1. Vital Signs

2. 4 main vital signs
Pulse
Temperature
Respirations
Blood pressure

3. PULSE
The pressure of the blood pushing against the wall of the vein as the heart beats and rests

4. WHERE TO FIND PULSES?
Pulse points are where the artery is between finger tips and a bony area
Felt with 2-3 fingers, but never the thumb

5. PULSE POINTS AND THEIR LOCATIONS
Temporal (sides of head)
Femoral (groin area)
Apical (apex of heart)
Popliteal (behind knee)
Posterior Tibial (ankle)
Carotid (neck)
Brachial (crook of elbow)
Radial (wrist)
Dorsal Pedalis (top of foot)

6. HOW TO MEASURE? Measured in beats per minute
Count the beats for 60 seconds
Or, count the beats for 30 seconds and multiply by 2
Or, count the beats for 15 seconds and multiply by 4

7. NORMS Pulses should be 60 - 100 beats per minute
Faster than 100 is tachycardia – can be caused by stress, pain, exercise
Slower than 60 is bradycardia – can be caused by medications, severe lack of oxygen.

8. Late Adulthood (Elderly)
Norms Continued
AGE
Newborn
1 month to 1 year
1 to 6 years
6 years to adolescence
Adult
Late Adulthood (Elderly)
RANGE
80-140
80-120
75-110
72-80
60-80

9. Using a stethoscope
The ear pieces and bell/diaphragm of the stethoscope should be cleaned with alcohol before and after each use
The ear pieces of the stethoscope should be bent forward toward the nose when placed in ears
Bell/diaphragm should be closed to get the best sound

10. TEMPERATURE

11. ROUTES TO MEASURE TEMPERATURE
Oral: By mouth
Rectally: By rectum
Axillary: armpit
Tympanic: In the ear
Forehead: Sweep across the forehead

12. PICTURES OF THERMOMETERS

13. Oral Temperature Norms: 97.6 - 99.6 degrees Fahrenheit
Thermometers: Digital and Mercury (glass)
Under the tongue for 3 to minutes

14. Rectal Temperature Norms: 99.6 - 100.6 Degrees Fahrenheit
Inside the rectum for 3 to 5 minutes
Adults: 1 to 1 ½ inches
Infants: ½ to 1 inch
Tips to know:
(a) Always lubricate the thermometer and hold it in place entire time
(b) DO NOT USE THIS METHOD ON PATIENTS THAT HAVE OR HAD HEART - CARDIAC PROBLEMS!!!
Most accurate measure of temperature

15. Axillary Temperature Norms: 96.6 - 98.6 Degrees Fahrenheit
Under the armpit

16. Tympanic (EAR) Temperature
Norms: Fahrenheit
Type Thermometers:  Tympanic Digital (it measures the thermal energy radiating from the ear blood vessels)
LEAST accurate measurement

17. Forehead Thermometers
Norms: Degrees Fahrenheit
Type Thermometers: Temporal Digital
Sweep across forehead

18. Temperature Vocabulary
Hypothermia- Temperature falls below 95̊̊ F
Hyperthermia- temperature above 102
Pyrexia- Means fever
Hyperpyrexia- fever above 106̊ F
(All of these can lead to death if not treated!)

19. READING THE THERMOMETER
Mercury Fahrenheit thermometers are read by degree and 0.2 of a degree
Long lines indicate degrees
Short lines indicate 0.2 of a degree
Four short lines between each long line (0.2, 0.4, 0.6, 0.8)

21. RESPIRATION
The mechanical act of breathing in air (inspiration) and expelling air (expiration) from the body

22. Norms Adult average 12-20 breaths per minute
Tachypnea: greater than 20
Bradypnea: less than 12
Newborns to 6 months: breaths per minute
Toddlers: breaths per minute

23. When To Measure You measure while you are taking temperature
Why do you think it would be important not to let the patient know that you are measuring respirations?
ANSWER: It may change the rate, depth, and rhythm of breathing.

24. What Can Change Respiration Rate?
Hyperventilation (breathing too fast/shallow)
-Physical or mental stress, (infection, exercise, anxiety)
-Increase in body temperature.
Hypoventilation (breathing too slow)
-Pain medications
-Decrease in body temperature.

25. TERMS Orthopnea - Sitting upright to breath more easily
Apnea - No breath
Hyperpnea - Fast, deep breathing
Tachypnea - Fast, shallow breathing
Wheezing – High-pitched whistling sound when exhaling.
Bradypnea - Slow breathing
Dyspnea - Painful or difficult breathing
Hyperventilation – increased movement of air in/out of lungs.
Hypoventilation – decreased movement of air in/out of lungs.

26. Blood Pressure
Amount of pressure or tension put on the arterial wall as blood pulsates or goes through the arteries.

27. How are the Two Pressures Measured?
Systolic blood pressure – the pressure placed on the arteries when the heart is contracting or squeezing. This number is the largest number!
Diastolic blood pressure – the pressure on the arteries when the heart is resting or not contracting. This number is usually lower!
Example: 120/80; 100/60
It is measured in millimeters (mm) of mercury (Hg)

28. What are the Blood Pressure Values?BP
Normal
Prehypertension
Hypertension
Systolic
(top #)
90-119
140 or higher
Diastolic
(bottom #)
60-79
80-89
90 or higher
Hypotension = BP less than 90/60
Hypertension “silent killer” = BP greater than 140/90

29. What Causes Hypertension? (High Blood Pressure)
Called silent killer because there are often no symptoms
Some individuals may have headaches, pressure in head, ringing in ears
Can be caused by:
Overweight
Emotional upset / anxiety
Family history
High salt diet
Pain
If left unnoticed can lead to stroke, kidney disease, heart disease, and death!
High Risk Individuals:
African Americans
Elderly
Heavy drinkers
Middle-aged

30. What causes Hypotension? (Low Blood Pressure)
Symptoms: dizzy, light-headed, or they may feel faint.
Medications
Level of physical fitness – ex. Someone extremely fit or one exercises a lot.
Illness
Decrease blood volume
Injury
If not corrected could lead to death.

31. Where can we take Blood Pressures?
Brachial – inner aspect of forearm (crease of elbow)

32. What kind of Equipment can we use to take blood pressure?
Sphygmomanometer
“sphygmo” = pulse
“mano” = pressure
“meter”= measure *

33. Aneroid – dial with a needle
that points to numbers

34. Electronic – digital display
You will not need a stethoscope when you are using an electronic one, but you need one when using the non-electric one.