Vital signs

Body Temperature

• Normal range: 97º-99.5º F (36.0º-37.5º C).
• Afebrile: absence of fever, body temperature may still elevate under certain conditions.

Fever

• Defined as hyperthermia with temperatures exceeding normal.
• Temperature > 102º F commonly linked to infections.
• An increase of 1º C raises metabolic rate and oxygen consumption by 10%.

Hypothermia

• Body temperature falling below normal.
• Can result from severe head injuries or cold exposure.
• Hypothalamus triggers shivering and vasoconstriction for heat conservation.
• Often presents with shallow breathing and bradycardia.

Measurement of Body Temperature

• Measurement sites include mouth, tympanic (ear), axillary, and rectal; tympanic and oral are most common.
• Wait 10-15 minutes post-consumption of liquids or smoking before taking oral measurements.
• Axillary temperatures suited for infants and small children; tympanic uses infrared technology.

Pulse Rate Assessment

• Evaluate pulse for rate, rhythm, and strength; varies by age.
• Tachycardia: heart rate (HR) > 100 bpm; Bradycardia: HR < 60 bpm.

Measuring Pulse Rate

• Most common site for pulse measurement is the radial artery.
• Assess pulse for a full minute.
• Pulse volume classification: 0 (absent), 1+ (weak), 2+ (normal), 3+ (strong), 4+ (bounding).

Pulse Oximetry

• Measures heart rate and oxygen saturation.
• Useful for oxygen therapy adjustments, monitoring during activities, and tracking trends.

Respiratory Rate Terms

• Tachypnea: elevated respiratory rate; Bradypnea: lowered respiratory rate.
• Evaluate for Apnea, Eupnea, Hypopnea, Hyperpnea, Intermittent breaths.

Measuring Respiratory Rate

• Count respiration when the patient is unaware for accuracy.
• Count for one minute due to potential variability in rate and rhythm.

Blood Pressure

• Systolic pressure reflects peak force during heart contractions; diastolic measures force during relaxation.
• Normal adult blood pressure: 120/80 mmHg (with an acceptable range of 90/60 – 140/90 mmHg).
• Pulse pressure: difference between systolic and diastolic readings.

Measuring Blood Pressure

• Use a sphygmomanometer; cuff inflated to exceed systolic BP, then gradually released to feel pulsations.
• Korotkoff sounds indicate arterial blood flow and are audible through a stethoscope.

Errors in Blood Pressure Measurement

• High readings may result from a narrow cuff, incorrect cuff application, or excessive pressure.
• Low readings can occur with a cuff that is too wide.

Effects of Respiratory Cycle on Blood Pressure

• Systolic BP generally decreases during inspiration; this can indicate cardiac issues when severe.
• Paradoxic pulse present in conditions like asthma or cardiac tamponade.

Obtaining Vital Signs

• Classical vital signs include temperature, pulse, respiration, and blood pressure.
• Initial assessment also includes height, weight, level of consciousness, and overall clinical impression.

Frequency of Vital Sign Measurements

• Baseline measurements taken on admission, shift beginnings, before treatments, or when patient condition changes.
• Can be done intermittently or continuously depending on acuity.

Trending Vital Signs

• A trend indicates a series of measurements over time; comparing abnormal to prior data is crucial.
• Continuous reassessment and analysis of vital signs help inform clinical decisions.

Differential Diagnosis

• Weigh the likelihood of one disease against other potential illnesses based on symptoms.
• Example: Differential diagnosis for rhinitis includes allergic rhinitis, nasal decongestant abuse, and the common cold.

Clinical Presentation

• General appearance indicates distress and severity of illness.
• Rapid evaluations are essential for distressed patients; a non-distressed assessment proceeds with a head-to-toe inspection.

Level of Consciousness

• Evaluation assesses orientation to time, place, and person.
• States of consciousness include lethargy, obtunded, stupor, and coma, indicating varying levels of responsiveness.
• Glasgow Coma Scale is a tool for assessing consciousness levels.

Temperature Context

• Normal body temperature is recognized as 98.6º F (37º C).

Obtaining Vital Signs

• Four classical vital signs (VS) include temperature, pulse, respirations, and blood pressure.
• Initial assessments also include height, weight, level of consciousness (LOC), responsiveness, and general clinical impression.
• Pulse oximetry and ECG monitoring are important in patient assessments.

