1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Fundamentals of Nursing: Human Health and Function Chapter 17: Vital Signs

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature Humans maintain a consistent internal body temperature Core temperature: Temperature inside the body; normal body temperature when measured orally ranges between 36.5º and 37.5ºC (97.6º and 99.6ºF)

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature (Cont’d) Regulation of body temperature –Heat production Metabolism –Heat loss Heat is lost through four processes: Radiation; conduction; convection; evaporation

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature (Cont’d) Factors affecting body temperature –Age –Environment –Time of day –Exercise –Stress –Hormones

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature (Cont’d) Factors affecting oral body temperature measurement –Smoking; chewing gum –Oxygen administered by mask or cannula –Intake of hot or cold liquid drinks

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature (Cont’d) Assessing body temperature –Sites Oral Rectal Ear Forehead (temporal artery) Axillary

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature (Cont’d) Assessing body temperature (cont’d) –Equipment Electronic thermometers Tympanic membrane thermometers Temporal artery thermometers Disposable paper (chemical) thermometers Glass mercury thermometers

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Body Temperature (Cont’d) Assessing body temperature (cont’d) –Scales: Temperature can be measured on the Celsius or Fahrenheit scale –Methods: Nurses use critical thinking to interpret temperature measurements, document the results, and report abnormal values

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse Characteristics –Rate or frequency; rhythm; quality Factors affecting pulse rate –Age –Autonomic nervous system –Medications

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse (Cont’d) Assessing the pulse –Sites Temporal; carotid Apical; brachial Radial; femoral; popliteal Pedal; posterior tibial

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse (Cont’d) Equipment –Stethoscope –Doppler ultrasound device Methods –Palpation –Auscultation

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse (Cont’d) Assessing pulse characteristics –Dysrhythmic: Any pulse out of the range of normal rate or rhythm –Rate: Normal adult pulse rate is 60 to 100 pulsations per minute Tachycardia; bradycardia

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse (Cont’d) Assessing pulse characteristics (cont’d) –Rhythm –Quality –Pulse deficits

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Cardiac medications such as digoxin increase pulse rate in patients.

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Rationale: Cardiac medications such as digoxin decrease pulse rate, whereas atropine inhibits parasympathetic input, causing increased pulse rate in patients.

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Respirations External respiration; internal respiration Tidal volume: Amount of air moving in and out with each breath

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Respirations (Cont’d) Factors affecting respirations –Age –Medications –Stress –Exercise –Altitude –Gender

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Respirations (Cont’d) Assessing respirations –Rate –Rhythm and depth –Quality: Usually automatic, quiet, and effortless

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Respirations (Cont’d) Assessing respirations (cont’d) –Quality Dyspnea –Methods: Perform the respiratory assessment without patients being aware of the assessment

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What is the term used for normal respiratory rhythm and depth in a patient? a. Eupnea b. Apnea c. Bradypnea d. Tachypnea

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer a. Eupnea Rationale: Eupnea is the term used for normal respiratory rhythm and depth in a patient. Apnea is the absence of respirations in a patient. Tachypnea is an abnormally fast respiratory rate, and bradypnea is an abnormally slow respiratory rate in an adult patient.

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure Physiologic factors determining blood pressure –Systolic blood pressure –Diastolic blood pressure –Pulse pressure –Blood flow –Resistance

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure (Cont’d) Factors affecting blood pressure –Age –Autonomic nervous system –Circulating volume –Medications –Normal fluctuations

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure (Cont’d) Assessing blood pressure –Sites Upper extremity Lower extremity

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure (Cont’d) Assessing blood pressure (cont’d) –Equipment Sphygmomanometer Stethoscope Doppler ultrasound Automated devices

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure (Cont’d) Assessing blood pressure (cont’d) –Methods Proper cuff size Proper positioning Correlation with the respiratory cycle Proper inflation and deflation

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure (Cont’d) Assessing blood pressure (cont’d) –Methods (cont’d) Auscultation: Korotkoff sounds can be heard with a stethoscope placed over the artery Palpation: When Korotkoff sounds are inaudible, blood pressure may be estimated by palpation

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Blood Pressure (Cont’d) Assessing blood pressure (cont’d) –Abnormalities Hypertension; prehypertension Hypotension Orthostatic hypotension

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What is the term used for a high-pitched musical sound in patients during a respiratory assessment? a. Crowing b. Wheezing c. Stridor d. Sigh

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. Wheezing Rationale: The term used for a high- pitched musical sound in patients is wheezing. Stridor is a harsh inspiratory sound, which may also be compared to crowing. Sighs are breaths of deep inspiration and prolonged expiration.

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Documenting Vital Signs Data entered into an EMR may be viewed in a graph format that allows vital sign trends to be seen easily Trends may reflect normal variations or a change in response to disease or therapy

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Lifespan Considerations Newborn and infant Toddler and preschooler School-age child and adolescent Adult and older adult