Vital Signs 3-4 PDF

VITAL SIGNS IBN-Alnafis University for medical signs 1st Year Respiratory Therapist Student Dr:MOHAMMED-SENAN BS, RCP, MsRC 1 DR:MOHAMMED-SENAN  VITAL SIGNS...

VITAL SIGNS IBN-Alnafis University for medical signs 1st Year Respiratory Therapist Student Dr:MOHAMMED-SENAN BS, RCP, MsRC 1 DR:MOHAMMED-SENAN  VITAL SIGNS Definitions:  There are four objective assessment data that indicate how well body is functioning and very sensitive to alteration in physiology.  indicate how well or poor body is functioning.  Vital signs are very sensitive to alterations in physiology  Vitalsigns are -Body Temperature -Pulse -Respirations -Blood Pressure  VITAL SIGNS  1)Body temperature: Definition: the balance between the heat production and heat lost from the body, measured in heat unit called degree. Fahrenheit scale uses 32 F as the water freeze point and 212 F as boil point. centigrade scale uses 0 as the water freeze and 100 C as boil point. Normal body temperature: 36.4 – 37.4 C  1)Body temperature:  Two type of body temperature:  Core temperature: is the temperature of deep tissue of the body such as thorax, abdominal cavity. it relatively constant.  Surface temperature: is the temperature of skin, subcutaneous tissue rise and fall in response to environment. 1)Body temperature: Ways of heat loss:  Radiation: is transfer of heat from one object to another object without contact.  Conduction: is transfer of heat from one molecules to another of lower temperature.  Convection: dispersion of heat by air current.  Evaporations: continuous evaporation of the moisture from the respiratory tract.   1)Body temperature: Temperature regulation: Hypothalamus: a structure within the brain that helps controls various metabolic activities. It acts as the center of temperature regulation. When sensor of hypothalamus detect heat, they send signals intend to reduce temperature. Temperatures above 105.8°F (41°C) and below 93.2°F (34°C) indicate impairment of the hypothalamic regulatory center. The chance of survival is diminished when body temperatures exceed 110°F (43.3°C) or fall below 84°F (28.8°C).  1)Body temperature: Terms: Pyrexia: body temperature above the usual range (fever or hyperthermia). (38 – 40). Hyperpyrexia: very high temperature more than 40 C. Hypothermia : body temperature less than 35. Note: the client who has a fever is referred to as febrile, the one who has not called Afebrile. 1)Body temperature: Clinical signs of fever:  Increase heart rate  Increase respiratory rate  Shivering  Palled  Cyanotic nail beds  Increase thirst.  Loss of appetite. 1)Body temperature: Assessment sites: Oral site: mouth,  Advantage: convenient and accessible  Disadvantage: can break in bitten, so its contraindicated for: uncooperative client, children, unconscious, shivering and prone to seizures.  Inaccurate if the patient been smoking, eating hot or cold food or drinks. So you should delay taking oral temperature at least 10 min. 1)Body temperature: Assessment sites:  Rectal site:  Advantage: Most reliable  Disadvantage: can be embarrassing for alert client, (inconvenient), and can injury the rectum.  Its above than the oral site by 0.5 c 1)Body temperature: Assessment sites: Auxiliary: Advantage: safe, and most noninvasive, its preferred site for infant, unconscious patient. Disadvantage: it takes long time to obtain an accurate reading. Its less than the oral site by 0.5 c 1)Body temperature: Assessment sites:  Tympanic: Advantage: Very fast, accessible, and reflect the core temperature.  Its suitable for children Disadvantage: right and left measurement can differ, and there is risk of membrane injury in inserted too far. Contraindications a.Oral Temperature ❖ Uncooperative or unconscious patient. ❖ Following oral trauma or surgery. ❖ Oral temperatures are inaccurate in patients receiving oxygen therapy. Oxygen cools the mouth and tachypnea leads to a low reading. b.Rectal Temperature ❖ Prolapsed rectum. ❖ Following rectal surgery. ❖ Severe diarrhea. ❖ Bleeding tendency, e.g., leukemia, thrombocytopenia. c. Tympanic Temperature Do not use in infected or draining ear or if lesion or incision is adjacent to ear. 1)Body temperature: Types of thermometers  Mercury glass thermometer.  Electronic thermometer.  Skin tape.  Tympanic thermometer. Instruments & materials Thermometer Glass, oral, or rectal, at client’s bedside Electronic thermometer with disposable protective sheath Tympanic membrane thermometer with probe cover Disposable, single-use chemical strip thermometer Lubricant for rectal and glass thermometer Two pairs of non-sterile gloves Tissues  VITAL SIGNS 2) Pulse: Is the wave of blood created by contraction of the ventricles of the heart.  Cardiac out put = Stroke volume * heart rate. Two types of pulse:  Peripheral pulse: is pulse located in peripheral of the body, foot, hand.  Apical pulse: is centered pulse located above the apex of the heart.  Pulse deficit: difference between the apical pulse and radial pulse rate.  VITAL SIGNS 2) Pulse: Pulse site:  temporal  posterior tibial  radial  Dorsals pedis  carotid pulse.  