Vital Signs
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Vital Signs body bo dy brea eath ea thingg th temperature breathing te Vital Signs pul p ulse ul se pulse bloo blood ood oo d pressure pr University Univ iver iv ersi er sity si ty of of Pécs Pécs Faculty of Health Hea H ealt ea lth lt h Sciences Scie Sc ienc ie nces nc es Institute of Nursing Nur N ursi ur sing si ng Scie Sciences, ienc ie nces nc es, Basic Health Science es Sciences cess and He ce Heal Health alth al th Visiting Visit itin it ingg in András Oláh Dr. An Andr drás dr ás O Olá láh lá h1, Noémi Noém émii Fullér ém ér2, Gy Gyula Szebeni-Kovács Szebeni-Ková vács vá cs3, Zsuzsann Zsuzsanna nnaa Ge nn Germ Germán rmán án3, 3 Szilvia Szunomár 1 associate e professor, pro pro rofessor, vice dean, head of the departm department tmen tm entt deputy head of the department nt 3 subject teacher 2 assistant t professor, pro pro rofe fessor, fe 2 Body B ody temperature Body B ody ttemperature emperature - Hypotermia Hypoterrmia Body temperature temperature • Body • C auses/Risk ffactors actors Causes/Risk Core temperature temperature – Core – Surface Surface ttemperature emperature –h homeless water, omelesss person, person, rescued d ffrom rom wate er, aalcohol, lcoho ol, aantidepressants, ntidepressants, infants, eelderly lderly fecting body body temp perature • Factors aff affecting temperature • Artificial h ypothermia hypothermia (outer temperature, temp mper mp erat er atur at ure, metabolic ur met etab et abol ab olic activity, physical ac ol acti activity, tivity, infe infections, fect fe ctions, use ct us of personal persona nall protectors) pro pro rote tect te ctors) ct levels: • Depth Depth level ls: • Heat Heat p production roducction • Exothermis Exo othermis process • Thermostatic Therrmostatic control –M Mild: ild: 33 C-35 C-3 35 C –M Moderate: oderate: 28 C-32 C – Se Severe: evere: <28 C 3 4 Body B ody ttemperature emperature - Hypoter Hypotermia rmia Temperature Temp Te mper mp erat er atur at ure ur e 36 qqC C 35 qqC C 34 qC intranasal int tranasal cooling coo oling ssystem ystem 33-31 1 qC qC C 30-28 qC 27-25 qC 17 qC Body B ody temperature temperature - Hypotermia Hypoterrmia Symp Symptoms mpto mp toms to ms Normal Norm No rmal temperature rm Peripheral vasoconstriction,shivering, speech Peri Pe ripheral vasoco ri cons co nstr ns tric tr iction,shi ic hive hi vering, sp ve spee eech ee hyperreflexia disturbances, hype di perr pe rref rr efle ef lexi le xia xi The patient pati pa tien ti ent is stilll con en cconscious,burdensome onsc on scious sc us,b us ,burdensome ,b movements, abnormalities move mo veme ve ment me nts, nt s, ECG abn bnor bn orma or malililities mayy occur. ma o The Jwave ca wa can n be b found at the me meeting point poin intt of in o thee QRS QRS comple co lexx and le and ST-segment SSTT-segment Tcomplex Retrograde Retr Re trograde tr de amnesia, shivering ng ceases ce rigidity, Unconsciousness, muscle rig igid idit id ity, it y, bradpnoea, bradp dpno dp noea no ea, ea bradycardia which increases, s, J-wave J-wav avee amplitude av amp amp mplililitude ventric No reflexes can be induced, vven entr en tric tr ic fibrillation fibr fi brilililla br lati la tion ti on Isoelectric ECG 6 Body B ody temperature temperature - Hypotermia Hypoterrmia TTreatment reatment • Active Active aand nd dp assive techni iques passive techniques TTreatment reatment passive • Active Active and a nd p assive techniques tech hniqu ues Application Application of liquid or ai air ir circulating circulating heating heating blankets Heated blankets blanketts Heated infusion about in nfusion (heated (h heated to ab bout 38°C) 38°C) Makking the the patient paatieent inhale heated ox xygen Making oxygen Mediastinal Mediasttinal or peritoneal peritoneal lavage with witth fluid fluid The and The lavage lavagee of of the urinary uriinary bladder an nd the the stomach stom macch with with heated d solutions solutions Warm water enema – Warm – Heating Heating through extracorporal circu circulation ulatio on – Haemodialysis – – – – – – – Inc Increasing creasing the temperature temperatu ure of th the he outer