Vital Signs and Measurement Basics

Vital Signs & Anthropometric Measurements

• Vital signs include pulse, temperature, blood pressure, and respiratory rate.
• Pulse oximetry is added for patients with respiratory problems.
• Anthropometric measurements involve height, weight, and Body Mass Index (BMI).
• Additional measurements like head circumference are taken for children.
• A walker can be used to assist elderly patients stepping on/off scales.

Importance of Baseline Vital Signs

• Vital signs are recorded every patient visit and used as a baseline/reference.
• This baseline helps compare and track changes in the patient's condition over time.
• It allows for the detection of potential health problems like rising blood pressure or fever.
• Familiarity with normal vital sign values is essential for identifying abnormalities.

Body Temperature Regulation

• The hypothalamus in the brain regulates body temperature.
• Body temperature is maintained by balancing heat production and heat loss.
• Normal variations are limited to 1-2 degrees Fahrenheit.
• The body responds to temperature increases (e.g., during exercise) by increasing sweat production, which cools the body through evaporation.

Heat Production

• Muscle activity (voluntary and involuntary) generates heat.
• Cell metabolism, the breakdown of food into simpler forms, produces heat.
• Stress, anger, and fear can increase body temperature.

Heat Loss

• Perspiration (sweat evaporation) removes heat.
• Exhaled air contains water vapor and heat, contributing to heat loss.
• Urine and stools eliminate heat.
• Radiation, conduction, and convection are three mechanisms of heat loss.
• Radiation: Heat radiating from body (e.g., in a cold room).
• Conduction: Heat transfer through direct contact (e.g., sitting on a cold metal chair).
• Convection: Heat loss through air currents (e.g., walking in cool air).

Normal Body Temperature & Fever Types

• Normal body temperature ranges from 97 to 99°F (36.1 to 37.2°C), with an average of 98.6°F (37°C).
• Use formulas to convert between Celsius and Fahrenheit.
• Fahrenheit = (Celsius × 9/5) + 32, Celsius = (Fahrenheit − 32) × 5/9
• Three fever types exist:
  • Low-grade fever: 99-100.4°F (37.2-38°C).
  • Fever (pyrexia): above 100.4°F (38°C).
  • Hyperpyrexia (high-grade fever): above 105.8°F (41°C); temperatures above 109.4°F (43°C) are fatal.

Factors Affecting Body Temperature

• Age: Children tend to have higher temperatures due to activity and less developed heat regulation; elderly individuals may have lower temperatures.
• Diurnal variation: Temperature is typically lowest in the morning after waking up.
• Emotional status: Stress, anxiety, and fear can increase body temperature.
• Environmental temperature: Cold or hot weather has a limited effect (1-2°F variation).
• Physical activity: Exercise increases body temperature due to muscle activity.
• Pregnancy: Pregnant females often have slightly elevated temperatures due to increased metabolism and hormones.

Fever (Febrile State)

• A feverish patient has a temperature above 100.4°F (38°C) and is considered febrile.
• Absence of fever is referred to as afebrile.
• Pyrogens released during infection reset the hypothalamus, raising the body's temperature.
• Increased temperature creates an unfavorable environment for microorganism growth and multiplication.
• Most fevers are self-limiting and subside as the infection/inflammation resolves.

Stages & Forms of Fever

• Onset: Can be gradual or sudden; often associated with feeling cold and chills.
• Increased respiratory rate results from stress hormones affecting the heart and respiratory systems.
• Fever forms include:
• Continuous: Elevated temperature with limited variations.
• Intermittent: Temperature rises for a period, then drops to normal or below.
• Remittent: Fluctuations in temperature, but always above normal.
• Associated symptoms include headaches, flushed skin, thirst, loss of appetite, and malaise (weakness/fatigue).
• Subsiding stage: Fever decreases gradually or suddenly (crisis), often with sweating.

Methods of Taking Temperature

• Common areas for temperature measurement: oral (mouth), axillary (armpit), tympanic (ear), temporal (forehead), and rectal.
• These areas are chosen due to high blood supply and minimal air currents (except forehead).
• Method choice depends on patient condition and age.
• Unconscious patients typically require rectal temperature measurement.

