Physical Assessment
(Part I )
PHCL 326
Vital Signs
Vital Signs
• Temperature (T)
• Blood pressure (BP)
• Pulse (P, HR, RRR)
• Respiratory rate (R)
Pain scale (“5th vital sign”)
Smoking status,
Nutritional status,
spirometry
Vital signs
• VS are useful in detecting or monitoring
medical problems.
• VS + Wt&Ht provide important screening and
diagnostic information as well as monitoring
data for assessment of short/long term
response to medication therapy.
• VS can be measured in a medical setting, at
home, at the site of a medical emergency, or
elsewhere
Temperature
• Normal range depends on route
▫ Rectal > Temporal artery > Ear > Oral > Axillary
• Where’s the best place to take a
temperature?
▫ <3 months old: rectally
▫ 3 months – 5 yrs old: rectal, temporal, ear
▫ >5 yrs old: oral, ear, temporal artery
WHAT IS A NORMAL TEMPERATURE?
• A normal temperature is 98.6 degrees
Fahrenheit (37 degrees Centigrade)
• Hypothermia is defined as a drop in body
temperature below 95° F
• Fever:
▫ Oral temp of >=38°C (100.9°F)
HOW TO TAKE TEMPERATURE
How to take an oral temperature :
 Place thermometer under tongue; use probe cover
 Wait 3 minutes if mercury thermometer, 10 seconds if electronic
 Wait 10 minutes after eating or drinking hot or cold liquids
How to take a rectal temperature :
 Use lubrication and probe cover
 Rectal temperature is 0.4-0.5 degrees C (0.7 to 0.8 degrees F) higher
than oral
Use of axillary temperature :
 Axillary temperature correlates poorly with rectal temperature
 It may be OK to do axillary reading in neonates if can't do rectal
thermometer
Blood Pressure
• Measures force of blood against artery walls
Blood Pressure
Systolic and diastolic blood pressure :
 Systolic blood pressure is the highest
pressure in the arteries, just after the heart
beats
 Diastolic blood pressure is the lowest
pressure in the arteries, just before the
heart beats
 Blood pressure is measured indirectly by
blood pressure cuff (sphygmomanometer)
Blood Pressure: Measurement
• Under external pressure, circulating blood
hits the arterial wall which results in
turbulence (Korotkoff’s sounds)
• Systolic BP: start of Korotkoff’s sounds
• Diastolic BP: point at which sounds disappear
Korotkoff’s Sounds
• Measurement of blood pressure by auscultation is based on the
sounds produced as a result of changes
1.
Phase I The pressure level at which the first faint, clear tapping sounds
are heard, which increase as the cuff is deflated (reference point for
systolic BP).
2. Phase II During cuff deflation when a murmur or swishing sounds are heard.
3. Phase III The period during which sounds are crisper and increase in
intensity.
4. Phase IV When a distinct, abrupt, muffling of sound is heard
5. Phase V The pressure level when the last sound is heard (reference point for
diastolic BP).
Blood Pressure: Measurement
Recommended Blood Pressure
Measurement Technique
• Patient should be seated and have rested for 5 minutes and have arm supported
at heart level.
• Appropriate cuff size should be used, and the bladder should nearly (at least
80%) or completely encircle arm.
• Patients should not have smoked or ingested caffeine within 30 minutes before
measurements.
• Measurements should be taken with a mercury sphygmomanometer, a recently
calibrated aneroid manometer, or a calibrated electronic device.
• Both systolic and diastolic blood pressure should be recorded.
• Korotkoff’s phase V (disappearance of sound) should be used for the diastolic
reading.
• Two or more readings, separated by 2 minutes, should be averaged, and more
taken if they differ by more than 5mmHg.
HOW A CUFF MEASURES BLOOD
PRESSURE
 Inflating cuff increases pressure until it cuts off arterial
circulation to the arm
 Deflating cuff, decrease pressure by 2 to 3 mm of mercury
per second until blood first enters the artery, creating
turbulence; this causes a sound with each heartbeat
 Sounds continue with each heartbeat until pressure lowers
to the lowest pressure in the artery; then turbulence stops,
so the sound stops
 Systolic blood pressure is the cuff pressure at the first
sounds; diastolic is the cuff pressure just before the sounds
stop
DOES YOUR PATIENT HAVE HYPERTENSION
(HIGH BLOOD PRESSURE) ?