ou uter environment environm ment Covering patient best bee use used) – Cov vering the p atient ((wool wool is the b est to b ed) Applying blankets sheets –A pplyingg preheated preheaated b lankets and sh heets body – TThese hese methods metthods are applied on thee whole whole b ody Head –H ead should be covered 7 8 Body B ody temperature temperature - Hypotermia Hypoterrmia Body B ody ttemperatureemperature- Hyperthermia Hypertheermia • If temperature temp te mper mp erat er atur at uree falls ur fal fal alls below 25 C malignant malign gnan gn antt arrythmia an a hm arrythm hmia ia deve de velo ve lops lo ps develops Deegrees: Degrees: • M Mild: heat ild: h eat ffatigue, atigue, heat syncope, syyncope, heat heaat eexhaustion, xhaaustion, sunstroke sun nstroke strroke (body (body tem mperature above 40°C) • Severe: heat stroke temperature • Prevention Prev Pr even ev enti en tion ti on is importa tant nt important • Intensivee monitoring mon mon onit itor it orin or ingg in Causes development Causees of of iits ts d evelop pment • H Heat stagnation eat st taggnatiion • Incr Increased reased metabolic activity • Decre Decreased eased heat dissipation • Ambulance Ambu Am bula bu lance la below therapy, vasoactive • Temperature Temp Te mper mp erature bel er elow el ow 30°C defibrillation the hera he rapy, vaso ra soac so acti ac tive ti ve and d an antiarrythmic medications are not ef effect ctivee -> ct -> in incr crea cr ease effective increase body dy ttem temperature emperature em 10 9 Body B ody ttemperatureemperature- Hyperthermia Hypertheermia Body B ody ttemperatureemperature- Hyperthermia Hypertheermia Symptoms: Symp Sy mpto mp toms to ms:: ms • Se Sens nsee of ns of weakness weak we akne ak ness ne Sense • Co Cool ol and and we wett ski sskin kin • Ra Rapi pid pi d we weak ak pulse Rapid • Dizziness • Paleness • Spasm m in in lim llimbs imbs im bs • Ab Abdo domi do minall cra mi ccramp ramp ra mp Abdominal • Na Nausea ea • Co Coor ordi or dination di di disorders Coordination Sweating • Swea eati ea ting ti • Ri Risk sk gr grou groups oups ou ps Treatment Trea Tr eatm ea tmen tm entt en • Im Imme medi me diat di atee heat at h withd hdra hd rawal ra Immediate withdrawal • Cooling • Treatmentt of of associated asso as soci so ciat ci ated at ed hypotoni niaa ni hypotonia substitution • Fluid su subs bsti bs titu ti tution tu • Pr Prev even ev enti en tion ti Prevention Protection • Pr Prot otec ot ection ec on from om di direct sunlight • Ap Appl plyi pl ying yi ng ventilat ators or air-conditioners at Applying ventilators Forced • Forc rced rc ed fluid intake 11 12 Body B ody ttemperatureemperature- Hyperthermia Hypertheermia Body B ody ttemperatureemperature- Hyperthermia Hypertheermia TThe he ccauses auses of of fever fever can be: Bacterial • B acterial iinfection nfection • V Viral iral infection infection • Parasitic in nfection n infection off u unknown origin • Feverr o nkno own or rigin • M alignantt hyperthemia: hyperrthemia: Malignant TThe he degrees degrees o off fever are: • ssubfebrility: ubfebrility: 37,5qC -38 8 qC C • febrility: febriility: 38qC -39 -39 qC • pyrexia: 3 9qC -4 40 qC qC 39qC -40 • hy hyperpyrexia: yperpyrrexia: >>40 40 qqC C – potentially potentiallyy fatal, fatal, rapidly developin developing ng febrile condition associated with musclee sti iffnesss, condition stiffness, taachycardia, acidosis tachycardia, 13 14 Body B ody ttemperatureemperature- Hyperthermia Hypertheermia B Body ody ttemperature emperature - measurement measurem ment FFever ever of of Unknown Unknown Origin - FU FUO UO • body body ttemperature emperature is over ovver 3 38.3 8.3 C for for at lleast east 3 weeks weeks • cause is nott detected detected even eveen aafter fter a week-long medicaal check-up checkk-u up medical core co ore temperature temperature • • • • –n nosocomial osocom mial – neu utropeenic neutropenic HIV –H IV – iinduced nduced by medicaments tymp tympanic mpan mp anic an ic nasopharyngeal pulmonaryy art aartery rter rt eryy er oesoph phag ph agus ag us oesophagus • axil illa lary la axillary • • • • 15 ssurface urfacce ttemperature emp perature rectal re