1. Vitals

2. Vital Signs include Temperature Pulse Respiration Blood Pressure
Skin Color
Level of Consciousness
Pupil Size, Reactivity & Trackability

3. Vital signs are interdependent of each other because a change in one will affect another. Like a rise in temperature will increase respiration rate.

4. Temperature
Temperature is one way we can determine the body’s level of homeostasis & refers to temperature inside the body or core body heat.

5. Temperature Four of the most commonly used routes measured are:
1. Oral
2. Rectal
3. Axillary
4. Tympanic

6. Several types of thermometers 1. Electronic/Digital 2. Glass /Mercury
Temperature
Several types of thermometers
1. Electronic/Digital
2. Glass /Mercury
3. Clinical

7. Normal Temperature Ranges
1. Oral 97.6 degrees F. – 99.6oF.
Most common site to measure tempt.
2. Axillary 96.6 degrees F. – 98.6oF.
Least accurate site measured
3. Rectal 98.6 degrees F. – 100.6oF.
Most accurate site to measure tempt.

8. Reading Glass Thermometer
1. By degree and tenth of a degree
2. Place thermometer at eye level and look for silver line of mercury
3. Never place fingers on bulb of thermometer as this might change the value.
4. The short lines = .2oF
5. The long lines = 1oF

9. Color Coding Thermometers
1. Probes for electronic and mercury-free ends are color coded for route.
2. Red = rectal;
Blue = oral/axillary
3. If no color present, the route will be written on the thermometer

10. Using a Thermometer
1. Use protective cover on each type of thermometer 2. Tympanic probe placed in ear canal. 3. Rectal thermometer or probe placed in rectum one inch with lubrication applied before insertion. 4. Oral thermometer placed in mouth under the tongue

11. Oral Thermometer Use 5. Do not take oral temperatures on
a. preschool children
b. patients with oxygen
c. delirious, confused, disoriented patients
d. comatose patients
e. patients with nasogastric tubes in place
f. patients who have had oral surgery
g. patients who are vomiting or are nauseated

12. Rectal Thermometer Use
6. Do not take rectal temperatures on
a. infants or children unless a core temperature is needed
b. patients who have had rectal surgery
c. combative patients

13. Duration of Taking Temperature
1. Tympanic – a couple of seconds – long 2. Oral and rectal (glass thermometer) – three minutes. 3. Axillary glass thermometer) – 10 minutes 4. Electronic temperatures – when beep sounds, temperature is obtained

14. Abnormal temperatures
1. Fever (febrile), hyperthermia all indicate someone has an elevated temperature (greater than 100oFahrenheit).
2. High fever would include anything over 103o Fahrenheit.
3. Moderate fever would include anything 100 – 103oFahrenheit.
4. Hypothermia is subnormal temperature. This can be equally problematic for a person. Anything under 96oFahrenheit would indicate hypothermia.

15. Pulse
A. Pressure against the arterial walls when heart is contracting or relaxing. B. Can feel at points where the artery is between finger tips and a bony area. C. These areas are called pulse points and include: 1. Temporal 2. Carotid 3. Apical 4. Brachial 5. Radial 6. Femoral 7. Popliteal 8. Dorsal Pedalis 9. Mandibular 10. Posterior Tibial

16. Pulse
D. Measured by index & middle, or middle & ring fingers over pulse point.
E. Do not take with the thumb, since it has a pulse of its own.
F. Count for 30 seconds and multiply by 2, or count for 60 seconds

17. Pulse
G. Normal range is 60 – 100 beats per minute. The pulse should not constantly bpm.
H. > than 100 = tachycardia
I. < than 60 = bradycardia

18. Quality of pulse is determined as well as rate
1. Rhythm – regular or irregular 2. Strength – Bounding or thready

19. Circumstances affecting pulse rate
1. Body temperature 2. Emotions
3. Activity level Health of heart
5. Age Sex
7. Medications Illness
9. Shock Bleeding
11. Sleep

20. How to take a pulse
How to take a pulse

21. Perfusion
L. Perfusion is the flow of blood throughout the body. Someone with sufficient perfusion has a strong enough heart beat to adequately oxygenate the body.

22. Respiration A. Each breath includes inspiration and expiration.
B. Measure by observing chest rise and fall.
C. Measured in breaths per minute.
D. Normal Adult range = breaths per minute.

23. Respiration
E. > than 24 = tachypnea – if breathing in great depth then called hyperpnea
F. < than 12 = bradypnea
G. Difficulty in breathing is called dyspnea
H. Quality of breathing is determined as well as the rate of breathing:
1. Depth 2. Clarity of breath sounds
3. Pain with breathing
4. Difficulty breathing – use of accessory muscles – sternocleidomastoid, intercostals or trapezius.

24. Croup http://www.youtube.com/watch?v=nmJzDicuPc4

25. Pertusis Clinical presentation of Whooping Cough – YouTube
Clinical presentation of Whooping Cough – YouTube

26. Stridor http://www.youtube.com/watch?v=1Enq2BvX9aw

27. Cheyene-Stokes http://www.youtube.com/watch?v=CrKfmfuP9l4
ED Sing-a-Long: Cheyne-Stoking - YouTube

28. Rales, Rhonci & Wheezing
Adventitious Breath Sounds – YouTube

29. How to take respiration rate

30. Procedure for taking TPRs
If using glass thermometer, insert the thermometer. If axillary or rectal-hold the thermometer throughout the time. If oral, insert the thermometer and proceed to take the pulse and respiration.
B. If using electronic – take the temperature first, then proceed to the pulse and respiration

31. Procedure for taking TPRs
C. When taking the pulse and respiration, do not drop the wrist until both the pulse and respiration are taken. This way the person does not know when his/her respirations are being measured – insuring a more accurate measurement. D. When measuring axillary temperature, remove any clothing that could impede the accuracy of the temperature. Also clean the axilla if there is excessive deodorant or perspiration present.