Oral Temperature

• Place thermometer on either side of the frenulum linguae (tongue anchor) under the tongue.
• Patient closes mouth to eliminate air currents.

Axillary Temperature

• Primarily used for toddlers and preschoolers.
• Place thermometer in the center of the armpit with the arm lowered.
• Add 1 degree Fahrenheit to the reading to estimate oral temperature.

Rectal Temperature

• Invasive and generally accurate.
• Subtract 1 degree Fahrenheit from the reading to estimate oral temperature.
• For infants, insert thermometer half an inch into the rectum.

Tympanic (Ear) Temperature

• Uses an infrared thermometer to measure heat radiating from the eardrum (tympanic membrane).
• Important to position the probe toward the eardrum by straightening the ear canal.
  • Pull the ear backward and upward for individuals older than 3 years.
    • Pull the ear backward and downward for children younger than 3 years.

Temporal Artery (Forehead) Temperature

• Uses a temporal artery thermometer on the forehead.
• Hold down the scan button while slowly moving the probe across the forehead.
• Generally accurate and suitable for all ages, but avoid if patient is sweating.
• Subtract one degree fahrenheit from the reading as it is close to rectal temp.
• If the forehead is sweaty, measure behind the earlobe on the mastoid process (less accurate).

Types of Thermometers

• Mercury thermometers: Accurate but no longer used due to mercury toxicity concerns.
• Chemical thermometers: Use chemical substances that change color to indicate temperature; least accurate.
• Digital thermometers: Commonly used in clinics; can be used for oral, axillary, or rectal temperatures.
  • Blue probe: oral or axillary use.
  • Red probe: rectal use.
  • Use disposable plastic covers and dispose of them in biohazard containers.
  • Clean the thermometer probe with an alcohol wipe after each use.
• Tympanic thermometers: Measure heat radiating from the eardrum. Cone-shaped cover. Earwax isn't infectious, unless ear infection present.
  • Clean probe regularly w/ alcohol to prevent dirt buildup
• Temporal Artery Thermometers: Has a scan button that is held down as the probe is moving across the forehead. Has compensation technology that accounts for heat loss, or ambient temperature. -If the patient is sweating measure behind the earlobe on matoid process. Still less accurate

Cleaning and Storage

• Clean thermometers and probes with alcohol wipes or disinfectants.
• Avoid washing thermometers under water, which can damage the device.
• Do not expose thermometers to extreme temperatures or direct sunlight.

Pulse Measurement Sites

• Temporal: Forehead or in front of the ear.
• Carotid: On either side of the middle of the neck.
• Apical: Apex of the heart (5th intercostal space at midclavicular line).
• Brachial: Front of the elbow (antecubital fossa).
• Radial: Base of the thumb.
• Ulnar: Base of the little finger.
• Femoral: Upper part of the thigh.
• Popliteal: Back of the knee.
• Posterior Tibial: Behind the medial malleolus.
• Dorsalis Pedis: Upper aspect of the foot (between first and second metatarsal bones).

Apical Pulse Measurement

• Used to count the pulse in young children or when an accurate count is needed.
• Can verify high or low pulse rates.
• Measured using a stethoscope placed over the apex of the heart.

Factors Affecting Pulse Rate

• Age: Infants and children have higher pulse rates. Newborns can see pulses between 120-160 bpm
• Gender: Females tend to have faster pulses than males.
• Exercise: Physical activity increases pulse rate.
• Emotional status: Stress, anxiety, anger, and fear increase pulse rate.
• Metabolism: Increased metabolism raises pulse rate (e.g., during pregnancy).
• Fever: Increases heart rate and respiratory rate.
• Medications: Epinephrine increases heart rate. Digitalis reduces pulses in patients, and is commonly used for such treatment.

Uncommon Pulse Sites

• Temporal is measure in front of the ear, it is used when you can't from the radial arch.
• Carotid pulse can monitor the pulse in those with cardiac arrest, and is the best way to detect the patients pulse, and is located next to the Adam's apple
• Femoral pulse, is at the upper part of the thigh to show detection in infants, and blood evaluation to the foot. Located In the middle between Pubic bone.
• Popliteal pulse can be use used on bilateral amputees in the upper half.
• Tibial Evalution is present in medial mallous
• Dorsalis Pedis evalution, checks circular in terminal of foot, on diabetics. Located at the top of the foot

Finding Regular Pulse

The rhythm should be regular If too much or not enough force, cannot detect the pulse. do not use thumb, use finger for gentle pressure, or it risks using your own pulse.