oral urinaryy bladder b temporal tempor oral artery 16 Body B ody ttemperatureemperature- Hyperthermia Hypertherrmia Types of thermometers Contact Cont Co ntac nt actt thermometers: ac therm the rmom rm omet om eters: et – – – – – – Glas Gl asss mercurial as mer mer ercu curi cu rial ri al Glass Nonmercurial Nonm No nmer nm ercu er curi cu rial ri al glass gl Digital thermometers Digi Di gita gi tall th ta ther ermometers er Liquid crystals Thermistor Thermo moco mo coup co uple up Thermocouple 18 17 Body B ody ttemperature emperature - measurement measurem ment TTypes ypes of thermo thermometers ometers distance distance thermometer: thermometer: Hyperthermia Reduction off ffever Reduction no eve er – TTympanic ympanic – Infrared d camera camera medicaments medi dica di camentss ca Diiagnostics: Diagnostics: Haemoculture • H aemocultu ure physical al cooling cool co olin ol ingg in NSAID – non NS n non-steroid on-steroid on id anti inflamator in orry or ry drugs dr inflamatorry 19 20 Body B ody ttemperatureemperature- Hyperthermia Hypertherrmia Body B ody ttemperatureemperature- Hyperthermia Hypertheermia reducttion o fever reduction off fever • useful? useful? • fever fever loses loses its its positive ef ffect >>40 40 C effect Fever rreduction: eduction: Fever • caring caring ffor or a ffebrile ebrile patie patient ent • continuous co ontinuous monit toring monitoring • vital paramet ters parameters • state o off skin, skin, the th he d degree egree of perspiration, perspiiration, temperature teemperatture • increasing increaasing o xygen provision oxygen balance • fluid-ion flu uid-ion supplementation-fluid ba alaance • increasing incrreasing sense of comfort multiorgan – ttissue issue and and brain damage, m ultiorgan failures faailu ures may develop • the bodyy temperature temperature is being beiing raised raiised by by 1 C increa ases the the heart heeart frequency freequency by 1 0/min increases 10/min • iin n ccase ase of cchildren hildren n iitt rraises aises breath hingg ffrequency requency breathing b 2.5/min, iin n case of adults is 5-6 6/m min byy 2.5/min, 5-6/min • febr rile seizures febrile • febrile phobia 21 Body B ody ttemperatureemperature- Hyperthermia Hypertherrmia Physical P hysical cooling g FFever ever reduction: re eduction: • Physical Physical ffever eveer reduction reduction (redu (reducing ucing b body ody temperature until temperature u ntil 38 C): – SSponge-down ponge-down with lukewar lukewarm rm water water – Cooling bath – Water compress co ompress (full-body, (full-body, par partial) rtial) • IInvasive nvasive methods meethods ffor or reducing bod dy temperature: temperraturre: body – – – – SStomach tomach lava age lavage P eritoneal lavage Peritoneal Int travascular cooling Intravascular Intranasal cooling 22 23 Spon Sponge-down onge on ge-d ge -dow -d own with ow wit ith it h lukewarm l ew lukew ewar arm ar m water Cooling Co oolling bath h Body B ody ttemperatureemperature- Hyperthermia Hypertheermia Vital Signs FFever ever reduction: reduction: • Physical Physical fever fever reduction iin n iinfant nfant an and nd child childhood??? dhood??? body bo dy breathing eath ea thingg th temperature brea p pul pulse ulse ul se bloo ood oo d blood pressure pr • Advantages, Advantagees, d isadvantages of of physical physical ffever ever disadvantages reducction reduction • Combination Combination n of of physical and drugg fever feever reduction red ducttion 27 28 Blood pressure Daily D aily variation of BP Factors Fact Fa ctor ct orss aff or aaffecting ffec ff ecti ec ting ti ng blood bl pressure • Amount Amou Am ount ou nt of b blo blood lood lo od flow • Peripheral Peri Pe riph ri pher ph eral er al re resi sist si stence resistence • Neural, Neur Ne ural ur al, reflexive al refl re flexive and fl nd h humoral re regu regulations gula gu lations off the la th blood vessels • Age • Muscle le work work • Body Body position pos p ositio os ion io n • Pregnancy Preg Pr egna eg nanc na ncy nc • Gender Gend Ge nder nd er • Sleeping Slee eepi ee ping pi • Emotional Emot otio ot ional state-stress io 29 30 BP B P in in different posture European Euro Eu