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Vital Signs Health Science
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State Standard 19) Understand principles of and successfully perform skills related to Medical Assisting Skills, incorporating rubrics from textbooks or clinical standards of practice for the following: a. Temperature, pulse, respiration and blood pressure assessment b. Screening for vision problems
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Objectives Students will identify the types of vital signs
Students will explore normal and abnormal vital signs Students will demonstrate knowledge of vital signs through performing assessments of a partner using a rubric.
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Vital Signs Temperature Pulse Respiration Blood pressure Pain
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Vital Signs Indicators of body function
Assess body systems Signify changes taking place in body Observations should also include Skin color & temp Behaviors Statements from resident (subjective) Discussion: Which body systems are we assessing when we take pulse, BP, and respirations?
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Temperature Balance of heat gained & heat lost
Hypothalamus is temp regulation center Heat produced by Cellular activity Infection elevates temp Brain injury can increase or decrease temp Break down of food Muscle activity Exercise elevates temp Hormones External factors – heat, hot drinks, warm clothing Internal factors – dehydration
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Discussion Applying what you know about temperature, theorize what will happen to a patients temperature in the following scenarios. Sleeping Coma Pneumonia Long distance running
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Temperature Heat is lost from body through the… Skin Lungs Elimination
Sweating Increased blood flow to skin surface Lungs Increased resp rate Elimination Urine or feces
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Temperature Heat conserved by body through Reducing perspiration
Decreasing flow of blood to skin Shivering Increases muscle activity & produces heat Discussion: Theorize in the following scenarios how the body will respond to maintain a proper temperature. Running Skiing Hot tub
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Temperature Norms Adult 97 – 99 degrees Fahrenheit Oral – 98.6
Rectal – 99.6 Axillary – 97.6 Tympanic – 98.6 Normal temperature degrees Pyrexia- fever over degrees Afebrile- without fever Hyperthermia- increased body temperature Hypothermia- decreased body temperature Lower in the AM and Higher in the PM
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Discussion Using the terminology that you just learned about temperature, describe the following patient temperatures. 102.3 degrees 95.4 degrees 99.9 degrees
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Temperature procedure
Wait 10 minutes if the patient has eaten, drank, or smoked. Explain what you are doing Wash your hands Apply gloves Put cover on the temperature probe
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Contraindications for oral temps
Confused, disoriented Restless Unconscious Coughing, unable to breathe through nose Seizures Oral/nasal oxygen NG Discussion: Theorize why you would not want to take a confused or disoriented patient temperature orally.
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Contraindications for rectal temps
Diarrhea Fecal impaction Rectal bleeding Hemorrhoids Surgical rectal closure When doing rectal temps, remember Lubricant before inserting thermometer Insert 1 – 1 ½ inches Hold thermometer in place NEVER leave resident Discussion: Theorize why you would not leave a patient that has a rectal thermometer in place.
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Pulse Force against the arterial walls that cause them to expand with each heartbeat Palpation-process of pressing an artery against a bone to feel a pulse Count for one minute Norm adult pulse is 60 –90 beats/min < 60 beats/min = bradycardia > 100 beats/min = tachycardia Discussion: Why would it be good practice to count the pulse for a full minute the first time you take it?
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Major pulse sites Carotid – neck
Apical – left chest below nipple (need stethescope) Brachial – inner aspect of elbow Radial – thumb side of wrist Femoral – groin Popliteal – behind knee Posterior tibialis – behind inner ankle Dorsalis pedis – on top of foot
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Discussion Take a moment and try to find the pulse points on yourself.
Can you tell a difference between the pulses of your upper body vs. the ones of your lower body?
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Factors that increase pulse
Exercise Strong emotions – fear, anger, laughter, excitement Fever Pain Shock Hemorrhage Discussion: Explain why your pulse increased during exercise.
