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Vital Signs Characteristics and Norms

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1 Vital Signs Characteristics and Norms
Unit 102.2 Vital Signs Characteristics and Norms

2 Objectives Describe the basic body functions that produce each vital sign. Describe normal and abnormal characteristics, normal measures, methods and sites for measuring. Discuss related terminology.

3 Vital Signs Measurable, concrete indicators that pertain to and are essential for life Vital signs are the signs of life! They are: Temperature Pulse Respirations Blood Pressure

4 Temperature measured degree of body heat
balance maintained between heat produced and heat lost by the body can’t be changed at will lower in morning elevated more in evenings

5 Temperature heat produced by oxidation of food heat lost through
skin (perspiration) lungs (breathing) excretions ( urine, saliva)

6 Fever an elevated temperature from normal everyone has a temperature
ill people have a fever

7 Normal Temperature Type: oral thermometer Time: 3 minutes
98.6 F or 37 C easiest to obtain

8 Normal Temperature Type: rectal thermometer Time: 5 minutes
99.6 F or 37.6 C most accurate

9 Normal Temperature Type: axillary placement of thermometer
Time: 10 minutes 97.6 F or 36.4 C most inaccurate

10 Normal Temperature Type: Thermoscan Time: 1 second
Ranges of 96.6 F F or C C very accurate when circumstances and technique are correct

11 Glass Thermometers glass hollow tube (stem) with a bulb containing mercury, that expands and is read on scale on the stem Fahrenheit 212 is boiling, 32 is freezing scale measured in .20 (ea. little line represents .20) Celsius (Centigrade) 100 is boiling, 0 is freezing scale measured in .10 (ea. little line represents .10)

12 Basic Rules for Glass Thermometers
rinse off glass thermometer in cold water if stored in a disinfectant shake mercury of glass thermometer down to 94F or 35C use disposable sheath/cover over bulb end of thermometer inserted in mouth no cold or hot food or drinks 15 min. prior to procedure & no smoking Keep in place for 3-5 minutes.

13 Glass Thermometer If mercury falls between two lines, round up to
next line for temperature reading

14 Glass Thermometer Celcius thermometers are graduated in
increments of 0.1 therefore, each line represents 0.1 Celcius Mercury Thermometer

15 Glass Thermometer Fahrenheit thermometers are graduated in
increments of 0.2 therefore, each line represents 0.2 Fahrenheit Mercury Thermometer

16 How to Read Glass Thermometer
hold the thermometer at eye level, rotate until you can see the column of mercury observe the lines on the scale at the upper side of the mercury read the whole number and the tenths when present

17 Key Factors Glass Thermometers
guard against breaking a mercury thermometer. Mercury is hazardous material and requires special handling for disposal if thermometer breaks in a patient’s mouth, give them soft bread to eat and notify the physician immediately very few glass thermometers used today because of the above hazard

18 Oral Thermometers always place protective sheath over oral thermometer
don’t use if patient can’t breathe through their nose ask patient not to talk with thermometer in their mouth place under the tongue be sure patient has had nothing hot or cold & not smoked 15 min. prior don’t use if patient can’t cooperate

19 Conversion between Celsius and Fahrenheit
C = (F-32) x 5/9 F=C x 9/5 + 32

20 Other Thermometers electronic or battery operated thermometers, cover probe with plastic sheath, reads and prints out in seconds(oral & rectal units) disposable patches for forehead disposable plastic strip placed in mouth, turns colors according to degree of temperature tympanic thermometers, for the ear with results in a second

21 Digital Oral Thermometer
use according to the manufacture’s instructions lab practice

22 Thermoscan Tympanic (ear) thermometer. Use according to manufacture’s
instructions lab practice Pull pinna up an Back before inserting

23 Tympanic Temperatures
reflects body core temperature the eardrum shares same blood supply as hypothalmus measures infrared heat of eardrum & surrounding tissue scans eight (8) measurements per reading & displays highest as the temperature

24 External Factors Influencing Accuracy
lying on ear for extended period of time ears covered with cap, scarf, ear muffs exposure to extreme heat/cold recent swimming/bathing Wait 20 minutes if the above are factors to be considered

25 Key Factors Thermoscans
temperature should be taken in same ear for duration of an illness ear must be free of obstructions to get an accurate reading (earwax, drainage, etc.) if right ear is used, right hand should hold Thermoscan & visa versa on left over age 1 year, pinna of ear should be pulled up and back under 1 year, pinna of ear back only, NOT UP