rope ro pean an Society SSoc ocie oc iety ie ty of o Hypertension and European Society ty of of Cardiology Card Ca rdio iolo io logy lo Systolic pressure Sy Dias Di astolililicc as Diastolic pres pr essu sure su re pressure (Hgmm) (H (Hgm gmm) gm m) (Hgmm) Optimal and Opti Op tima ti mall BP ma BP <120 <1 <80 31 Norm rmal rm al BP Normal 120–129 and an d 80–84 Increased-normal BP I. degree hypertonsion on degree II. degr gree gr ee hype hy pert pe rton rt onsi on sion si on hypertonsion III. I. d deg degree egree eg hypertonsion hype pert pe rton rt onsi on sion si on Isolated ed di diastolic hyperton hype hypertonsion onsi on sion si on (IDH) (I ) Isolated sy syst stolic st systolic hypertonsion (ISH) 130–139 130– 0–13 0– 139 13 9 and/or an or 85–89 140–159 140– 14 0–15 0– 159 15 9 and/or and/ an d/or d/ 90–99 90–9 90 –99 –9 9 160–17 160–179 179 17 9 and/or 100– 10 100–109 0–10 0– 109 10 9 >180 >1 and/or >110 <140 >89 ш140 <90 <9 0 32 Blood pressure Blood pressure Hypertension: Hypertension: • If If the the blood blood pressure pressure was measured measured among am mong cli clinical inical circumstances or at the GP’s GP P’s office, offfice, while whille keeping keepiing the circumstances regulations regullations of thee ssurroundings urroundin ngs of thee blood blo ood pressure measurementts, aatt least least three times tim mes and and during each measurements, occasion n tthe he b blood lo ood p pressure ressure wass mea measured asured d twice twice and d their aaverage verage equa equals alss orr it it iiss over 140Hgmm 140H Hgmm in in tterms erms o off tthe he ssystolic ystolic value value an and nd eequals quals or it is ov over verr 9 90 0 Hgmm Hgmm iin n tterms ermss o off the dyastolic dyastolic value Normal blood Norm No rmal rm al bl bloo ood d pressure pres pr essu es sure su re Increased Incr crea cr ease ea sed se d nor n normal orma or mall ma Hypertension Hypertensi sion si I. degree Preliminary Prel Pr eliminary blood pressure values el (Hgmm) (Hgm (H gmm) a. gm Syst Sy Systolic stolic st Diastolic <130 <1 30 <85 <8 5 CheckChe ck-up, ckup, fol follow-up b. Check-up, In 2 ys.. at at least least 130–139 140–159 9 85–89 85–8 85 –89 –8 9 90–99 90–9 90 –99 –9 9 Yearly at least c Yea II. degree 160–179 160–17 179 17 100–109 Examinati Examination, ation, ati on, care in one month c mon III. II I. de degr degree gree gr ee 180 18 110 Examination, Examin Exa minati ation, on, car care e in one week c within 2 months c wit a. in n case cas cas ase e of of difference di ce between betw be tween systolic and diastolic categories cate tego te gori go ries check-up ri up is recomm mmen mm ended in shorter period en recommended b. in case cas ase as e of o blood pressure value different from anamnes esis, other es othe ot herr risk ris ris iskk factor, f to facto tor, anamnesis, organ damage dam amag am age the frequency of check-up can be modified ag d c. life-style changing is recommended ite coat hypertension’ • ’whi ’white • ’masked’ hypertension 34 33 Blood pressure Blood B lood pressure pressure - measurement measurem ment hypotension: h ypotension: • the the systolic systolic blood press pressure sure d does oes n not ot exceed excceed 100Hgmm 10 00Hgmm invasive inva in vasi va sive si ve • • • • hypotension postural • orthostatic ortho ostatic hyp poten nsion or pos stural hypotension hypotensio on 35 Extravascular pressure sensor sen enso en sor so Intravascular pressuree sen ssensor enso en sor so Swan-Ganz catheter cathe hete he ter te PICCO non-invasive non-in no inva in vasi va sive si • me merc mercurial rcur rc uriall blo ur b blood lood lo od pressure measuring techni niqu ni quee qu technique • anerio iod io d metho m hod ho d aneriod method • oscillometricc met m etho et hod ho method • ABPM • Ultrasound me meth thod th od method • Pulse wave veloc ocit oc ityy method it m (PW PWV) PW V) velocity (PWV) • Blood vessel releasing rel eleasi el sing method si od (P (Pen enaz en az or (Penaz FINEPRES) • Tonemetric me meth thod th method • Pulse pressuree measure m reme re ment me nt measurement • Arterial stiffness stiffnes esss es • Electronic method 36 Blood