Vital Signs

What are the standard vital signs that will be important to providing PT treatment?

Blood Pressure (BP) Pulse (heart rate) Respiration Temperature Pain

What information can vital signs provide?

Vital signs can … give quantitative measures of the function of cardiovascular and respiratory systems. indicate the body’s physiological status and function of internal organs.

Why monitor vital signs

Monitor vital signs to … to establish baselines monitor effectiveness/ineffectiveness of an activity establish prognosis, POC, goals

Variables that may affect vitals: (see 208) food consumption meds level of physical activity response to stress time of day vitals are taken general health of patient alcohol or narcotic drug consumption These factors may be modified

age gender hormonal status family history These factors can not be changed.

Blood Pressure

What is blood pressure?

Blood pressure is the pressure of the blood against the walls of the arteries. Blood pressure results from two forces. One is created by the heart as it pumps blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow.

What do blood pressure numbers indicate? The higher (systolic) number represents the pressure while the ventricles contracts to pump blood to the body.  The lower (diastolic) number represents the pressure when the ventricles relaxes between beats.

The systolic pressure is always stated first The systolic pressure is always stated first. For example: 118/76 (118 over 76); systolic = 118, diastolic = 76. Normal systolic pressure = 90-120 mm Hg Normal diastolic pressure = 60-80 mm Hg

How to document BP? Systolic/Diastolic 120/80 ** Also document the arm that BP was taken

*** STUDENTS SHOULD KNOW*** Review Table 12-1, page 209 *** STUDENTS SHOULD KNOW***

BP will vary with age. BP will increase with ex especially systolic due to vasodilation of peripheral blood vessels.

Hypertension (HTN) Hypertension (HTN) - abnormally high BP HTN increases risk for coronary artery disease, CHF, CVA, PVD, and kidney failure. Primary vs. Secondary HTN Primary – no identifiable cause Secondary – caused by another disease/cause such as renal disease, pregnancy, or meds

Othostatic (Postural) Hypotension Othostatic (Postural) Hypotension - sudden drop in BP while moving from lying down to sitting or standing

Blood Pressure Assessment

Equipment Blood pressure cuff stethoscope sphygmomanometer

Blood pressure cuff

Cuff should be appropriate size for patient arm.

Stethoscope

Sphygmomanometer

Review procedure on page 211

http://homepage.smc.edu/wissmann_paul/anatomy1/1bloodpressure.html

Korotkoff’s sounds first sound you hear is systolic pressure the point the sound disappears is the diastolic pressure.

Pulse

Definition A rhythmic throbbing in an artery as a result of each heart beat. The “throbbing” is caused by the regular contraction and alternate expansion of an artery as the blood passes thru the vessel. The force of the pulse is dependent on the quantity of blood within the vessels.

Pulse Rate Normal adult pulse rate = 60 – 100 beats per minutes (bpm) Infants = 120 bpm Child = 125 bpm

Abnormal Pulse Rate Bradycardia = slow pulse, less than 60 bpm Tachycardia = raid heart rate, greater than 100 bpm

Pulse Assessment Pulse can be assessed at various superficial arteries: radial & carotid is most common Other sites: temporal, femoral, popliteal, and pedal Review procedure on page 213

Respiration

Definition Respiration is the act of breathing that involves the exchange of gases. The act of breathing involves inhaling (O 2 ) exhaling (CO 2).

Inhaling = inspiration Diaphragm moves downward and the intercostals mm lift the ribs and sternum up and out The thoracic cavity increases in size and the lungs expand with air

Exhaling = expiration Passive process where respiratory mm and thorax relax & lungs recoil

Respiration Rate Respiration can be influenced by age, body size & stature, body position, meds, emotions, and exercise/activities. Normal Adult = 12 – 18 breaths/minutes Infant = 30 br/min Child = 20 min

Breathing Abnormalities review definitions on page 214

Respiration assessment on page 214

Temperature

Body temp can provide info concerning basal metabolic rate, potential presence of infection, and metabolic response to exercise. Typically, PT and PTA’s do not measure body temp but they do need to knoe the methods and the norms.

Body temp can provide info on circulatory status, potential nerve injury, and local inflammatory responses and infection. Body temp can be measured by placing a thermometer in the mouth, rectum, under the arm and with some devices in the external auditory canal of the ear.

Normal body temperature varies by person, age, activity, and time of day. The average normal body temperature is 98.6°F (37°C). A temperature over 100.4 degrees Fahrenheit usually means you have an infection or illness. Body temperature normally changes throughout the day.

Temperature Norms ORAL RECTAL ºF ºC Normal Ranges 98.6-99.5 36.0-37.5 96.8-99.7 36.0-37.6

Terms related to temperature Afebrile – oral temp remains below 100 º F (Normal) Febrile - oral temp exceeds 100 º F