26 Recommendation Take tympanic temperature 3 times in the same ear and use the highest reading when: *the patient is an infant less than 90 days old *a child is less than 3 years & has a compromised immune system. A fever is critical in these situations, therefore one must be sure *if you are an inexperienced user of the Thermoscan thermometer

27 When NOT to use Thermoscan
*blood/drainage present in external ear canal *ear is painful/swollen/red *ear is plugged with earwax *ear drops are being used *facial deformities involving the ear *when hearing aids are present (must wait 20 minutes after removing for an accurate temperature)

28 Rectal Temperature use in young children and mentally disabled individuals who may bite patients having difficulty breathing confused patients unconscious patients patients on oxygen the Thermoscan thermometer could be used for above situations & reduce risk of rectal tears

29 Key Factors Rectal Temperature
apply a lubricating jelly, K-Y, Vaseline, or even shortening (not a medicated jelly like Vicks) to approximately 1/2 of length have adults lay on their side infants lay on stomach or over parent’s knees insert the thermometer gently 1 1/2” into rectum hold gently in place for 5 minutes

30 Key Factors Rectal Temperature
wipe from stem to bulb wash thermometer with cool water and soap, rinse , dry and place in container with disinfectant Rectal temperature is the most accurate temperature.

31 Key Factors Axillary Temperature
use on infants with diarrhea and/or well infants axillary area should be dry (DO NOT rub) 10 minutes required for accurate reading could be used for someone unable to tolerate or understand the concept of oral thermometers

32 Signs & Symptoms of Fever
Early Signs: shivering increased metabolism increased pulse feeling cold goose bumps

33 Signs & Symptoms of Fever
Later Signs: skin warm to the touch flushed dehydration dry skin, sunken dull eyes, poor skin turgor diaphoresis profuse sweating, indicating hypovolemic shock weakness thirsty rapid respirations

34 Documentation when recording temperature on chart indicate: the degree
whether it is Fahrenheit or Celsius whether the left or right ear was used what site was used. Oral is universal, if other sites used, an indicator must be shown R for rectal A for axillary T with circle around it for tympanic

35 Pulse a rhythmic beat or vibration detected by palpating an artery over a bony prominence that indicates the heart rate should be the same at all arterial pulse sites

36 Pulse Sites areas where you can compress an artery against a bone
Temporal side of the head

37 Pulse Site Carotid neck

38 Pulse Site Brachial (not shown) Radial
distal upper arm, just above elbow, medial aspect Radial wrist, thumb side Most common site for conscience adult patients

39 Pulse Sites Apex Femoral Popliteal Dorsalis pedis point of heart groin
behind knee Dorsalis pedis top of the foot Test Question: If you are concerned about circulation in the feet or lower extrememties dorsal pedis used.

40 Normal Pulse Range varies with age, gender, activity, physical conditions General rule: The younger the patient the faster the heartbeat

41 Pulse Ranges Normal Prenatal Infant Child Adult 120-160 115-130 80-115

42 Tachycardia Definition: pulse rate greater than 100
Causes of tachycardia: stimulant drugs coffee, tea, soda elevated temperature pain anxiety shock diseases like hyperthyroidism digestion and exercise

43 Bradycardia Definition: heart rate less than 60 Causes of bradycardia:
poisons sleeping pills, tranquilizers resting or fasting accidents or disease causing brain pressure mental depression

44 Force of Pulse How does the pulse force feel against your finger pressure? Weak or thready (difficult to detect) Strong (easily detected) Bounding (very strong, so much so that your fingers feel as though they are being pushed off the artery)

45 Pulse Rhythm Definition: Intervals between heart beats should be regularly spaced when describing the rhythm on chart, note whether the rhythm is regular or irregular directly after the rate

46 Arrhythmia Definition: Irregular heart beat

47 Apical Pulse apex of heart is the pointed end of heart or its’ base
found at the 5th intercostal space at mid left chest just below left nipple heard with a stethoscope frequently used with infants or when a pulse is difficult to detect

48 Procedure Reminders never use your thumb to detect & count pulse (thumb has own pulse) Use a watch with a second hand and count pulse for 60 seconds this may vary in some facilities. You may count for 30 seconds and multiply by 2, or 15 seconds and multiply by 4, etc. Know protocol when an arrhythmia is detected, the pulse must be taken for 60 seconds

49 Respirations the act of inhaling oxygen and exhaling carbon dioxide
Inspiration= breathing in Expiration= breathing out

50 Normal Respirations Rates
Adult 12-20 Child/Infant 20-30 Newborn 35-50

51 Factors that Affect Respirations
Increases rate: diseases of lungs & circulatory system hemorrhage pain shock fever vigorous exercise anxiety, excitement altitude atropine

