Vital Signs Assessment Quiz

Vital Signs Assessment

• General Conditions: Assess consciousness level, facial expressions (happy, sad, pain, pale)
• Vital Sign Checks: Include body temperature, pulse, respiration, blood pressure, pain assessment, and oxygen saturation.
• Medical History: Obtain patient's history including present complaints, problems, pain, allergies, and past medical history.

Body Temperature

• Normal Range (Adults): 36°C – 37.5°C (Afebrile)
• Hyperthermia/Fever: 38°C
• Hyperpyrexia: 41°C
• Hypothermia: < 36°C
• Factors Affecting Body Heat Production: Basal metabolic rate, muscle activity, thyroxine output, epinephrine, and fever.

Heat Loss from the Body

• Radiation: Heat loss due to a temperature gradient.
• Conduction: Transfer of heat from one object to another.
• Convection: Heat loss via air or water movement.
• Evaporation: Heat loss via sweat evaporating.

Factors Affecting Body Temperature

• Age: Infants and children have immature thermoregulatory systems, making them more sensitive to temperature changes; elderly may have lower metabolic rates.
• Diurnal Variation: Body temperature naturally fluctuates throughout the day, typically lowest in the early morning and highest in the late afternoon/early evening.
• Exercise: Muscle contractions generate heat.
• Hormones: Thyroid hormones and epinephrine.
• Stress: Stress triggers the release of adrenaline increasing metabolic activity & related factors (pulse/respiration).
• Environment: Cold weather leads to vasoconstriction; hot weather leads to vasodilation and sweating.

Types of Fever

• Intermittent: Body temperature returns to normal at least once within 24 hours.
• Remittent: Temperature fluctuates above baseline, but doesn't reach normal.
• Relapsing: Periods of fever alternate with periods of normal temperature.
• Constant: Elevated temperature without returning to normal.
• Fever Spike: Sudden, brief elevation in temperature that quickly returns to normal.
• Heat Exhaustion: Excessive heat exposure leading to dehydration and elevated temperature.
• Heat Stroke: Extremely high body temperature due to prolonged heat exposure.

Measuring Body Temperature

• Oral
• Tympanic Membrane

Vital Sign - Pulse

• Factors Affecting Pulse: Age, sex, exercise, stress, medications, and medical conditions.
• Explanations: Pulse rate higher in infants/children, females generally slightly higher than males, physical activity increases pulse rate.
• Pulse Rate Variations: tachycardia, bradycardia, dysrhythmia/arrhythmia, affecting volume.
• Evaluation: Assess rate, rhythm, volume.

Vital Sign - Respiration

• Definition: The act of breathing (inspiration/ inhalation & expiration/ exhalation).
• Ventilation: Air movement in and out of the lungs.
• Types of Breathing: Costal (thoracic), diaphragmatic (abdominal).

Respiratory Rate/Quality

• Terminology: Eupnea, tachypnea, bradypnea, apnea, hyperventilation, hypoventilation.
• Factors Affecting Respiratory Rate: Exercise, stress, environmental temperature, and lowered oxygen concentrations.

Vital Sign - Blood Pressure

• Measurement: Sphygmomanometer/ Dynamap.
• Units: 120/80 mmHg (systolic/diastolic).
• Determinants: Pumping action of the heart, peripheral vascular resistance, blood volume, and blood viscosity.
• Factors Affecting Blood Pressure: Age, exercise, stress, sex, medications, obesity, and diurnal variations.
• Explanations: Blood pressure generally increases with age, exercise increases blood pressure, stress-related hormones increase BP; menopause-related changes (hormonal shifts) affect woman's BP. Medications, obesity, and diurnal patterns influence BP fluctuations.

Vital Sign - Oxygen Saturation

• Measurement: Pulse oximeter.
• Factors Affecting Oxygen Saturation: Hemoglobin levels, circulation, activity level.
• Explanations: Low hemoglobin levels result in lower oxygen saturations. Impairment to circulation reduces oxygen transport to tissues.
• Clinical Importance: Essential assessment in many medical conditions, such as shock, hypothermia or poor perfusion.

Vital Signs - Pain Assessment

• Classifications: Localized/referred pain, visceral/visceral pain, acute/chronic.
• Pain Description: Intensity (mild/moderate/severe) and location.
• Duration: Duration of pain (acute/chronic, short-term or long-term).