2. 1 VITAL SIGNS ASSESSMENTS (Respiration And Blood Pressure) Prof. M.ABD ELAZIZ, MD, Ph D- Clinical Pharmacology Department of Clinical Pharmacy College of Pharmacy Salman Bin Abdulaziz University Mohammad Ruhal Ain (M Pharm, R Ph, PGDPRA) Department of Clinical Pharmacy College of Pharmacy Salman Bin Abdulaziz University

3. 2 Objectives 37-1 Recognize common terminology and abbreviations used in documenting and discussing vital signs. 37-2 Describe the instruments used to measure vital signs and body measurements. 37-3 Explain the procedure used to measure vital signs and body measurements. 37-4 Demonstrate the procedures for measuring vital signs and body measurements. Vital Signs and Measurements

4. 3 Introduction  Vital Signs Temperature Pulse Respirations Blood Pressure  Body Measurements Height Weight Head Circumference Vital signs and body measurements are used to evaluate health problems, therefore, accuracy is essential.

5. 4 Vital Signs  Usually taken at each medical office visit, and are compared to patient’s baseline values  Results must be kept private according to Health Insurance Portability and Accountability Act (HIPAA) of 1996  Following OSHA Guidelines is essential in preventing the transmission of diseases TemperaturePulse Respirations Blood Pressure

6. 5 Respiration

7. 6  Respiration (R) is the act of breathing.  Respiratory Rate (RR) Observe the client’s chest movement upward and outward for a complete minute. Children under 7 years of age use abdominal breathing. Auscultation with a stethoscope may be necessary on clients who are aware that you are counting their respiratory rate.

8. 7 Respiration  Respiratory rate is an indication of how well the body is providing oxygen to the tissues.  One respiration consists of both inhaling and exhaling air also referred to as breathing in and breathing out.  Respiratory rates are higher in infants and children than in adults.

9. 8 Normal Respiration Rates (26-40) (20-30) (18-24)(16-24) (12-20) (12-24) NOTE: Ranges reflect breaths per minute

10. 9 Taking Respirations  Most reliable method for measuring respirations is with a stethoscope to count the number of breaths heard per minute.  Other methods include: Look, listen and feel for movement of air by placing your hand over the patient’s chest, shoulders or abdomen. NOTE: If patients are aware that you are counting their respirations they may unintentionally alter their breathing

11. 10 Respiration Temporary absence of breathing Apnea Dyspnea Difficult or painful breathing Tachypnea Rapid breathing Hyperpnea Deep, rapid breathing

12. 11 Respiratory Assessment

13. 12 Inspection  Kyphosis AKA  Hunchback Abnormal curvature of the thoracic spine

14. 13 Inspection  Lordosis AKA  Sway-back Abnormal curvature of the lumbar spine

15. 14 Inspection: Breathing patterns Rate  Eupnea Normal 12-20 / min  Tachypnea  rate Pnuemonia, pulm edema, acidosis, septicemia, pain  Bradypnea  rate  ICP, drug OD

16. 15 Inspection: Breathing patterns Depth  Hyperpnea  depth  Hyperventilation  depth & rate  Hypoventilation  depth & rate

17. 16 Inspection: Breathing patterns Rhythm  Apnea Not breathing  Cheyne-stokes Varying depth f/b apnea Death rattles Death rales

18. 17 Percussion: results  Resonance – drum like Normal  Hyper-resonance Too much air Emphysema  Flatness / dull Fluid or solid Pleural effusion Pneumonia Tumor

19. 18 Auscultation Purpose  Asses air flow through bronchial tree Procedure  Diaphragm of stethoscope  Superior  inferior  Compare rt to lf

20. 19 Quiz?  A child with difficulty breathing and a “barking” cough id displaying signs associated with which condition? A. Asthma B. Croup C. Cystic fibrosis D. Epiglottitis

21. 20 Quiz?  When assessing the lung sounds of a child with asthma, which sound are you most likely to hear? A. Murmurs B. Sibilant Wheezing C. Crackles D. Pleural friction rub

22. 21 Early & late signs of hypoxia  Anxiety  Bradycardia  Cyanosis  Depressed respirations  Diaphoresis  Disorientation  Dyspnea  Restlessness  Headache  Agitation  Poor judgment  Retraction  Tachycardia  Tachypnea

23. 22 which of the following as an early sign of hypoxia? A. Restlessness, yawning & tachycardia B. Dyspnea, confusion & bradycardia C. Bradycardia, hypotension dyspnea D. Dyspnea, restlessness, hypotension

24. 23 Dyspnea  Definition SOB SOB, flat affect, BS x 4

25. 24 Dyspnea  Significance Common with cardiac & resp. disease Sudden onset – healthy person   Pneumothorax Sudden onset ill, post-op or injury   Pulmonary emboli

26. 25 Dyspnea  Orthopnea Sit up to breath  COPD  CHF

27. 26 Dyspnea  Right ventricle If chronic airway resistance   pressure  Rt ventricle  work  Rt. Vent damage