52 Factors that Affect Respirations
Decreases Rate: sleep or relaxation narcotic analgesics morphine kidney failure brain tumors injuries

53 Respiratory Terminology
Pnea respirations Eupnea normal respirations Bradypnea slow respirations Tachypnea fast respirations Apnea Cessation or absence of respirations Hyperventilation rapid breathing depleting carbon dioxide

54 Various Qualities of Respirations
Shallow very little air inhaled little chest movement Deep more air inhaled seen in brain injuries often chest pathology in progress seen with exersion Full viewed as normal breathing

55 Procedure Reminders Immediately begin counting
respirations after counting pulse with NO perceivable break patients can alter breathing pattern, count respirations without the patient being aware count for 60 seconds while still appearing to take pulse record rate & quality of breathing

56 What to do if Breathing is Difficult to Detect
while appearing to take pulse, watch chest rise and fall place arm across chest, take pulse, and then count each rise and fall of chest assume patients breathing pattern and count your own watch abdomen rise and fall

57 “Temperature, Pulse, Respirations” approximately 23 minutes
Vital Signs View Video KHO 17 “Temperature, Pulse, Respirations” approximately 23 minutes

58 Blood Pressure the force of blood pushing against the walls of the arteries Test Question: blood pressure measures the blood as it pushes against the walls of the arteries.

59 Blood Pressure Terminology
Systolic greatest force exherted as heart is contracting “heart at work” top number quick to change affected by exercise emotions illness medications illegal drugs

60 Blood Pressure Terminology
Diastolic least force exherted during relaxation phase of cycle “heart at rest” bottom number affected by disease medications slower to change

61 Blood Pressure Adult Normal Ranges
Systolic 90-140 Diastolic 60-90 record as a fraction systolic/diastolic and in even numbers, unless using digital BP equipment

62 Abnormalities Hypertension Hypotension Elevated or high blood pressure
usually greater then 140/90 Hypotension decreased blood pressure usually less than 90/60

63 Factors that Increase Blood Pressure
loss of elasticity of arteries (disease) exercise, eating stimulants like coffee, caffinated beverages, drugs emotional disturbances gender (females often not affected until after menopause) excess weight (not hard rule) family history

64 Factors that Decrease Blood Pressure
depressants like sleeping pills narcotic pain relievers, tranquilizers fasting shock caused from blood or body fluid losses

65 Sphygmomanometer (Blood Pressure Cuff)
measures arterial pressure in mm of mercury (Hg) or its equivalent rubber bladder covered with unyielding material hand bulb with stop cock to inflate cuff aneroid dial or mecurial column to measure cuff inflated mm Hg release at rate of 4 mm Hg per second and listen for first heat beat & last heartbeat

66 Key Factors Blood Pressure
remove clothing from above the elbow when possible cuff size should be 2/3 length of upper arm (humerus) too small of a cuff may give false high blood pressure reading too large of a cuff may give false low blood pressure reading The valve is turned clockwise to inflate the cuff support extremity at heart level to get an accurate reading listen over brachial artery pulse site if repeating is necessary, wait 1 full minute before re-inflating the cuff

67 Stethoscope bell and/or diaphragm placed on organ/vessel to auscultate
the diaphragm must be in full contact with organ/vessel for maximum audibility use two fingers, NOT thumb only to make contact diaphragm

68 Key Factors Stethoscope
diaphragm (flat side) is used to auscultate blood pressure, lung sounds, bowel sounds, bruits bell is used for heart sounds and pediatric patient assessment ear pieces point to nose when in ears minimize tube noise to maximize ability to hear sounds clean the diaphragm/bell between patients (do not transmit germs this way) & keep ear tips clean

69 Vital Signs

70 Unit 102.3 Recording Vitals Record findings To correct an error
charting shows comparisons quickly Narrative write down pulse rate (beats per minute), quality of pulse, and rhythm write down respiration rate (breaths per minute) & quality of breath describe abnormal (be specific) To correct an error DO NOT erase or obliterate any info

71 Correction of a Handwritten Entry
draw line through the error insert correction above or immediately following the error in the margin, write “correction” or “corr”, your initials and date

72 Knowledge Assessment Give normal temperatures for oral, rectal, and axillary temperatures. List and describe the different types of thermometers. Define pulse and list all pulse sites. Define respirations, normal rates, and factors that affect respiration counts. Contrast systolic and diastolic. Define blood pressure, give normal ranges, abnormalities, and equipment.

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