficult to palpate; easy to obliterate

2 Strong/Normal, easily found; obliterated by pressure

3 Bounding/Full, difficult to obliterate with fingertips

PulsePulse

Normal Pulse Ranges:

Newborn 120-160

1 month to 1 year 80-140

1-6 years 80-120

6 to adolescence 75-110

Adulthood 72-80

Late Adult 60-80

Normal Pulse Ranges:

Newborn 120-160

1 month to 1 year 80-140

1-6 years 80-120

6 to adolescence 75-110

Adulthood 72-80

Late Adult 60-80

Table 9-2 p.327Table 9-2 p.327

Pulse Rates“outside of normal range”Pulse Rates

“outside of normal range”

Lower than normal= Bradycardia

Higher than normal= Tachycardia

Lower than normal= Bradycardia

Higher than normal= Tachycardia

Pulse Rates“Factors that affect pulse rate”

Pulse Rates“Factors that affect pulse rate”

Age-slows with age

Sex- women tend to have faster rates

Level of fitness

Physical/mental stress-elevates

Lack of Oxygen or low BP-elevates

Medications/Alcohol

Age-slows with age

Sex- women tend to have faster rates

Level of fitness

Physical/mental stress-elevates

Lack of Oxygen or low BP-elevates

Medications/Alcohol

Respiratory RateRespiratory Rate

Respiration (ventilation):the act or process of inhaling and exhaling; breathing. Also called ventilation.

Respiration (ventilation):the act or process of inhaling and exhaling; breathing. Also called ventilation.

Respiratory RateRespiratory Rate

Like the pulse rate, the normal respiratory rate decreases as a person becomes older.

Apnea-absent respirations

Like the pulse rate, the normal respiratory rate decreases as a person becomes older.

Apnea-absent respirations

Respiratory Rates “Ranges (per minute) by Age”

Respiratory Rates “Ranges (per minute) by Age”

Infant 30-60

Toddler 24-40

Preschool 22-34

Shool-aged 18-30

Adolescent/Adult 12-20

Infant 30-60

Toddler 24-40

Preschool 22-34

Shool-aged 18-30

Adolescent/Adult 12-20

Respiratory“Observing chest movement”

Respiratory“Observing chest movement”

Adults and Older Children- chest movement outward/upward in.

Under 7 years old- use combined chest and abdominal breathing.

Abdominal breathing in adults= sign of difficulty breathing (dyspnea)

Adults and Older Children- chest movement outward/upward in.

Under 7 years old- use combined chest and abdominal breathing.

Abdominal breathing in adults= sign of difficulty breathing (dyspnea)

Respiratory Rate“Assessing”

Respiratory Rate“Assessing”

Most common- observe chest movement for one minute

Auscultation- with stethoscope on chest wall. Best in infants whose rate is difficult to observe and adults who may be aware you are observing.

*warm stethoscope in hands

Most common- observe chest movement for one minute

Auscultation- with stethoscope on chest wall. Best in infants whose rate is difficult to observe and adults who may be aware you are observing.

*warm stethoscope in hands

Respiratory Rate Respiratory Rate

Hyperventilation- increase in respiratory rate; beyond normal range.

Causes: Physical/mental stress, fever (pyrexia), lack of oxygen, low blood pressure.

Hyperventilation- increase in respiratory rate; beyond normal range.

Causes: Physical/mental stress, fever (pyrexia), lack of oxygen, low blood pressure.

Respiratory Rate Respiratory Rate

Hypoventilation- decrease in respiratory rate; below normal range.

Causes: Pain Meds, Alcohol, Hypothermia, severe lack of oxygen, No blood pressure

Hypoventilation- decrease in respiratory rate; below normal range.

Causes: Pain Meds, Alcohol, Hypothermia, severe lack of oxygen, No blood pressure

Respiration Rhythm Respiration Rhythm

Respirations should be regular (evenly spaced).Respirations should be regular (evenly spaced).

Respiration QualityRespiration Quality

Volume and effort of each respiration should be comparable throughout the observation.

Dyspnea- labored/difficult breathing; accessory muscle use seen in neck,chest, and abdomen

Volume and effort of each respiration should be comparable throughout the observation.