28. 27 Dyspnea  Management Find cause Give O 2 HOB  Communication

29. 28 Cough  Definition To expel air from the lungs suddenly Irritation of mucous membrane

30. 29 Cough  Significance Infection Irritants Protective mechanism Dry, irritating  URT Cough + chest pain  Pleural or musculoskeletal

31. 30 Cough  management Assess Describe Directed Pain control  Splinting Infection control Suppressants / Anti-tussives

32. 31 Sputum Production Definition  Matter discharged from resp. track that contains mucus and pus, blood, fibrin, or bacteria

33. 32 Sputum Production Significance  Purulent Thick, yellow/green Bacteria  Rusty Strep or staph  Thin, mucous Viral

34. 33 Sputum Production  Pink-tinged Lung CA TB  Pink tinged, profuse, frothy Pulmonary edema  Malodorous Lung abscess

35. 34 Sputum Production Management  Thick Hydrate   water  Nebulizer  Humidifier  No smoking  Oral care   Appetite

36. 35 Obtaining a sputum specimen  Explain From lungs  Sterile cup  Deep breath x 3   Cough deeply  Expectorate  Best time for specimen collection? AM

37. 36 Chest pain Definition  Cardiac or pulmonary

38. 37 Chest pain Significance  CA (late stage)  Pneumonia  Pulmonary embolism  Pleurisy

39. 38 Chest pain  Pleurisy Inflammation of pleura Sharp with breath  breath sounds

40. 39 What????? What breath sound would you expect to hear on a patient suffering from pleurisy? A. Crackles B. Sonorous wheezes C. Sibilant wheezes D. Pleural Friction Rub

41. 40 Chest pain Management  Assess  Analgesics OK, but…  Position for pain Affected side Splint

42. 41 Clubbed fingers Definition  Sponginess of the nail bed  Loss of the nail bed angle  Finger tip is round and bulbous

43. 42 Clubbed Finger Significance  chronic hypoxia

44. 43 Mr. Caveman: Mr. Caveman enters the ER unconscious following an Automobile accident. The paramedics report that his O2 sats are 86%. You note that Mr. Caveman has clubbed fingers. What does this tell you?

45. 44 Hemoptysis Definition  Expectoration of blood from the respiratory tract

46. 45 Hemoptysis Significance  Pulm or cardiac  Common causes Pulm infection CA of lungs Pulm. Emboli Pulm. Infarction TB

47. 46 Hemoptysis  Hemoptysis Definition?  Coughed up blood From?  Pulm hemorrhage Description  Pink, red, mixed with sputum Blood pH  Alkaline blood  Hematemesis Definition?  Vomited blood From?  Stomach / GI Description  “Coffee ground” Blood ph  Acidic blood

48. 47 Hemoptysis Management  Determine source  Serious

49. 48 Cyanosis Definition  Bluish coloring of skin

50. 49 Cyanosis Significance  Very late indicator of hypoxia  Appears when O2 sats < 85%  NOT a reliable sign of hypoxia Esp. with anemia

51. 50 Cyanosis  O2 sat definition % of hemoglobin carrying oxygen compared to total # of hemoglobin

52. 51 Cyanosis  Normal Breath 100 O2 molecules  98 cross into blood Blood: 100 Hgb  O2 SATS 98% No cyanosis

53. 52 Cyanosis  Hypoxia Breath 100 O2 molecules  75 cross into blood Blood: 100 Hgb  O2 SATS 75% Cyanosis

54. 53 Cyanosis  Anemic and hypoxic Breath 100 O2 molecules  75 cross into blood Blood: 75 Hgb  O2 SATS 100% No Cyanosis

55. 54 Cyanosis Management  Know color of Pt. skin  Assess color of tongue & lips  Fingernail polish  African-American  Vasoconstriction (cold weather)  peripheral cyanosis

56. 55 Apply Your Knowledge A 26-year old athlete visits the medical office for a routine check-up. The medical assistant takes T-P-R and obtains the following: Temperature 98.8° F Pulse 52 beats/minute Respirations 18/minute What should the medical assistant do about these results?

57. 56 Answer Apply Your Knowledge -Answer  The temperature and pulse are within the normal range.  The pulse of 52 is below the normal range. Check the patient’s previous vital sign results. Remember for some patients, especially athletes, a low pulse rate is normal so these results may be within normal limits for this patient.

58. 57 Blood Pressure

59. 58 Blood Pressure  The force at which blood is pumped against the walls of the arteries yields blood pressure.  Two pressure measurements are obtained with blood pressure readings: Systolic pressure (measurement of pressure during contraction of left ventricle) is the top number. Diastolic pressure (measurement of minimal amount of pressure against vessel walls at all times) is the bottom number.

