1. Chapter 15
Vital Signs

2. 15:1 Measuring and Recording Vital Signs (VS)
Record information about the basic body conditions
Abnormalities from homeostasis
Main vital signs (VS)
Temperature
Pulse
Respiration
Blood pressure
HOMEOSTASIS – the ideal health sate in the human body

3. Other Assessments
Pain—patients asked to rate on scale of 1 to 10 (1 is minimal and 10 is severe)

4. Other Assessments Color of skin Pallor Cyanosis Jaundice Erythema
Ecchymosis

5. Other Assessments Size of pupils and reaction to light
ANISOCORIA – unequal pupils

6. Other Assessments
Level of consciousness

7. Other Assessments
Response to stimuli

8. Vital Sign Readings Accuracy is essential Report abnormality or change
Must know how to accomplish task with various equipment
Never guess or report false readings
Report abnormality or change
Severe abnormalities indicate life-threatening conditions
If unable to get reading, ask another person to check

9. 15:2 Measuring and Recording Temperature
Temperature: Measures balance between heat lost and heat produced in the body
Thermal activity
Heat produced by metabolism of food and by muscle and gland activity
Heat lost through perspiration, respiration, and excretion

10. 15:2 Measuring and Recording Temperature
Conversion between Fahrenheit and Celsius temperature
F C: C = (F - 32) x (5/9 or )
C F: F = (C x 9/5 or 1.8) + 32
Practice:
102o F to C 212o F to C
19o C to F 37o C to F
102F = = 70 x = 38.9 C
212F = 212 – 32 x = C
19C = 19 x 1.8 = = 66.2 F
37C = 37 x = 98.6 F

11. Variations in Body Temperature
Normal range
97-100o F, o C
Causes of variations
Size/shape of individual, time of day, part of body, metabolic activity
Accelerated body processes = higher body temperature
Lower body processes = lower body temperature
Morning = LOWER temperature as body has rested
Evening = HIGHER after muscular activity

12. Variations in Body Temperature
Temperature measurements — oral, rectal (often used on infants/children), axillary or groin, aural, and temporal
Normal:
Oral: 98.6o F Axillary: 97.6o F
Rectal: 99.6o F Aural/Temporal: no normal range

13. Variations in Body Temperature
Abnormal conditions affecting temperature
Increase:
Illness and infection
Exercise, excitement, fear
High environmental temperatures
Decrease: Starvation or fasting Sleep Sedation Mouth breathing Cold environmental temperatures

14. Variations in Body Temperature
Abnormal conditions
Hypothermia: body temperature < 95o F
Fever: elevated above 101o F
Pyrexia, Febrile, Afebrile
Hyperthermia: body temperature > 104o F
Fevers are usually caused by infection or injury
Pyrexia = fever
Febrile = fever is present
Afebrile = no fever present

15. Thermometers Clinical thermometers
Glass: contains mercury, analog
Electronic: digital reading, quicker results
Tympanic: use infrared energy
Temporal: measures temporal artery
Plastic or paper: disposable
Reading thermometers and recording results
Read in 1o increments, labeled by site
R, Ax,, A, 986
On a thermometer each short line represents 0.2 (two-tenths) of a degree.
Orally it does not need to indicate it. It is assumed it is an oral reading
R = Rectal
Ax = Axillary
A = Aural
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17. Thermometers (continued)
Avoid factors that could alter or change temperature
Examples???
Cleaning glass clinical thermometers
Clean with alcohol wipe or soap/cool water
Paper/plastic sheath on glass thermometer
Used to prevent transmission of disease
Dispose of properly
Still wipe with alcohol pad
Examples = eating, drinking, smoking in the last 15minutes

18. 15:3 Measuring and Recording Pulse
Pulse: Pressure of the blood pushing against the wall of an artery as the heart beats and rests
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19. 15:3 Measuring and Recording Pulse
Major arterial or pulse sites
Temporal
Carotid
Brachial
Radial
Femoral
Popliteal
Dorsal Pedal
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20. 15:3 Measuring and Recording Pulse
Must note 3 different factors of the pulse:
Pulse rate (beats per min)
Pulse rhythm (regular or irregular)
Pulse volume (strong, weak, thready, bounding)
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21. 15:3 Measuring and Recording Pulse
Pulse rate – adult bpm, varies
Bradycardia: slow pulse rate, < 60 bpm
Tachycardia: fast pulse rate, >100 bpm
Pulse rhythm – spacing between beats
Regular vs. irregular
Arrythmia: abnormal heart rhythm
Pulse volume – strength/intensity of the pulse
Strong vs. weak, thready, bounding
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22. Measuring and Recording Pulse
Factors that change pulse rate
Increase: Exercise Stimulant drugs Excitement Fear Fever Shock Nervous tension
Decrease: Sleep Depressant drugs Heart disease Coma Physical training

23. Measuring and Recording Pulse (continued)
Basic principles for taking radial pulse:
Patient positioned comfortably, palm down
Use tip of index/middle fingers to locate pulse on thumb side of wrist
First beat counted starts with zero
10 sec x 6
15 sec x 4
30 sec x 2
60 sec

24. Measuring and Recording Pulse (continued)
Recording information:
Include rate, rhythm, volume
Example:
P 82 regular and strong
(rate)(rhythm)(volume)

25. 15:4 Measuring and Recording Respirations
Respiration: Measures the breathing of a patient
Process of taking in oxygen and expelling carbon dioxide from the lungs and respiratory tract
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26. 15:4 Measuring and Recording Respirations
One respiration: one inspiration (breathing in) and one expiration (breathing out)
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27. Measuring and Recording Respirations (continued)
Normal respiratory rate
Adults: breaths per minute
Children: per minute
Infants: per minute

