1. Chapter 15: Measuring Height, Weight, and Vital Signs

2. Vitals
When you go to the doctor‘s office, your vital signs are some of the first things your health professional will evaluate
Vital signs are clinical measurements that indicate the state of a patient's essential body functions. Vital signs are a quick and effective way to monitor a patient‘s condition.

3. Vital Signs Are Measured:
Upon admission
As often as required by the person’s condition
Before & after surgery and other procedures
After a fall or accident
When prescribed drugs that affect the respiratory or circulatory system
When there are complaints of pain, dizziness, shortness of breath, chest pain
As stated on the care plan
When Measuring Vital Signs
Usually taken with the person sitting or lying
The person is at rest
Always report:
A change from a previous measurement
Vital signs above or below the normal range
If you are unable to measure the vital signs

4. Vitals Vital signs measure some of the body’s essential functions.
Temperature
Pulse (heart rate)
Respiration
Blood Pressure
Breathing Sounds
Oxygen Saturation

5. Height and Weight
Used to determine if patient is underweight or overweight
Height and weight charts are used as averages
Weight greater or less than 20% considered normal
BMI or Body Mass Index a statistical measure of body weight based on a person's weight and height.
BMI from 18.5 to 24.9 is considered normal
Baseline measurement at patient’s first visit
Measured in kg or lbs
Common types of scales
Balance beam
Dial
Digital

6. General Guidelines:
Use the same scale every day
Make sure the scale is balanced before use
Weigh the patient at the same time each day
Remove jacket, robe, and shoes before weighing
OBSERVE SAFETY PRECAUTIONS!
Prevent injury from falls and the protruding height lever.
Some people are weight conscious.
Make only positive comments when weighing patients

7. Height and Weight (cont’d)
The three types of scales—balance beam, dial, & digital

8. Height and Weight (cont’d)
Patients Required to Have Weight Measured
Pregnant patients
Infants
Children
Older adults
Patients prescribed medication based on body weight
Those attempting to lose or gain weight
Those with certain conditions

9. Height and Weight (cont’d)
Measured by
Movable ruler on back of most balance beam scales
Rule mounted on wall
Parallel bar on ruler is moved down against patient’s head
Measured in inches or cm

10. Temperature
Body temperature is defined as the measurement between heat lost and heat produced by the body.
How can heat be lost?
How can heat be produced?
These reactions maintain homeostasis
Body temp is measured by…?

11. Temperature
Overview
Core temperature: relatively constant internal temperature of body
Normal (afebrile) range: 97°F to 99°F (36.1°C to 37.2°C)
Febrile: >99°F (37.2°C) or feverish temporary increase in temperature
Hypothermic: <95°F (35°C)

12. Temperature (cont’d) Neural Control of Body Temperature
Hypothalamus: part of brain that regulates body temperature
If body too cool, brain signals to conserve & generate heat
If body too warm, brain signals to carry heat away from core to surface

13. Temperature (cont’d) Factors Influencing Body Temperature
Age: higher in children than adults; lower in older adults
Gender: slightly higher in women
Exercise: increases temperature
Time of day: lowest in early morning, before activity
Emotions: rises with stress, falls with depression
Illness: can increase or lower

14. Temperature (cont’d) Sites for Measuring Temperature Mouth
Rectum (most accurate)
Tympanic: ear or temple (best for children)
Axillary
Skin

15. Temperature Comparisons
Fahrenheit
Centigrade
Oral
Rectal
Axillary
Tympanic

16. Temperature (cont’d) Types of Thermometers Electronic Tympanic (ear)
Temporal (forehead)
Disposable

17. Temperature (cont’d)
Electronic thermometers and probes

18. Temperature (cont’d)
Tympanic thermometer

19. Temperature (cont’d)
Disposable thermometer

20. Temperature (cont’d)
Temporal artery thermometer

21. Pulse
Overview
The pulse, or heart rate, is the number of times the heart beats per one minute.
A pulse consists of two phases: contraction and re-laxation. The combination of one contraction phase and one relaxation phase is equal to one heartbeat.
Allows measurement of heart rate
Indicates flow of blood to a particular area
A healthy adult should have a pulse that ranges from heart beats per one minute
Readings may vary

22. Pulse (cont’d) Factors Influencing Pulse
Age: greater in infants, children, & some older adults
Fitness: lower in conditioned athletes
Time of day: lower in early morning, higher later in day
Body type & size: lower in tall, thin people; higher in short, stocky people
Stress or emotion: higher in anger, fear, excitement, & stress; lower in depression
Fever: higher
Medications: higher or lower
Blood volume: higher with decreased blood volume

24. What areas of the body can we get a pulse reading?
A pulse can be detected from areas of the body where an artery is closest to the surface of the skin.