32. Procedure for taking TPRs
E. When measuring the rectal temperatures, always lubricate the thermometer with water-soluble gel before inserting into the rectum. F. Never touch the bulb end of the thermometer with the fingers.

33. Do not write T =, P =, etc., simply 98.6 – 84 – 22.
Charting TPR
Do not write T =, P =, etc., simply 98.6 – 84 – 22.

34. Instruct on the correct reading of a glass thermometer
A. Read between the markings and numbers. B. Large lines indicate full degrees. C. Small lines are two-tenths of a degree.

35. Complete Graphing TPR activity

36. Blood Pressure
BP = The measurement of the force of blood against artery walls. 1. Force comes from the pumping of the heart. 2. If arteries are hardened or narrowed, this force might be increased to pump the blood throughout the body.

37. Blood Pressure Measurement
Measurement is done by listening for two sounds with a stethoscope - the first sound and the change in sound/or in some instances the last sound 1. The first sound is called the systolic blood pressure - it measures the pressure in an artery when the heart is contracting 2. The change in sound/or last sound heard is the diastolic blood pressure - it measure the pressure in an artery when the heart relaxes between contractions

38. Blood Pressure Measurements
BP is measured in units of millimeters of mercury (mmHg). 1. the top number/systolic is charted first, then the diastolic as in systolic/diastolic /80 is an example of a normal blood pressure and this would be in millimeters of mercury or mm Hg

39. Blood pressure values
A. Normal range of B/P = 90/ /90 B. B/P < 90/60 is said to be hypotensive. 1. Hypotension symptoms include: dizziness, light-headedness, & might faint. 2. No presence of signs and symptoms

40. Blood pressure values 3. Contributing factors include
a. Medications b. Exercise/fitness level
c. Illness d. injury
Pain f. Body position
Shock h. Hemmorhage
i. Family Hx. j. diet

41. a B/P greater than 140/90 mmHg is said to be hypertensive
1. Hypertension is called the silent killer because there are often no symptoms. Some people might experience headache, pressure in the head, ringing in ears, general feeling of malaise. 2. Continued elevation over time may result in a Cerebral Vascular Accident (stroke).

42. Blood Pressure Systolic (top #) Diastolic (bottom #) Blood Pressure
Normal
Pre-hypertension
Hypertension
Systolic (top #)
120 mmHg or less
mmHg
140 mmHg or higher
Diastolic (bottom #)
80mmHg or less
80-89mmHg
90mmHg or higher

43. High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially along with other risk factors.

44. High blood pressure can occur in children or adults
High blood pressure can occur in children or adults. It's particularly prevalent in African Americans, middle-aged and elderly people, obese people and heavy drinkers. People with diabetes mellitus, gout or kidney disease have hypertension more often.

45. High blood pressure usually has no symptoms
High blood pressure usually has no symptoms. It's truly a "silent killer." But a simple, quick, painless test can detect it.
BP monitoring video

46. How to take blood pressure
What bp sounds like: Taking Blood Pressure with Sound's of HeartBeat :) – YouTube
Self bp w/manual operations: Video: How to measure blood pressure using a manual monitor - MayoClinic.com
BP Sounds: Korotkoff Blood Pressure Sights and Sounds on Vimeo

47. Instruments need to take blood pressure
A. Blood pressure cuff/sphygmomanometer 1. This must fit the arm properly. The width of the cuff should approximately equal the width of the upper arm. 2. The gauge should be calibrated and the needle should be on 0 B. Stethoscope

48. BP Procedure
A. Person should be comfortably seated or lying down B. Should have rested for minutes prior to the reading C. Arms that are paralyzed, injured, have an IV or shunt should not be used

49. BP Procedure
D. Infant blood pressures can be taken on the leg, but adults must use the arm E. Electronic blood pressure equipment can be used - the type used most often in the hospital setting is the Dyna-map F. Excess air should be squeezed out of the cuff

50. Taking BP
F. Excess air should be squeezed out of the cuff G. Cuff should be placed snugly on upper arm. H. Gauge should be easily visualized I. Valve should be closed, but easily able to be opened J. Two techniques for obtaining the pressure 1. Find radial pulse. Pump cuff till pulse no longer palpated. Then pump another 30 mm Hg higher. Place diaphragm of stethoscope on brachial artery about ½ - 1 inch above the elbow. Release the valve and listen for the two measurements - slowly deflating the cuff.

51. Taking BP
2. Find brachial artery and put diaphragm over the site. Pump cuff to 120 mm Hg and listen for the heart beat. If it is heard, pump another 30 mm Hg and listen again. When the pulse is no longer heard, then pump another 30 mm Hg and slowly deflate, listening for the two measurements.

52. Taking BP
K. If reading is uncertain, wait 30 seconds to 1 minute before remeasuring L. Record the reading and report any abnormalities. If the B/P reading is outside of the normal limits, retake it before reporting

53. How to Take Vitals Vital Signs (Nursing Procedures) - Pluto – YouTube
Children’s vitals:
UCC Nursing Students Vital Signs Get'em RIght! – YouTube
EMT vital skills:

54. Reference