Vital Signs
•
Accuracy is very important
– Things one can do to achieve most accurate
measurements
– Maintain a positive attitude
– Explain the procedure to the patient
•
VS
1.
2.
3.
4.
Temperature
Pulse
Respiration
Blood Pressure
• Currently, Pain considered the 5th Vital Sign
TEMPERATURE
Body Temperature = regulated in hypothalamus is balance between :
* heat production via cell metabolism & muscle movement
&
* heat loss via skin (85%) , lungs , urine, & feces
• Norms:
– Oral = 97.6 F to 99.6 F ( avg: 98.6 F)
– Rectal = 99.6 F
– Axillary = 97.6 F
– Tympanic (aural) = same as oral
takes 3 min
takes 5 min
takes 10 min
instantly
• Diurnal variation : lowest in early morning
highest in early evening
• Age variation : very old & very young show 1 degree higher
• Centigrade vs Fahrenheit
C = (F-32 x 5/9)
F = (Cx 9/5) + 32
98.6 F = 37 C
Temperature
TERMS
• Fever = Febrile = Pyrexia ( def of fever(morbidity) = > 100.4 F )
• Afebrile = no fever
• Hyperthermia = higher than normal temperature
• Hypothermia = lower than normal temperature
• Tympanic Thermometry = use of special instrument(Thermoscan)
that takes infrared snapshot of eardrum &
converts reading into Fahrenheit temp
– MOST ACCURATE METHOD
• Reasons:
1. Near hypothalamus (body’s temp regulator)
2. Not relying on contact, but on heat radiation
• Temporal Artery Temperature Scanner
– Currently considered most accurate
PULSE
def: beat of heart as felt through wall of artery
• Characteristics :
1. rate = frequency = beats per minute
2. rhythm = time interval between each pulse
noted as------ regular or irregular
– If irregular do APICAL PULSE (with stethoscope)
– This checks for “pulse deficit” (difference between radial & apical pulse)
– Apical usually slower e.g. atrial fibrillation
Key = If irregular also record apical pulse to see if pulse deficit
3. volume = refers to strength of pulsations e.g. strong, weak, feeble, etc.
•
4. condition of arterial wall = texture of artery
normal = soft & elastic
Pulse Rates
generally faster in women ( versus men) & short stature ( versus tall)
BIRTH ----------------------120 - 160 beats/ minute
INFANTS ------------------110 - 130
CHILD (till age 7)----------80 - 110
CHILD (after age 7) --------80 - 90
ADULT ---------------------60 - 80
PULSE
• Different Sites (see next slide)
– Temporal = in front of ear
– Carotid = in neck at ant edge of sternocleidomastoid
– Apical =apex of heart ; fifth intercostal space at left midclavicular line
– Brachial = inner aspect of bend at elbow
– Radial = wrist ( thumb side)
– Femoral = mid-groin
– Popliteal = behind the knee
– Dorsalis pedis = upper surface of foot between ankle & toes
• Terms
– Thready = faint, weak
– Bounding = strong; usually indicates increase volume
Respiration
RESPIRATION
• def: - external respiration = exchange of gases that occurs in lungs
- internal respiration = exchange of gases that occurs in tissues
• relationships: ratio of resp : pulse = 1:4
• Respiratory Rates
newborn ---------------30 - 60 respirations per minute
infants ----------------- 30 - 40
children --------------- 20 - 30
adults ------------------ 14 - 20
Respiration
• characteristics:
rate = number per minute
rhythm = regular or irregular
depth = deep or shallow
• sounds :
rales = any abnormal sound ; moist or dry
ronchi = like snoring; rattle in throat
stridor = high pitched sound on inspiration
stertor = snoring sound
wheeze = high pitched whistling on expiration
friction rub = rubbing leather or sandpaper
gurgle = low pitched sound on expiration
Respiration
• Terms
– apnea = no breathing
– bradypnea = slow breathing
– tachypnea = fast breathing
– eupnea = normal breathing
– dyspnea = difficulty in breathing
– hyperventilation (hyperpnea) = increase rate & depth
– hypoventilation (hypopnea) = decrease rate & depth
– orthopnea = breathing only possible sitting or standing
( hard to breath lying FLAT)
– Cheyne - Stokes respiration = gradual decrease; then apnea ;
then gradual increase; then apnea
---in coma, brain dysfunction, terminal
BLOOD PRESSURE
systolic = heart contraction phase
diastolic = heart relaxation phase
• diastolic pressure more important than systolic
reasons: 1. it indicates the pressure to which the blood vessel walls are
constantly subjected & their “elastic rebound”
2. it reflects peripheral resistance e.g. if patient has sclerosed
walls both the peripheral resistance & diastolic are increased
• PULSE PRESSURE = difference between systolic & diastolic
– normal = 40
- excessive (> 50) due to: anxiety , aortic insufficiency, arteriosclerosis, etc.
- MAP = mean arterial pressure
•
- Used when recording a single number as BP
- MAP = diastolic pressure + pulse pressure/ 3
Standards:
newborn - - child -------adult - - -----
60/30
100/60
120/80 (adult = everyone over age 6)
140/90 = upper limit of normal
BLOOD PRESSURE
• Korotkoff Sounds = sounds heard when taking BP
–
–
–
–
–
Phase I
Phase II
Phase III
Phase IV
Phase V
first heard; faint; systolic
swishing quality
sounds become crisper & louder
sound become muffled; fainter
sounds disappear; diastolic
• Terms
– Benign Hypertension = slow onset; without symptoms
• Essential (Primary) Hypertension = idiopathic; no obvious cause;most common
–
–
–
–
Malignant Hypertension = rapid onset; ominous course
Secondary Hypertension = when cause is known
Orthostatic (Postural) Hypotension = when change position (flat- to- sit / stand)
Toxemia of Pregnancy = pre-eclampsia; eclampsia
BLOOD PRESSURE
Causes of Hypertension
- “highs” = exercise, stress, anxiety
- rigid blood vessels
- increase peripheral resistance
- increase weight = increased pressure
on CV system
- smoking
- organ disease
Renal, Heart, Liver
Causes of Hypotension
-cardiac failure
- decrease volume = hemorrhage
- shock
- dehydration
- nervous system diseases = only
those with no incr in CSF pres
- diseases
adrenal insufficiency
- pain
hypothyroidism
- diseases
cancer
hyperthyroidism
acromegaly
- sleep
BLOOD PRESSURE
• Sphygmomanometer
– mercury
– aneroid
– wide cuff for the obese; pediatric cuff for children
– Parts: pressure indicator, cuff, inflation bulb, pressure control valve
• Auscultation method & palpation method
• Hypertension is the leading cause of morbidity & mortality in the United
States for men and women !!!
• Classify the degree of hypertension ( based on diastolic)
– mild - - - - 90 to 100
– moderate ----100 to 110
– severe ------- > 110