pressure Blo Blood ood pressure pressure m measuring easuring techniques • aauscultational uscultational m ethod (Riva-Rocci,, K oro otkovv) method Korotkov) – Ko Koro rotk ro tkov tk ov vo voic ices ic es Korotkov voices • Gallavardin Gallav Gal lavard lav ardin ard in ausc aauscultational uscult usc ultational gap ethod • palpational m method – only the the sys ssystolic ysto ys tolic value to val alue al ue 37 38 Blood pressure Mercurial M ercurial b blood lood pressure me measuring easuring te technique: echnique: • „„golden golden standard” standard” • cl losed ssystem ystem closed • the pressure pressu ure p put ut o on n the m mercury ercury chang changes ges Aneroid A neroid blood blo ood pre pressure essure measurin measuring ng ttechnique: echnique: • TThe he cuff cuff a m metal etal cylinder gets pr pressed ressed tog gether or expands together 39 40 Blood pressure O scillometric m ethod: Oscillometric method: • the the m ethod is is suitable for the dir rect method direct measurement measurement of arterial mid midpressure dpressure • In In w hat ccases ases is it not su uitable? what suitable? monitors, semi-automatic • ABPM, ABPM, m onitors, aautomatic utomaatic and and sem mi-automatic pressurre d evices blood pressure devices aneroid device oscillometric device 41 Ultrasou und ttechnique: echniique:: Ultrasound • the the m ovem ment off tthe he artery wall ccan an nb movement bee percieved percieved • blood bllood flow velocity and movemen nt of of thee artery arttery movement walll cause cause changes in ultrasound wall • transmitter-receiver unit transdermally transderrmally 42 Blood pressure Pulse wave Pu ulse w ave velocity velocity measuring technique ((PWV): PWV): wave pressure • Pulse Pulse w ave velocity velocity varies with the aarterial rterial p ressu ure with decrease • Pulse Pulsee wave wave velocity veelocity increases w ith d ecrrease off cuff cu uff pressure pressure • In case case of of rise rise in blood d pressure pressu ure ttension ension in n the the wall of blood vessels incr increases reases ABPM – ambulato AB ambulatory tory to ry blood bloo bl ood oo d pre p pressure ress re ssur ss uree mon ur m monitor onit on itor it or 43 Blood vessel vesssel rrelease elease technique techniq que (Penaz orr FFinepress inepre ess method): metho od): blood • Taking Taking b lood pressure pressuree on a finger • Cuff Cu uff rreleases eleases artery arrtery transmission • Arterial Arteeriaal volume change is detected by a tra ansm missio on pletisemograph pletiseemograph 44 Blood pressure Blood pressure Tonemetric method: method: Tonemetric The p ower n ecessary for holdingg the the p ressed d su urface • The power necessary pressed surface artery on proportion with blood arteery o n bone bone is in proportio on w ith aarterial rterial b lood pressure pressure • The usually put wrist Th he sensory sensory head is is u sually p utt on on the wr rist • Electropneumatic necessary Electropneumaatic unit unit is neces ssaary for for pressing radial artery Groups G roups o off pa patients atients requiringg special special cconsideration onsideration in terms o blood pressure prressure e off blood me easurements are: measurements • Children (reliabil (reliability, bility bil ity,, reproducible, ity repr repr eproducible, IV. Koro Korotkov orotko oro tkovv sound tko so sound, und,, prefer und p sys.value, cuff size, oscillometric not) • Overw Overweight weight patients paatieentts (cu (cuff size, tight clothes) es) • A Arrhythmia rrhythmiia (no oscillometric oscillom lometric device) lom Electronic blood Ele ectronic blo ood pressure presssure technique: • Inflate automatically Inflatte cuff cuff au utomatically • Built-in defining Bu uiltt-iin microphone is used for definin ng systole systolle and and dyastole dyaastole pressure • Setting microphone above radial arte artery ery Qualification Qual lification of blood pressure de devices evicces 45 46 47 48 Blood B lood pressure pressure - measurement measurem ment Tasks before before blood blood pressure mea asuremen nt Tasks measurement Suittable cuff cuff ssize ize • Suitable od p ressure measurement meassurement