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Factors that decrease pulse
Sleep/rest Depression Drugs – digitalis, morphine Athletes in good physical condition may have a lower pulse, probably <60 beats/min. This is normal Discussion: Explain why your pulse decreases while you sleep.
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Qualities of pulse Rate – number of beats/min Tachycardia- fast
Bradycardia- slow Rhythm – regularity of pulse Irregular-arrhythmia Strength – force Weak or thready Bounding Strong Discussion: How would you document the following pulse information? 40 beats per minute, then jumps to 45 beats per minute, barely palpable.
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Respiration Exchange of oxygen & carbon dioxide in lungs
1 respiration = 1 inhalation + 1 exhalation Regulated by the medulla in the brain Normal adult rate is 14 – 18 breaths/min Normal breathing is quiet, effortless, & regular in rhythm Discussion: Is respiration considered a voluntary or involuntary process?
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Qualities to observe for Resp
Rate- normal breaths/minute Tachypnea > 25 breathes per minute Bradypnea <10 breathes per minute Apnea – absence of respirations Rhythm Depth – shallow, norm, deep Effort involved to breathe Dyspnea- severe Shortness of breath Orthopnea- difficulty breathing lying down Color of skin, mucous membranes, nailbeds – check for cyanosis (bluish skin)
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Discussion Theorize what the breathing pattern of someone who is suffering from an asthma attack might be like.
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Process of taking vital signs
Take temperature first Pulse second Respirations last When taking resp., keep fingers on pulse so that patient does not know you are counting respirations Document all together Discussion: Why do you not want the patient to know that you are counting their respirations?
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Blood pressure Pressure exerted against walls of blood vessels
Systolic – highest reading Pressure when heart contracting Diastolic – lower reading Pressure when heart is at rest Hear thumping sounds as blood flows through arteries Sounds correspond to numbers representing mm Hg on sphygmomanometer (BP cuff) First sound heard is systolic Last sound heard is diastolic
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Blood pressure Normal adult reading 120/80 Normal systolic = under 120
Normal diastolic = under 80 Abnormal readings Hypertension – BP > 140/90 Hypotension – BP < 100/60 Discussion: Describe the following patient blood pressures. 160/98, 90/56, 120/60
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Factors increasing BP Strong emotion Exercise Sitting or standing Excitement Pain Decrease of vessel size Digestion Improperly placed or sized cuff Arterial resistance Artery Elasticity Blood volume Discussion: When the BP of a patient increases, what other vital sign will also increase?
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Factors decreasing BP Hypotension
Rest/sleep Starvation Lying down Depression Shock Hemorrhage (blood loss) Improperly sized cuff Discussion: Applying what we have learned so far, describe the vital signs of someone who is asleep.
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Equipment for BP Sphygmomanometer Stethoscope
Cuff too tight can give a false high Cuff below heart level will give false high Cuff too large or improperly placed can give false low
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Procedure for BP Guidelines Measure BP at brachial artery
Do not use injured arm, arm with IV, or casted Resident should be at rest Position arm level with heart Apply cuff to bare arm NOT over clothing Use appropriate size cuff Position sphygmomanometer at eye level Discussion: Theorize why you would you not take a blood pressure in an arm with an IV?
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Pain Ask resident if they have pain
Observe facial expression, movement, respiration Ask level of pain using facility method (Usually number 0 – 10) Document pain level Discussion: Theorize how someone's vital signs will react when they are in pain.
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Charting VS Report normal and abnormal
Record on flow sheets, graphic records, & notes according to facility Chart rectal temps with “R” Chart axillary temps with “Ax” Pulse readings other than radial are noted If BP in a place other than the arm, note location Write BP on chart as a fraction
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Activity Follow the provided Rubric and complete a full assessment of 10 “patients”. Make sure to take the vital signs in the correct order and with correct procedure. I will be observing you as well. Individually write an essay detailing why knowledge of vital signs a good foundational skill to have when going into the health care field.
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