28. Measuring and Recording Respirations
Must note 3 different factors:
Rate (breaths per minute)
Character (depth and quantity)
Rhythm (regularity)

29. Measuring and Recording Respirations (continued)
Character of respirations – refers to depth and quality
Deep vs. shallow, labored, moist, difficult, noisy
Rhythm of respirations – refers to spacing between breaths
Regular (or even) vs. irregular

30. Measuring and Recording Respirations (continued)
Abnormal respirations
Dyspnea: difficulty breathing
Apnea: absence of respirations
Tachypnea: rapid, shallow > 25/min
Bradypnea: slow <10/min

31. Measuring and Recording Respirations (continued)
Abnormal respirations
Orthopnea: severe dyspnea in any position besides sitting or standing
Cheyne-Stokes: abnormal breathing pattern, periods of dyspnea and apnea
Rales: bubbling or noisy sounds caused by fluid
Cheyne stokes – chain stokes

32. Measuring and Recording Respirations (continued)
Voluntary control of respirations
Respiration can be controlled if consciously thought about
Important to keep the patient unaware breathing is being assessed
Do not tell the patient you are counting respirations

33. Measuring and Recording Respirations (continued)
Record information
Rate, character, rhythm
Ex: A child with R 22, shallow, labored, and regular would suffer from?
Ex: An adult with R 8, deep, regular would suffer from?
Ex. Tachypnea
Ex. Bradypnea

34. 15:5 Graphing Temperature (TPR)
Graphic sheets are special records used for recording TPR
Presents a visual diagram (easier to follow)
Uses – hospitals or long care facilities
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35. 15:5 Graphing TPR Color codes Temperature in blue Pulse in red
Respirations in green
Factors affecting vital signs are often noted on the graph
Surgeries, medications, day & time, etc.
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36. Graphing TPR (continued)
Graphic charts are legal records
Must be legible and neat
Completed in ink
Use straightedge to connect lines
HIPAA act!
To correct an error: cross out in red ink and correct, initial next to correction

37. Graphing TPR (continued)
Basic principles for completing:
Fill in patient information accurately
Fill in dates, times (mm/dd/yyyy, __:__am/pm)
Adm = admission (first measurement)
Following days are numbered
PO = after surgery
PP = post partum (after delivery)

39. 15:7 Measuring and Recording Blood Pressure
Blood Pressure: Measurement of the pressure the blood exerts on the walls of the arteries during the various stages of heart activity
Measured in millimeters of mercury (mmHg) on a sphygmomanometer
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40. Measuring and Recording Blood Pressure (continued)
Systolic pressure: pressure when left ventricle contracts and pushes blood to arteries
Normal is <120 mmHg (range of mmHg)
First sound heard during reading of sphygmomanometer

41. Measuring and Recording Blood Pressure (continued)
Diastolic pressure: constant pressure when left ventricle is at rest, or between contractions
Normal is < 80 mmHg (range of mmHg)
Last sound heard during reading of sphygmomanometer

42. Measuring and Recording Blood Pressure (continued)
Blood pressure is read as a fraction
Systolic pressure / Diastolic pressure
Ex: (120/80 mmHg)

43. Measuring and Recording Blood Pressure (continued)
Pulse pressure: difference between systolic & diastolic pressure
Important indicator of health and tone of arterial walls
Normal range is mmHg
The pulse pressure should be approximately one third of the systolic reading ( = 40)

44. Measuring and Recording Blood Pressure (continued)
Hypertension—high blood pressure
Prehypertension ( mmHg / mmHg)
Systolic > 140 mmHg / Diastolic > 90 mmHg
Hypotension—low blood pressure
Systolic < 90 mmHg / Diastolic < 60 mmHg
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45. Measuring and Recording Blood Pressure (continued)
Factors influencing blood pressure readings (high or low)
Force of heartbeat
Resistance of arterial system
Elasticity of the arteries
Volume of blood in arteries
Position of the patient (standing vs sitting vs lying down)
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46. Measuring and Recording Blood Pressure (continued)
Increased BP
Excitement, anxiety, nervous tension
Pain
Obesity
Stimulant drugs
Exercise and eating
Smoking
Decrease BP
Rest or sleep
Depressant drugs
Shock
Dehydration
Hemorrhage
fasting

47. Measuring and Recording Blood Pressure (continued)
Types of sphygmomanometers
Mercury: uses a column of mercury in a tube to measure the pressure (discouraged by OSHA)
Aneroid: uses a round gauge to measure pressure
Each line on gauge = 2 mmHg
Measure at eye level, deflated cuff should read zero
Electronic: measures pressure automatically
Shows reading on a digital display
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49. Measuring and Recording Blood Pressure (continued)
Factors to follow for accurate readings
Patient should sit quietly for at least five minutes before BP is taken
Two readings should be taken and averaged
Minimum wait of 30 seconds between readings
Arm should be rested on a flat surface & free of restrictions

50. Measuring and Recording Blood Pressure (continued)
How to measure blood pressure
Cuff should be placed above the crook of the elbow, with arrow pointing over brachial artery
Place the bell/diaphragm of stethoscope directly over brachial artery in the antecubital fossa
Hold as securely as possible with index/middle fingers
Inflate cuff to mmHg
Deflate slowly and listen for heart sounds
First sound = Systolic Blood Pressure (Top #)
When sound disappears = Diastolic Blood Pressure (Bottom #)

53. Measuring and Recording Blood Pressure (continued)
Record all required information
Date, time, BP, signature/initials
Do not discuss the reading with the patient; it’s the doctor’s responsibility
Could cause personal reaction to patient

54. Blood Pressure Practice
19: 102/58
18: 142/72
17: 100/60
16: 96/58
15: 128/60