Respiratory Rate and Temperature 7. Respiratory rate - Inconspicuously watching chest movement (at least 20-30 seconds) 8. Temperature (thermometer will beep when done if electronic) Vital Signs: Blood Pressure Pulse (heart rate) Respiratory Rate and Temperature 7. Respiratory rate - Inconspicuously watching chest movement (at least 20-30 seconds) 8. Temperature (thermometer will beep when done if electronic)

BP Classification for Adults Category Systolic Diastolic Hypertension Stage 3 (severe) >180 >110 Stage 2 (moderate) 160-179 100-109 Stage 1 (mild) 140-159 90-99 High Normal 130-139 85-89 Normal <130 <85 Optimal <120 <80

Sphygmomanometers Sphygmomanometers Types Mercury-gravity Aneroid Automated Components: Pressure manometer Inflatable rubber bladder within an inelastic covering Size is important Width - 40% arm circumference Length – 80% arm circumference Most are marked Rubber hand bulb and pressure control valve  

Blood Pressure 2._____ Blood Pressure done - 1 arm 3._____ Systolic Pressure estimated by palpitation of brachial or radial arteries with blood pressure cuff. 4._____ Blood pressure done correctly (not over clothing, cuff tight, arm in correct relaxed position, not too rapid deflation; if retaken, does not repeatedly re-inflate) 5._____ Blood pressure taken with the bell of the stethoscope

The Patient The patient Not smoking, ingesting caffeine, or vigorous activity for 30 min prior Rest sitting comfortably for 5 – 10 min Room quiet and warm Arm rested and free of clothing Sitting in a chair Back supported Both feet on the ground Be aware of conditions which may alter BP such as: Dialysis fistula, Lymphedema Atherosclerosis Anxiety (white coat hypertension), Circadian variation  

Applying the cuff   Correct setting for patient as above Palpate brachial (or radial) artery Position arm so brachial artery is at heart level 4th intercostal space at its junction with the sternum Center bladder over brachial artery Cuff’s lower boarder 2.5 cm above antecubical crease Secure cuff snugly Slightly flex arm at elbow Estimating Systolic Pressure Inflate cuff until pulse is no longer palpable Read this pressure Deflate cuff

Auscultatory gap

Measuring the Blood Pressure The arm of the patient should be in a relaxed position. The brachial artery should be at the level of the right atrium. The blood pressure cuff should be inflated to approximately 20-30 mmHg above the estimated systolic blood pressure as estimated previously. The blood pressure cuff should be deflated about 2-3 mmHg per second. The bell of the stethoscope should be placed over the brachial artery. The pressure at which you hear two consecutive beats will be the systolic blood pressure, and the last audible sound before silence will be the diastolic pressure. The bell of the stethoscope is used because the last sounds in the diastolic pressure, or Korotkoff sounds, are low-pitched and are best heard with the bell of the stethoscope. The cuff should not be inflated multiple times as this will create venous pooling and may artificially lower the systolic pressure and elevate the diastolic pressure. If blood pressure is elevated, it should be taken at least once in both arms. Record to nearest 2 mm Hg Ex: 120/80

Phases of the Korotkoff Sounds Starts with a loud “thud” Recorded at level when 2 beats heard in a row Systolic There may be an auscultatory gap Phase 2 A blowing or swishing sound Phase 3 Softer thud than phase 1 Still crisp Phase 4 Muffing Softer blowing sounds that disappears Phase 5 Silence Diastolic

Pulse 6. The heart rate can be estimated by palpating the radial pulse for at least fifteen (15) seconds with one or two fingers. Multiplying this number by four (4), if the pulse was counted for fifteen (15) seconds, will yield the heart rate for one minute. If the heart rate is rapid or irregular, direct auscultation of the heart will yield a more accurate heart rate, since not all beats will generate a palpable pulse. Also, if the heart rate is irregular, the pulse should be palpated for a full minute to ensure an accurate heart rate estimate. Respiratory Rate The patient will subconsciously vary his/her respirations if they know their respirations are being monitored. Thus, counting of respirations should be done inconspicuously. It can be done as part of the posterior chest examination or during the vital signs.

8. The examiner should be able to take a temperature on a patient with both a standard mercury thermometer and an electronic thermometer. The proper cover should be used, and instructions should be administered to the patient on what to do (place the instrument under their tongue and hold it there). The temperature should be recorded in degrees Celsius (°C) or Fahrenheit (°F), and a note made of the route (axillary, oral, rectally, or central temperature).