60. 59 Blood Pressure (cont.) 120/80 Systolic Pressure Left ventricle of heart is contracting Top or first number Diastolic Pressure Heart is at rest Bottom or second number

61. 60 Blood Pressure (cont.) Hypertension  High blood pressure readings  Major contributor to heart attacks and strokes  Physicians often request a re-check of patient’s blood pressure within two months or less when readings are elevated

62. 61 Blood Pressure (cont.) Hypotension  Low blood pressure reading  Is generally not a chronic health problem and may be normal for some patients  Severe low blood pressure readings occur with:  Shock  Heart failure  Severe burns  Excessive bleeding

63. 62 Blood Pressure Equipment  A sphygmomanometer is the instrument used to measure blood pressures consisting of a cuff, pressure bulb, and manometer.  Three types of sphygmomanometers: Mercury Aneroid Electronic

64. 63 Blood Pressure Equipment (cont.)  Mercury Sphygmomanometers Consists of a column of mercury that rises to reflect increased pressure as the cuff is inflated Very accurate, yet mercury has an ill effect on the environment, so these are no longer manufactured Require calibration every 6 to 12 months When properly calibrated the column of mercury will rest on “zero” when viewed at eye level

65. 64 Blood Pressure Equipment (cont.)  Aneroid Sphygmomanometers Consists of a circular gauge with needle dial that measures pressure Each line on the circular dial represents 2 mmHg Considered to be very accurate Must be checked, serviced, and calibrated every 3 to 6 months When properly calibrated, the needle on the dial rests within the small square at the bottom of the dial.

66. 65 Blood Pressure Equipment (cont.)  Electronic Sphygmomanometers Provides a digital readout of the blood pressure on a lit display Unlike mercury and aneroid devices, no stethoscope is needed Considered to be the least accurate, yet are easy to use

67. 66 Stethoscope  Amplifies body sounds  Consists of earpieces, binaurals, tubing and a chestpiece (bell and diaphragm) Earpieces Binaurals Rubber or plastic tubing Bell Chestpiece Diaphragm

68. 67 Stethoscope (cont.)  Bell Cone-shaped side of chestpiece Amplifies low- pitched sounds such as heart sounds Must be held lightly against skin for proper amplification  Diaphragm Larger flat side of the chestpiece Amplifies high-pitched sounds like bowel and lung sounds Must be held firmly against skin for proper amplification

69. 68 Measuring Blood Pressure  The cuff must be placed on the upper arm above the brachial pulse site.  Palpate the brachial pulse then place stethoscope over this site.  Inflate cuff about 30 mmHg above palpatory result or approximately 180 mmHg to 200 mmHg.  Release the air in cuff and listen for the first heartbeat (systolic pressure) and the softest or last heartbeat (diastolic pressure).  Record results with systolic being top number and diastolic being bottom number (i.e. 120/76).

70. 69 Measuring Blood Pressure (cont.)  Wait 15 minutes before taking readings if patient has been engaged in strenuous exercise or has ambulatory disabilities.  Be sure cuff is properly fitted and placed on the extremity or inaccurate readings may result.  DO NOT TAKE BP’s IN AN EXTREMITY IF: Injury or blocked artery is present History of mastectomy on that side Implanted device is under the skin

71. 70 Special Considerations Properly Fitting Cuff Age Patient Stress or Activity Current Circulation to Extremity Selected

72. 71 Apply Your Knowledge A 67-year old patient is in the medical office complaining of headache. The blood pressure reading is 212/142. What should the medical assistant do in this situation?

73. 72 Answer Apply Your Knowledge -Answer This blood pressure reading is very high and should be reported to the physician at once. The complaint of headache should also be reported to the physician. Recall that hypertension is a major contributor to stroke and heart attacks.

74. 73 Body Measurements  Adult and Older Children Measurements Height Weight  Infant Measurements Length Weight Head Circumference Measurements provide insight into metabolic functioning and growth and development patterns.

75. 74 Body Measurements (cont.)  Adult Weight Taken at each office visit Should be listed to the nearest quarter of a pound  Adult Height Taken on initial visit and whenever a complete physical examination is performed Measure following weight Record in inches and quarter inches

76. 75 Body Measurements (cont.)  Weight of Infants and Children Infants are weighed on infant scales and recorded in ounces and pounds. Children that can stand are weighed on adult scales. Children unable to stand may be held by an adult using the adult scale, and subtract adult weight from total to yield child’s weight.

77. 76 Body Measurements (cont.)  Length of Infants and Height of Children Length of infants is measured at each visit while the infant is lying down Height of children is taken using same technique as for adults. Some offices have wall charts that are separate from the scale.

78. 77 Body Measurements (cont.)  Head Circumference of Infants This is an important measure of growth and development Medical assistants are often asked to assist the physician with this measurement Tape measure is placed around head at its largest circumference to obtain measurement

79. 78 Apply Your Knowledge The medical assistant is about to weigh a 6- month old infant using the infant scale. When the medical assistant places the infant on the scale she notices the diaper is very soiled. What should the medical assistant do in this situation?

80. 79 Answer Apply Your Knowledge -Answer If the diaper is soiled, the medical assistant should weigh the diaper after weighing the infant and subtract the difference to obtain the infant’s accurate weight in pounds and ounces.

81. 80 End of Chapter