25. Pulse (cont’d) Pulse Sites Carotid artery (neck)- during CPR
Brachial artery (bend of elbow)-Blood Pressure
Radial artery (wrist)- to count pulse
Femoral artery (thigh/torso)- assessment and procedures
Popliteal artery (back of knee)- assessment
Posterior tibial artery (ankle)- assessment
Dorsalis pedis (top of foot)- assessment
Apical (over heart)- use stethescope

26. Pulse (cont’d)
Carotid pulse point

27. Pulse (cont’d)
Brachial pulse point

28. Pulse (cont’d)
Radial pulse point

29. Pulse (cont’d)
Femoral pulse point

30. Pulse (cont’d)
Popliteal pulse point

31. Pulse (cont’d)
Dorsalis pedis pulse point

32. Pulse (cont’d)
Posterior tibial pulse point

33. Pulse (cont’d) Pulse Characteristics Pulse rate
# of heartbeats in 1 min
Average: 60 to 100 bpm
Bradycardia: <60 bpm
Tachycardia: >100 bpm
Pulse rhythm
Pattern of heartbeats
Arrhythmia: abnormal heart rhythm
Pulse strength: soft, bounding, weak, thready, strong, or full

34. Pulse (cont’d) Taking a Pulse Manually Place fingers over pulse point
Index & middle
Middle & ring
Index, middle, & ring
Radial artery (on inside of wrist) is most common site
Count heartbeats for 30 seconds (& multiply by 2) or for 1 min

35. Pulse (cont’d) Using a Stethoscope Auscultate: to hear a pulse
Place stethoscope over patient’s heart
Doppler ultrasound stethoscope
Amplifies sound of pulse
Used when pulse is difficult to palpate or hear

36. Pulse (cont’d)
The stethoscope

37. Pulse (cont’d)
Doppler ultrasound stethoscope

38. Respiration
Overview
Exchange of gases between atmosphere & blood in body
Carbon dioxide is expelled
Oxygen is taken in
Respiration = 1 inhalation + 1 exhalation
measured when you are at rest
A healthy range is breaths per minute.

39. Respiration (cont’d) Inhale (breathe in) Exhale (breath out)
Air flows into lungs
Diaphragm contracts & flattens
Rib cage rises & expands
Exhale (breath out)
Air flows out of lungs
Diaphragm relaxes, becomes dome-like
Rib cage contracts

40. Respiration (cont’d) Characteristics of Respiration Rate
# of respirations per min
Normal (adults): 12 to 20 times per min
Eupnea: normal respiration
Rhythm: pattern of spacing between breaths
Depth: volume of air inhaled & exhaled

41. Average Normal Resting Respiration Ranges by Age
Respiration per Minute
Infant
20+
Child
18-20
Adult
12-20

42. Respiration (cont’d) Factors Influencing Respiration
Physical condition
Disease
Medication
Exercise
Pain
Emotions

43. Respiration (cont’d) Breathing Conditions
Tachypnea: fast respiratory rate
Bradypnea: slow respiratory rate
Dyspnea: difficult or labored breathing
Orthopnea: condition in which breathing is easier in an upright position
Apnea: temporary cessation of breathing
Cheyne-Stokes – periods of dyspnea followed by periods of apnea; often noted in the dying patient
Rales – bubbling or noisy sounds caused by fluids or mucus in the air passages

44. Blood Pressure Overview Pressure of blood against arterial walls
Measured during contraction & relaxation phases of heartbeat
Systolic pressure: highest pressure in arteries in contraction
Diastolic pressure: lower pressure when heart relaxes
Measured using a stethoscope & sphygmomanometer
Measured in millimeters of mercury (mm Hg)
Written as systolic/diastolic
Normal: <120/80 mm Hg

45. Blood Pressure Blood pressure is controlled by:
The force of heart contractions
weakened heart  drop in BP
The amount of blood pumped with each heartbeat
loss of blood  drop in BP
How easily the blood flows through the blood vessels
Narrowing of vessels  increase in BP
Dilatation of vessels  decrease in BP
Blood Pressure

46. Normal < 120/80 mm Hg
Elevated: SBP and DBP < 80 mm Hg
Stage I hypertension: SBP or DBP mm Hg
Stage II hypertension: SBP >= 140 or DBP >= 90 mm Hg

47. Blood Pressure (cont’d)
Factors Affecting Blood Pressure
Age
Activity
Stress
Body position
Medications

48. Blood Pressure (cont’d)
Blood Pressure Conditions
Hypertension: persistently above-normal blood pressure
The development of hypertension is directly affected by weight, inactivity, alcohol consumption, and salt intake.
Hypertension (HTN) causes and accelerates the progression of: Coronary artery disease, heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), left ventricular hypertrophy, aortic aneurysm development, peripheral arterial disease, stroke, chronic kidney disease, and retinopathy.
Hypotension: persistently below-normal blood pressure

49. Blood Pressure Readings
Systolic BP (mm Hg)
Diastolic BP (mm Hg)
Normal
<120
&
<80
Prehypertension or
80-89
Hypertension, stage I
90-99
Hypertension, stage II
≥160
≥100

50. Blood Pressure (cont’d)
Blood Pressure Equipment
Aneroid sphygmomanometer
Electronic sphygmomanometer
Doppler ultrasound stethoscope

51. Blood Pressure (cont’d)
Measuring Blood Pressure-Careful attention must be paid to the use of appropriate techniques, as measurement error(s) can lead to inaccurate values and diagnoses.
Wrap cuff around upper arm
Place stethoscope on inside of elbow
Squeeze hand pump to inflate cuff (artery is squeezed shut)
Turn screw valve slowly counterclockwise, releasing air
Listen through stethoscope as blood flows through vessel

52. Blood Pressure (cont’d)
Conditions Contraindicating Blood Pressure Reading in an Arm
Intravenous (IV) line
Dialysis shunts
Major cuts or wounds

53. Blood Pressure (cont’d)
Charting Vital Signs
Provides picture of patient’s health over years
Helps identify development of chronic health conditions
Recorded using either flow sheets or narrative charting
If flow chart is electronic, data can be converted to chart or graphic