Frequency of Vital Sign Measurements

• Baseline measurements are taken upon admission, beginning of the shift, prior to treatment or procedures, and with any change in patient condition.
• Vital signs can be assessed intermittently or continuously, especially in respiratory care before and after treatment.
• Measurement frequency depends on the patient’s acuity.

Trending the Vital Signs

• Trending refers to observing a series of vital sign measurements over time.
• Abnormal measurements should be compared with prior readings before changing therapy.
• Continuous reassessment through observation (look), auditory (listen), tactile (touch), and analysis of trend data is critical.

Differential Diagnosis

• Differentiating diseases involves weighing one illness’s probability against others that could cause a patient's symptoms (e.g., rhinitis, which can stem from allergic rhinitis, decongestant abuse, or the common cold).

Signs of Hypoxemia

• Assess hypoxemia symptoms during vital sign measurements to gauge oxygenation status effectively.

Height and Weight

• Height is measured in inches (convert to cm: 1 inch = 2.54 cm) and weight in kilograms (1 kg = 2.2 lb).
• Routine intake and output monitoring may accompany weight management.

Clinical Presentation

• General appearance indicates distress level, severity of illness, and overall hygiene or cultural context.
• Rapid evaluation is required in distress; head-to-toe inspections are more thorough when a patient is stable.

Signs of Distress

• Identifying signs of distress can guide the urgency and nature of the intervention required.

Level of Consciousness

• Orientation is assessed by evaluating awareness of time, place, and person.
• Levels of consciousness range from lethargy to coma, characterized by varied responsiveness and arousal levels.
• The Glasgow Coma Scale (GCS) is employed for assessing consciousness.

Temperature

• Normal body temperature is 98.6º F (37º C), with a range of 97º - 99.5º F (36.0º - 37.5º C).
• An afebrile state indicates the absence of fever, while elevated temperatures can signify infection or other metabolic changes.

Fever

• Hyperthermia is defined as a temperature above normal, often indicating infection, raising metabolic rate, oxygen consumption, and carbon dioxide production (10% increase in O2/CO2 for every 1º C rise).

Hypothermia

• Hypothermia reflects a body temperature below normal, potentially linked to severe injuries or cold exposure.
• Mechanisms include shivering and vasoconstriction to conserve heat, but may lead to reduced oxygen consumption and shallow breathing.

Measurement of Body Temperature

• Body temperature can be taken orally, tympanically, axillary, or rectally, with tympanic and oral being the most prevalent.
• Wait 10-15 minutes after ingesting liquids or smoking for accurate measurements.

Pulse Rate

• Pulse evaluation includes rate, rhythm, and strength, varying with age.
• Tachycardia indicates a heart rate above 100 bpm; bradycardia signifies a heart rate below 60 bpm.

Measurement of Pulse Rate

• The radial artery is commonly used for pulse assessment, typically measured for one full minute.
• Pulse volume ranges from absent (0) to bounding (4+).

Pulse Oximetry

• Measures heart rate and oxygen saturation, useful for evaluating oxygen levels and monitoring during therapy or exercise.
• Offers trending options for continuous observation.

Respiratory Rate

• Respiratory rates can vary, with tachypnea exceeding normal and bradypnea falling below.
• Important terms: apnea (no breathing), eupnea (normal), hypopnea (shallow), hyperpnea (increased effort).

Measuring Respiratory Rate

• Count respiration for one minute while the patient remains unaware to ensure accuracy, observing chest movements.

Blood Pressure

• Systolic pressure reflects ventricular contraction, while diastolic pressure is during relaxation.
• Normal blood pressure is approx. 120/80 mmHg, but ranges can vary by individual.

Measuring Blood Pressure

• Sphygmomanometer usage entails applying a cuff around the arm, pressurized to exceed systolic blood pressure to momentarily halt blood flow.
• Korotkoff sounds are produced as pressure is released, indicating systolic and diastolic readings.

Errors in Blood Pressure Measurement

• High readings can result from cuff size errors, excessive tightness, or incomplete deflation; low readings can arise from using a cuff that's too wide.

Effects of Respiratory Cycle on Blood Pressure

• Systolic pressure typically decreases slightly during inspiration.
• Paradoxic pulse may be present in conditions like asthma or cardiac tamponade.
• Hypotension may reflect a weak left ventricle, potentially due to certain medications like beta-blockers or diuretics.

Explore the concepts of thermal balance and the various states of body temperature. This quiz covers normal ranges, definitions of afebrile and febrile states, and the physiological implications of fever on metabolic processes. Test your understanding of how temperature affects oxygen and carbon dioxide levels in the body.