– Normal: <120/<80
– Prehypertensive: 120-139/80-89
– Stage 1 hypertension: 140-159/90-99
– Stage 2 hypertension: >=160/>=100
http://www.nhlbi.nih.gov/guidelines/hypertension/
•
The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure.
BLOOD PRESSURE
• Blood Pressure Checklist
What is the pulse rate?
• The pulse rate is a measurement of the heart
rate, or the number of times the heart beats
per minute.(beats/min,BPM)
• The normal pulse for healthy adults ranges
from 60 to 100 beats per minute.
Pulse
• Rate
– Number of beats in 30 seconds x 2
• Strength
-The strength of the pulse is described as
“normal,” “weak,” or “bounding”
• Regularity
– Regular or irregular
How to check your pulse:
• Using the first and second fingertips, press firmly but
gently on the arteries until you feel a pulse.
• Begin counting the pulse when the clock's second
hand is on the 12.
• Count your pulse for 60 seconds (or for 15 seconds
and then multiply by four to calculate beats per
minute).
• When counting, do not watch the clock continuously,
but concentrate on the beats of the pulse.
• If unsure about your results, ask another person to
count for you.
WHERE TO FIND PULSES
 Carotid: in neck, medial to and below angle of jaw
 Radial: ventral wrist proximal to base of thumb
 Brachial: antecubital fossa, medial to biceps tendon
 Femoral: in groin, just medial to quadriceps
 Popliteal: middle of popliteal fossa; knee flexed 30
degrees
 Posterior tibial (PT): posterior to medial malleolus, in
ankle
 Dorsalis pedis (DP): dorsal foot, lateral to extensor
hallucis longus
WHY FIND PULSES?
• Peripheral vascular disease : absent or
diminished DP and PT pulses - carries risk of
ulcers, infection, amputation and other
vascular disease.
• Obtaining arterial blood for blood gas
measurement
• Finding femoral vein for emergency access
(IV line)
WHAT IS A NORMAL PULSE?
•
•
•
•
•
•
Adult: 60 to 100
Newborn: 120-170
1 year: 80-160
3 years: 80-120
6 years: 75-115
10 years: 70-110
Arterial pulse checklist
 Locate the radial pulse.
 Palpate with the fingers (not thumb).
 Report/record the per-minute rate.
(Example: The heart rate is 80 beats per
minute.)
 Report/record the strength. (Example: The
pulse is normal strength.)
 Report/record the regularity. (Example: The
pulse is regular.)
What is the Respiration Rate?
• The respiration rate is the number of breaths
a person takes per minute
( breath/min, BPM)
RESPIRATION
• How to measure: observe rise and fall of chest
• In infants, count for 60 seconds; in adults, 15 or
30 seconds
• Normal respiration:
•
Adults: 12 to 20
•
Children:
•
•
•
•
newborn 30-80
1 year 20-40
3 years 20-30
6 years 16-22
Respirations
• Rate
– Number of breaths in
30 seconds x 2
• Quality
– Character of
breathing
• Rhythm
– Regular or irregular
• Effort
– Normal or labored
• Noisy respiration
– Normal, stridor,
wheezing, snoring,
gurgling
• Depth
– Shallow or deep
26
Respiration checklist
 Unobtrusively observe the patient’s breathing.
 Report/record the rate. (Example: The
respiratory rate is 12 breaths per minute.)
 Report/record the pattern. (Example: The
respiratory pattern is normal.)
 Report/record the use of accessory muscles.
(Example: No accessory muscles used.)
Tachypnea, a fast respiratory rate (>20)
Bradypnea, a slow respiratory rate (<12
breaths/min)
Height and Body Weight
• The patient’s height and body weight are not
considered vital signs but are useful
screening and monitoring parameters and
are components of the body mass index
(BMI)
• equation:BMI(metric)=weight in kilograms÷ (height in meters)
Classification BMI
•
•
•
•
•
•
Underweight <18.5
Normal weight 18.5-24.9
Overweight 25-29.9
Class I obesity 30-34.9
Class II obesity 35-39.9
Class III obesity =40
Vital Signs
• PHYSICAL EXAMINATION FINDINGS
General: WDWN AAM in NAD sitting
comfortably on examination table;
Wt: 75 kg; Ht: 150 cm
Vital signs:
BP 154/93 mm Hg,
HR 78 beats/min (regular, normal
strength),
RR 16 breaths/min ,
T 98.6° (37°C).
Video
• http://medinfo.ufl.edu/other/opeta/vital/VS
_main.html