Dyspnea- labored/difficult breathing; accessory muscle use seen in neck,chest, and abdomen

Blood PressureBlood Pressure

BP-measurement of the pressure exerted on the arterial walls as blood pulsates. Two pressures are measured.(Systolic and Diastolic)

BP is measured in mmhg= millimeters of mercury

BP-measurement of the pressure exerted on the arterial walls as blood pulsates. Two pressures are measured.(Systolic and Diastolic)

BP is measured in mmhg= millimeters of mercury

Blood PressureBlood Pressure

Systolic Blood Pressure (SBP)- pressure exerted on arterial walls during contraction phase of the heart .

highest pressure

120/70 - Systolic is 120 mmhg

Systolic Blood Pressure (SBP)- pressure exerted on arterial walls during contraction phase of the heart .

highest pressure

120/70 - Systolic is 120 mmhg

Blood Pressure Blood Pressure

Diastolic Blood Pressure- the resting pressure on arteries as heart “relaxes” between contractions.

120/70 - Diastolic is 70 mmhg

Diastolic Blood Pressure- the resting pressure on arteries as heart “relaxes” between contractions.

120/70 - Diastolic is 70 mmhg

Blood Pressure“Normal Ranges”

Blood Pressure“Normal Ranges”

Systolic range= 100-140 mmhg

Diastolic range= 60-90 mmhg

Systolic range= 100-140 mmhg

Diastolic range= 60-90 mmhg

Blood PressureBlood Pressure

Hypotension- When blood pressure drops below the normal range.

Hypertension- when blood pressure is higher than the normal range.

Hypotension- When blood pressure drops below the normal range.

Hypertension- when blood pressure is higher than the normal range.

Blood Pressure “Hypotension”

Blood Pressure “Hypotension”

When a patient is hypotensive (low BP) the body tries different methods to raise the blood pressure. This causes some signs of shock (lack of blood flow to tissues):

Change in level of consciousness

Increased heart rate/respirations

Weak, thready pulses

Pale, sweaty skin

When a patient is hypotensive (low BP) the body tries different methods to raise the blood pressure. This causes some signs of shock (lack of blood flow to tissues):

Change in level of consciousness

Increased heart rate/respirations

Weak, thready pulses

Pale, sweaty skin

Blood Pressure“Hypertension”

Blood Pressure“Hypertension”

Hypertension is largely “symptomless”

With severe hypertension (180+ systolic/110+ diastolic) a patient may exhibit some of the following:

Headache

Severe anxiety

Shortness of breath

Nosebleed

Hypertension is largely “symptomless”

With severe hypertension (180+ systolic/110+ diastolic) a patient may exhibit some of the following:

Headache

Severe anxiety

Shortness of breath

Nosebleed

Blood Pressure“most convenient sites”

Blood Pressure“most convenient sites”

Brachial- upper arm; most common in adults and older children.

Radial- lower arm; infants/patients with very large upper arms.

Popliteal- thigh; alternative to arms because of disease/trauma/medical treatments to arms/mastectomies

Dorsalis Pedis- lower leg; common site for infants when using electronic cuff.

Brachial- upper arm; most common in adults and older children.

Radial- lower arm; infants/patients with very large upper arms.

Popliteal- thigh; alternative to arms because of disease/trauma/medical treatments to arms/mastectomies

Dorsalis Pedis- lower leg; common site for infants when using electronic cuff.

Blood PressureBlood Pressure

Sphygmo-man-o-meter

Sphygmo= pulse

man= pressure

meter= measure

“measuring pulse pressure”

Sphygmo-man-o-meter

Sphygmo= pulse

man= pressure

meter= measure

“measuring pulse pressure”

Blood Pressure“Types of Sphygmomanometers”Blood Pressure

“Types of Sphygmomanometers”

Mercury-calibrated glass cylinder containing mercury

Aneroid- calibrated dial with needle that points to numbers

Electronic- digital display, no stethoscope required

Mercury-calibrated glass cylinder containing mercury

Aneroid- calibrated dial with needle that points to numbers

Electronic- digital display, no stethoscope required

Blood Pressure“Palpated BP?”

Blood Pressure“Palpated BP?”

It is possible to obtain the Systolic (top #) pressure with only a BP cuff.

Continuously palpate the radial pulse point, inflate the cuff until the pulse is obliterated and then +10-20 mmhg.

Deflate the cuff slowly, the number on the dial when you first feel the pulse again represents the systolic pressure

It is possible to obtain the Systolic (top #) pressure with only a BP cuff.

Continuously palpate the radial pulse point, inflate the cuff until the pulse is obliterated and then +10-20 mmhg.

Deflate the cuff slowly, the number on the dial when you first feel the pulse again represents the systolic pressure