Describing Pulse

The normal pulse should be between 60-100 100 is fast which is called tacharcardia. This can be seen in patients with heart problems, and loss of blood less than 60 is bradycardia due to low metabolism, can occur during sleep, athletic activities

Arrhythmia or Dysrhythmia

Arhythmia mean w/o rhythm, and dysrythmia is a bad rhythm. The patient would need to record the data for 24 hr, and the device can record the event and cause

Respiration Muscles

Main respirator muscles are intercostal, and diaphragm.

Respiration Cycle

Consists of inhale, and Exhale External Inhale, exchanges to blood vessel Internal exchanges blood vessel, to bodily cells.

The Factors that control Respiration

The medula oblongata is for the repsonrioty disease, by controlling the chest cavity, but can't control the process fully, once the dioxide levels are high. It will automatically inhale

Respiratory Rate

The normal respiratory rate is 12-20 , but needs to be 1/4 th of of rate so divide the heart rate by 4, and any fast is TAC, and Brad is slow

Respiratory Factors

Age, as infant, and children have a higher respiratory rate, du to their high metabolism. Also factors like, fever, exercise, medication, emotional states

Volume

Normal breaths means that there is normal respirations, and an increase respiration rate will lead to large deep volum, this is deep respparation, shallow breathing on the other hand can barley be seen

Respiratory Conditions

• Eupenia( normal respiration), with rate of 12-20 rate
• Hyperpnea( increased rate & depth respiration) due to exercising or any lung and heart activities
• Hyperventilation( faster and deeper, breathing than anyhting such as in the cases of anxiety & panic)
• Hypopnea slower breaths during sleep due to sleep disorder. With Cyanosis due to a bluish color on mucous for lack of oxygen,
• Apnea absence of rate with sleep apnea for smokers or in many cases brain damage
• Dyspnea difficulty in breathing for asthma patients and Orthopnea but only when lying flabt

Pulse Oximetry

SpO2 saturation of peripheral oxygen with a proper rate between 95-99 It travels between red bld cells, by Hemogoblin to transport protein and iron If Low, it leads to hypoxemia. a drop in the reduction

Pulse-Oximeter Factors

The arms needs to be alligned in order to properly read transmission pediatric Oximiter needs to be used, for a tighter fit earlobs can be used however if there is no other means availble to be used Dark Nail Pollishes will prevent the light from read the device hand needs to not be cold or have an blood circulation, for an proper read Also movement can affect the read of the transimmision. Neuroligical condition affect the read due to constant movements

Reading Pressure

Reading for blood is force, and the normal reading for blood should be below 120,

120-139, is elevation 149-159 Hypertension Stage One and Stage Two is 160 above

For the the low is below 95-60

Any in change over 30 is dangerous, and anything 15, in dia, for increase of pressure

The factors the Affect The pressure

puberty till after monpausing female is lower the male blood then increasing Diurnal sleeping the rate goes down due to the actiivity Emotion, anxiety increase the rate exercise increase, and to let the patient rest for 30 minutes to regain composure Position difference of about plus 5 points Medications Interaction, can lead to elevation Sphygmomater , and stethoscope reading The Stethoscope has buds, which leads to a head pice The Chest piece is flat, is called Diaphragm The cone shape os belly Rotate the chest to work the sphygmomater has as bulb and a cuff for inflation for around the artm

KorotKoff Sound for Hearts,

The pressure of sounds as hears. The first time it is hears, is the top The last time it is heard, is the diastolic

Guidelines to prevent errors for blood pressure

The right fit needs to be worn around 80-100% 2/3 of the between the shoulder and elbow , Feet need to not be crossed will affect systolic rate( increase) Both needs to be rested with support and arm not floating The dirphram of the scope. is position in the brachial need gentle pressure Never have head touch cuff Realease air flow, slowly instead of fast And at the end its never has more that 5 point between