Vital Signs

Labskill

Introduction
Vital signs
Temperature Pulse Respirations Blood pressure

Vital Signs
Provide information about patients overall condition Taken at each visit and compared to baseline

Vital Signs: Temperature

Febrile body temperature above patients normal range
Fever sign of inflammation or infection Hyperpyrexia extremely high temperature

Afebrile normal body temperature Body temperature varies with time of day

Vital Signs: Temperature (cont.)

Tympanic Oral

Measurements

Temperature Routes Rectal Axillary

Degrees Fahrenheit (F) Degrees Celsius (centigrade; C)

Temporal

Normal adult oral temperature

98.6F 37C

Vital Signs: Temperature (cont.)

Route Normal Range F / C 98.6 F / 37.0 C Sites Mouth

Oral

Tympanic
Rectal Axillary

99.6 F / 37.6 C
99.6 F / 37.6 C 97.6 F / 36.6 C

Ear
Rectum Axilla (armpit)

Vital Signs: Pulse and Respiration

Circulatory
Pulse

Respiratory
Respirations

Pulse and respirations are related because the heart and lungs work together. Normally, an increase or decrease in one causes the same effect on the other.

Vital Signs: Pulse

Pulse number of times the heart beats in 1 minute Respiration number of times a patient breaths in 1 minute

One breath = one inhalation and one exhalation

Ratio of pulse to respirations is 4:1

Vital Signs: Pulse (cont.)

Indirect measurement of cardiac output Problems if

Sites of measurement

Tachycardia Bradycardia Weak Irregular

Adults radial artery Children brachial artery (antecubital space) Apex of heart

5th intercostal space directly below center of left clavical Apical pulse taken with a stethoscope

Vital Signs: Pulse (cont.)

Locate pulse by pressing lightly with index and middle finger pads at the pulse site Count the number of beats felt in 1 minute If regular may count beats for 30 seconds and multiply by 2

Vital signs: Pulse (cont.)

Regular Pulse Rhythm Irregular Pulse Rhythm

Count for 30 seconds, then multiply by 2 (a rate of 35 beats in 30 seconds equals a pulse rate of 70 beats/minute)

Count for one full minute May use stethoscope to listen for apical pulse and count for a full minute

Vital Signs: Pulse (cont.)

Electronic devices
Blood pressure machines Pulse oxymetry

Infrared light measures pulse and oxygen levels

Vital Signs: Respiration

Respiratory rate indication of how well the body provides oxygen to the tissues
Check by watching, listening, or feeling movement

Vital Signs: Respiration (cont.)

Normal Respiratory Rates
(26-40)
40 35 30 25 20 15 10 5 0 0-1 yrs 1-6 yrs 6-11 yrs 11-16 yrs ADULT ELDERLY

(20-30) (18-24)

(16-24)
(12-20)

(12-24)

NOTE: Ranges reflect breaths per minute

Vital Signs: Respiration (cont.)

Check respirations

Rate Rhythm regular Count with a Effort (quality) stethoscope normal, shallow, or deep NOTE: If patients are aware that you are counting respirations, they may unintentionally alter their breathing.

Look, listen, and feel for movement of air

Count for one full minute

Vital Signs: Respiration (cont.)

Irregularities indication of possible disease

Hyperventilation excessive rate and depth Dyspnea difficult or painful breathing Tachypnea rapid breathing Hyperpnea abnormally rapid or deep breathing

Vital Signs: Respiration (cont.)

Other irregularities

Rales (noisy)
Constriction or blockage of bronchial passages Pneumonia, bronchitis, asthma, or other pulmonary disease

Cheyne-Stokes respirations
Periods of increasing and decreasing depth of respiration between periods of apnea Strokes, head injuries, brain tumors, congestive heart failure

Apnea absence of breathing

Vital Signs: Blood Pressure

The force at which blood is pumped against the walls of the arteries (mmHg) Two pressure measurements

Systolic pressure measure of pressure when left ventricle contracts

Diastolic pressure
Measure of pressure when heart relaxes Minimum pressure exerted against the artery walls at all times

Vital Signs: Blood Pressure (cont.)

120/80
Systolic Pressure Diastolic Pressure

Contraction of left ventricle Top or first number

Heart at rest Bottom or second number

Classification of Hypertension (JNC-7)

BP Classification
Normal Prehypertensive Stage 1 hypertension Stage 2 hypertension

SBP mm Hg*
< 120 120139 140159 160

DBP mm Hg*
< 80 8089 9099 100

*Classification determined by higher BP category. BP indicates blood pressure; DBP, diastolic blood pressure; SBP, systolic blood pressure

Pickering TG et. al. Circulation. 2005;111:697-716

Changes in systolic and diastolic blood pressure with age.

Chobanian A V et al. Hypertension. 2003;42:1206-1252

Copyright American Heart Association, Inc. All rights reserved.

Vital Signs: Blood Pressure (cont.)

Low blood pressure Normal for some people Severely low blood pressure readings occur with:

Hypertension
High blood pressure readings Major contributor to heart attacks and strokes

Shock Heart failure Severe burns Excessive bleeding

Hypotension

Vital Signs: Blood Pressure (cont.)

Equipment

Sphygmomanometer

Types of

Inflatable cuff Pressure bulb or other device for inflating cuff Manometer

sphygmomanometers

Aneroid Electronic Mercury

Vital Signs: Blood Pressure (cont.)

Aneroid sphygmomanometers

Circular gauge for registering pressure

Each line 2 mmHg

accurate

Must be checked, serviced, and calibrated every 3 to 6 months

Vital Signs: Blood Pressure (cont.)

Electronic sphygmomanometers

Provides a digital readout of the blood pressure

No stethoscope is needed
Easy to use

Maintain equipment according to manufacturers instructions

Vital Signs: Blood Pressure (cont.)

Mercury sphygmomanometers

A column of mercury rises with an increased pressure as the cuff is inflated If in use, must be checked, serviced, and calibrated every 6 to 12 months

Vital Signs: Blood Pressure

(cont.)

Stethoscope
Amplifies body sounds Earpieces Binaurals and tubing Chestpiece

Earpieces Binaurals

Bell low-pitched sounds Diaphragm high-pitched sounds

Rubber or plastic tubing Bell Chestpiece Diaphragm

BP by Palpation
Size using guides on cuff Position on upper arm centered over brachial artery Inflate 30mmHg past pulse Deflate Record point at which pulse returns Record as Systolic/P (135/p)

BP by Auscultation
Size using guides on cuff Position on upper arm hoses pointing down Inflate 30mmHg past pulse Position stethoscope over brachial artery Deflate Note first sound and last sound Record as systolic/diastolic (140/80)

Vital Signs: Blood Pressure (cont.)

Special considerations in adults

Post exercise, ambulatory disabilities, obese, known blood pressure problems Anxiety or stress

Avoid measurement in an arm

Injury or blocked artery is present History of mastectomy on that side Implanted device is under the skin

Proper cuff size improper size results in inaccurate reading

Vital Signs: Blood Pressure (cont.)

Special considerations in children

Not routinely taken on each visit Take before other tests or procedures Cuff size important Palpatory method not used with children Heartbeat may be heard to zero; record diastolic when strong heartbeat becomes muffled

Vital Signs:
Orthostatic or Postural Hypotension

Orthostatic or postural hypotension

Blood pressure becomes low and pulse increases when the patient moves from lying to standing Indicates fluid loss or malfunction of cardiovascular system Vital signs are taken in different positions Positive tilt test increase in pulse > 10 bpm and a drop in BP > 20 mmHg