Tasks during bloo blood pressure • Arm position posittion osition • Body p position • Process blood Process off b lood pressure pressure measurement measurrem mentt Tasks measurement Taskks aafter fter blood pressure measurem ment Before e the measurement – 5 min. re rest est ausculatational method palpate the systolic value 53 54 55 56 Blood pressure IInvasive nvasive techniques tech hniques (into artery, arttery, vvein) ein) • EExtravascular xtravascular pressuree sensor seenso or pressure • Intravascular p ressure sensor seensor • Swan-Ga anz ccatheter atheter Swan-Ganz PICCO • PIC CCO 57 Blood pressure 58 Vital Signs Less Less invasive invasive and and non-invasivehaemodynamic non-invasive ehaemodyn namic monitors: monitors: Continuous moni itoring off central central ven nous oxygen • Continuous monitoring venous CE-V VOX saturation- CE-VOX • Oesophageal Doppler Oesop phageal D oppler Monitoring-ODM Monitoringg-O ODM • Non-Invasive Measurement-NICO Non-IInvassive Cardiac Card diac Output Output Mea asurrement-NICO • Transthoracic Transthoraciic EEchocardiography-TTE chocardiography-TTTEE • Transoesophageal Echocardiography-TEE Traansoesophageal Echocardiograp phyy-TEEE 59 body bo dy brea eath ea thing th temperature breathing pulse puls pu lse ls e bloo ood oo d blood pressure pr 60 Pulse Pulse • b byy p palpation alpation • b nstrumental examin nation byy iinstrumental examination Agee Ag Puls Pu lse rate/min ls rat ate/ at e/mi e/ min mi n Pulse Newb Ne wborn wb Newborn 120-160 1-12 12 mon onths on months 80-140 1-2 ys 80-130 3-6 ys 75-120 7-12 ys 75-110 13 ys- adult 60-100 61 Factors Fact Fa ctor ct orss influencing or inf inf nflu luen lu enci en cing ci ng the pulse rate are: • Physical Phys Ph ysic ys ical ic al ac acti activity tivi ti vity vi ty • Age Age • Gender Gend Ge nder nd er • Hormonal Horm Ho rmon rm onal on al ef effects • Temperature • Emotionall eff eeffects ffec ff ects ec ts • Medication Medica cati ca tion ti on • Bleeding,loss Blee Bl eedi ee ding di ng,los ng osss of os of fluid d • Change Chan Ch ange ge in body dy p position factors • Pulmonrary Pulm Pu lmon lm onrary fact on ctors ct • Cardiac Card rdia rd iac factors ia • Stress ss • Stimulants: caffeine, smoking How H ow tto o count count the pulse? – irregu irregular? ular? 62 Pulse Assessing A ssessing tthe he q quality uality of pulse: pulse e: • rhythm rhythm – regular regular – irregular regu gula gu larr la • regular – bigeminy, bige bi gemi ge miny, trigeminy, mi trig tr igem ig emin em iny, in y, quadrigeminy, qua q uadrigeminy, related ua rel elated el ed extrasystole extr ex tras tr asys as ysto ys tole to le irre ir regula re lar la • irregular – – – – 63 ES respiratory arrythmia sinus arrythmia arrythmia absoluta (arrythmia perpetua) perpetu tua) tu 64 Pulse Pulse Frequency: Freq Fr eque eq uenc ue ncy: nc y: (frequens) • Frequent Freq Fr eque eq uent ue nt (f (fre requ re quen qu ens) Rare (rarus) en TThe he place place measuring measuring the puls pulse se are: are: • U pper llimb: imb: Upper Amplitude: Ampl Am plit pl itud it ude: ud e: • High High (a (alt ltus lt us)) Low (parvus) us (parv rvus rv us) us (altus) –A Axilliary xiilliary pulse ((axilliary axilliary ar artery) rtery) pulse artery) – Brachial p ulse ((brachial brachial art teryy) Radial pulse (radial – Rad dial p ulse (r radial aartery) rtery) –U lnar pulse pullse (ulna ar aartery) rtery) Ulnar (ulnar Suppressibilit ity: it y: Suppressibility: • Tightt and and full fful ulll (duru ul ((durus) rus) ru s) SSoftt and and easily sup uppr up pres pr essi es siblee (mollis) si (mo (mo mollllllis is)) is suppressible Thee pa Th pace ce of the ex expa expansion: pansion: pa • Fa Fast st (c (cel eler) Slow el ow (t (tardus) (celer) Equality ty:: ty Equality: • Equal (equalis) Unequal (inequalis) 65 66 a. u uln ulnaris lnar ln aris ar is a. axill llllar aris ar is axillaris aa.. radialis di li a. bra rachialis ra brachialis Pulse Thee place plac pl acee measuring ac mea mea easu suri su ring ri ng th the pulse are: Lower • Lo Lowe werr lim we llimb: imb: im b: – – – – Femoral Femo Fe mora mo rall pulse ra pul pul ulse se (femoral (fem (f emoral artery) Popliteal pulse (popliteal (poplite teal te al artery) arte ar tery) te pul pul ulse se )posterior )pos )p osteri os rior ri or tibial artery ry)) ry Posterior tibiall pulse artery) Dorsal pulse puls lsee (do ls ((dorsal dors do rsal pedis rs pedi diss artery) di art art rtery) aa.. po oplitea poplitea a. femoralis femoraalis 69 Pulse a. d dor dorsalis orsa or saliliss pedis sa p place measuring Thee pl plac acee mea ac m easu ea suri su ring ri ng th the pulse are: Head/neck: • He Head ad/n ad /nec /n eck: ec k: pulse – Carotid Caro Ca roti ro tid ti d pul p ulse ul se (carotid (car (c arot ar otid artery) ot – Facial Faci Fa cial ci al pulse puls pu lsee (fa ls ((facial facial artery) fa – Temporal pulse (temporal (temp mpor mp oral or al ar artery) aa.. ttibialis ibialis ibi li p posterior osteriior • Trunk: Apical (apex heart) – Ap Apic ical ic al pulse pu (ap apex ap ex of the he hear art) ar t) 72 Pulse Pulse We speak sp k of of tachcycardia tach ta chcy ch cyca cy cardia of an adult’s patient puls ca pulse lse ls e is is over over 100/min 1 Itss rea It rreasons easo ea sons so ns can can be: be: • Hypovolemia Hypo Hy povo po vole vo lemi le miaa related mi rel rel elat ated at ed to a temporaryy com ccompensational ompe om pens pe nsat ns atio at ionall mechanism mec mec echa hani ha nism ni sm • Ra Rais ised ed bo body dy ttem empe em perature pe Raised temperature • St Stre ress re ss Stress Heart disease, insufficiency, inflammation • Hear artt dis d isea is ease, heart ins ea nsuf ns uffi uf ficiency, in inflam ammation in th am the heart muscle physical • Infection short phys ysic ys ical ic al ac activity phase pain • The acute pha hase ha se of p pai ain ai n excitement • Anxiety, y, eexc xcit xc item it ement em Positive chronotropic medication • Po Posi siti si tive ti ve ch chrono notr no tropic me tr medi dica di cati ca tion ti on (atropin) • Bl Blee eedi ee ding di ng (the sy symp mpatheti mp ticc activity ti a increases as a co compensa sati sa tion ti onal on al Bleeding sympathetic compensational mechanism) mech me chan ch anis an ism) is Change • Ch Chan ange an ge of body position (sitting, standing) Pulmonary mechanism • Pulm lmon lm onary factors (part of a compensationall mecha on m hanism ha sm as a result r t of bad ad ox oxygenization) • Hyperthyroidism Treatment: Trea Tr eatm ea tmen tm ent: en t: • In wh what at ca case sess should sho sho houl uld it be treated? ul cases sooner better • The Th so soon oner on er thee bet b etter (malignant arrythmia, et arr rryt rr ythm yt hmia hm ia, shortening ia shor sh ortening or ng dystole) dyst dy stole) e) • Treating Trea Tr eati ea ting ti ng th thee und u nderlyingg disease nd d underlying • Increasing vagal vaga gall ton ga ttone onee on – Valsalva va maneuver mane ma neuver ne er – Carotis Caro roti ro tiss massage ti mas mas assa sage sa – Eyeball Eyeb Ey ebal eb all massage al mas assa as sage sa ge • In an electric eele lect le ctric way ay (defibrillator) (d • With th medicaments me 73 Pulse We sp spea speak eakk of of br brad bradycardia adyc ad ycar yc ardia in case an adult patient’s ar patient nt’s nt ’s pulse pul p ulse ul se is less les ess than es 60/min 60/m 60 /min /m in It can can be be ca caus caused used ed by: by: • The The parasympathetic para pa rasy ra symp sy mpat mp athe at hetic nervous syst he stem st em being be activated acti tiva ti vate va ted te system • Cardiac Card Ca rdia rd iacc insufficiency ia ins ins nsuf uffi uf fici fi ciency ci • Medication Medicati tion ti • The diseases of the he conduction cond co nduction system nd em of th thee heart h physical • Durable phy hysi hy sica si call exe ca eexertion xert xe rtio rt ion io n • Hypothermia Hypother ermi er miaa mi • Lying Lyin Ly ingg position in pos pos osition n • Durable Durabl Du blee intensive bl intensi int sive si ve pa pain • Relaxation Rela Re laxa la xati xa tion ti on • Negative Nega Ne gati ga tive chronotropic medication ti • Poisons Poison onss on • Increasing cerebral pression • Hypoxia 74 Pulse ttreatment: reatment: • with witth m edicaments medicaments (pacemaker) • instrumentally instrumentally (p pacemaaker) • manually (CPR) (CPR) 75 76 Pulse EExamination xamination of of the pulse: • by by p alpation palpation auscultation • with h auscultat tion • definingg pulse pulse deficit deficit • pulseoximetry pulseoxim metry • Doppler Doppleer ultrasound ulttrasound 77 Pulse 78 Pulse • M Monitoring onitoringg systems: systems: EExamination xamination o off the blood flow: flo ow: measurement • LLaser-Doppler aser-Doppler flow me easureemen nt Doppler • Doppl ler indexx ((DI) DI) Measurements heart • Measure ements of of h eart rate ratte Capillary • Ca apillary rrefilling efillin ng ttime ime – Alarms Alarms -electrode – Shuntings Shuntings (three-and (threee-and fivee -e electrode systems) systems) 79 80 IEC – International Electrotechnicial Comission (Hungary, Europe) AAMI – Association Asso As soci so ciat ci atio at ion io n for f the Advancement of Medical Instrumentation (USA, Australia) Color codes Co AAMI A AMI IEC White Whit Wh ite it Red Blac Bl ackk ac Black Yellow Red Green On the under th leftt side s the the ribs rib rib ibs at the anterior axilililla ax lary la ry liline ne axillary Bl Black On the the rig rright ight ig ht side ssid ide id e low llower ower ow er part off the e torso tor tor orso so (should (sho (s houl ho uld ul d placed be pla laced la d anywhere a e on o the e body bod bod odyy - grounding) grounding ng) ng white The place Th plac ace ac e of of th the e electrode electr trode depends tr dep epen ep ends en ds on what chest ches ch estt lead es lea lea ead d needed need ne eded ed ed to be monitored Gr Green Brown Pulse Placement of the the electrodes electrod odes od es Monitoring M onitoring ssystems: ystems: • • • • On th the e right rig rig ight side e under und und nder er the th e clavicule c le lef eftt side ef sid sid ide under er the th On the left clavicule clav avic av icul ic ule ul B Bedside edside monitors monitors Central C entral monitoring monitoring system m TTelemetry elemetry Modular monit tor system system monitor 82 Pulse Vital Signs important importtant parameters parameters measured by m monitors: onitorrs: • temperature temperature (surface, (surface, core) body bo dy brea eath ea thing th temperature breathing • • • • blood blood d pressure presssure oxygen oxxygen saturation G ECG Protocol watch (watching sepsis) 83 pulse puls pu lsee ls bloo ood oo d blood pressure pr 84 Breathing Breathing • Eupnoe: Eupnoe:: regular, regular, rythmic, calm aand nd n noiseless oiseless breathing b reathing with with even depth aand nd ttime ime sspan. pan. • non-instrumental non-instrumental examinat examination tion – rate, rate, d depth, epth, sound, rhy rhytm ytm – The The p proportion roportion o off inspira inspiration-expiration atiion-expirattion is 2:3 off rrespiration pulse – The rate o esspiration and dp ulse iiss 1:4 • unawaress counting countin ng – patient patieent can can affect affect his/her h i s /h e r breathing breatthing • just just aafter fter tthe he pulse pullse counting Physiological Phys Ph ysio ys iologicall respiratory io res res espi piratory pi ry rate ra in different age ge groups grou gr oups ou Age respiratory rate/ e/min e/ rate/min Newborn Newb Ne wbor wb orn 35-40 Infants Infant nts nt 30-50 Smalll children chi chi hild ldren ld 25-32 Children 20-30 Adolescents 16-19 Adults 12-20 85 86 Breathing Breathing Bad B ad breath-halitosis-foetor breath-h halitosis-foetor halitosis • Real Reaal h alito osis • Abnormal Abnormal respiratory respiratory soundss –R Rale ale – SSnore nore – Stridor – Gasp p – Physiological Physiological – Pathological • Acutee Chro Ch roni ro nicc ni • Chronic al ( ca caused ed by anaerobic anae an aerobic bacteria pro ae roduci ro cing ci ng su sulp lphu lp huri hu ricc ri – Oral producing sulphuric comp mpou mp ounds) ou compounds) Extraora rall (DM-breath ra ( aceto tone to ne,, kidney di dise seas se aseas – Extraoral smells like acetone, diseasedeficiency-s -smellllllss like -s l e meat) mea mea eat) smells like ammonia, liver deficiency-smells • H Hiccough iccough Cough • Co ough • Sneeze • Pseu Pseudo udo halitosis- psychological prob problem blem 87 88