Apical  Popliteal  brachial  Femoral Sites commonly used for assessing radial pulse.  VITAL SIGNS 2) Pulse: Terms:  Tachycardia: when pulse increase more than 100 bm.  Bradycardia: when pulse decrease less than 60 bm.  Normal heart rate: 60- 100 bm.  Infants more than 100 bm  Athletes less than 60 bm  Pulse rhythm: is the pattern of the beats and the intervals between the beats.  Dysrhythmia or arrhythmia: pulse with an irregular rhythm.  Pulse volume (pulse strength): the force of blood with each beat.  VITAL SIGNS 3) Respiration: ❖Definition: is act of breathing, the normal respiratory rate is 12 – 20 bpm. ❖Two types of respiration: * External: the exchange of oxygen and carbon dioxide between the alveoli of the lung and blood. * Internal: is the exchange of the same gas between blood and cell of the body tissue  VITAL SIGNS 3) Respiration: ❖muscles that contribute in the respiration: * Diaphragm muscle ( main muscle). * Intercostal muscle. * Sternocleidomastoid muscle. Note: * In female, observe chest movement. * In male, observe abdominal movement. 3) Respiration: Terms:  Inhalation (inspiration): intake of air into lung.  Exhalation (expiration): breathing out or the movement of gases from the lung into atmosphere. Breathing pattern  1) Volume:  Hyperventilation: refer very deep respiration.  Hypoventilation: refer to shallow respiration. 3) Respiration: Breathing pattern 2) Rate:  Eupnea: normal respiratory rate and depth.  Bradypnea: slow breathing.  Tachypnea: fast respiratory rate. 3) Easy or Effort:  Dyspnea: difficult and labored breathing.  Orthopnea: ability to breath only in upright sitting or standing positions.  3) Respiration: Breathing pattern 4) Secretions and Coughing:  Hemoptysis: the presence of blood in the sputum.  Productive cough: a cough accompanied by secretions.  Nonproductive cough: a dry, harsh cough without secretions. 3) Respiration: Regulation of respiration:  Controlled by respiratory center in the medulla oblongata.  Chemoreceptor located centrally in medulla and peripheral in carotid and aortic body. 4) Blood pressure:  Definition: is measure of pressure exerted by the blood as it flows through the arteries.  Systolic blood pressure: the pressure of the blood as a result of contraction of the ventricles.  Diastolic blood pressure: the pressure when the ventricles are at rest  The differences between the diastolic and systolic pressure called pulse pressure.  e.g. BP: 130/ 80  Pulse Pressure = 50  VITAL SIGNS 4) Blood pressure:  Mean Arterial Pressure (MAP):  MAP= 1/3 systolic + 2/3 diastolic  e.g. BP: 120/90  MAP= 40 + 60 = 100  Hypertension: blood pressure that is persistent above the normal.  Hypotension: the blood pressure is below normal range.  Orthostatic hypotension: blood pressure falls when the clients sits or stands.  VITAL SIGNS Sites of BP  1) the arm ( brachial artery)  2) the thigh (popliteal artery)  3) the forearm (Radial artery) To establish the diagnosis, measure BP accurately a. Office measurement b. Home measurement c. Monitoring BP Accurate blood pressure measurement I. Patient II. Equipment III. Technique  Blood pressure measurement I. Patient - Posture Patient seated , back supported, arm bared at heart level Five minutes rest  Blood pressure measurement I. Patient - Circumstances Quiet , warm room No caffeine, smoking, alcohol 30 min. p No talking  Blood pressure measurement II. Equipements Cuff size : 12-13 cm x 35 cm Manometer : types/calibration Blood pressure measurement II. Equipment - Devices Non - invasive Semi - automatic Automatic  Blood pressure measurement III. Technique Korotkoff Sound no 5 (disap of sound=DBP) Both arms: (if peripheral arterial dis) Standing BP: in elderly & diabetic(orthostatic HTN.) Cuff at heart level (whatever patient’s position) I. Patient - Posture I. Patient - Posture I. Patient - Arm I. Patient - Arm Popliteal BP +20 mmHg  Non - invasive Sphygmomanometer or Devices Blood pressure measurement II. Equipment Cuffs size Blood pressure measurement II. Equipment Cuff size  Cuff size  Cuff size  Cuff size Blood pressure measurement II. Equipment Blood pressure measurement II. Equipment II. Equipment Calibration II. Equipment Calibration Stethoscope  BP measurement devices Manual sphygmomanometers : - Mercury and aneroid sphygmomanometer Automated sphygmomanometers : - Use in hospitals - Self measurement - AMBP measurement - Measurement in community settings  Korotkoff sounds 200 No sound 180 Clear sound Phase 1 Systolic BP 160 Muffling Phase 2 No sound Auscultatory 140 gap 120 Clear sound Phase 3 Phase 3 100 Phase 4 Muffled sound Phase 4 80 Diastolic BP 60 40 No sound Phase 5 20 0 mmHg The ambulatory blood pressure monitoring (ABPM) The ambulatory blood pressure monitoring (ABPM)  Home measurement of blood pressure Home BP measurement should be encouraged to increase patient involvement in care Which patients? – For the diagnosis of hypertension – Suspected non adherence – White coat hypertension or effect – Masked hypertension Average BP equal to or over 135/85 mmHg should be considered elevated  VITAL SIGNS When you want to measure blood pressure :  Do not use caffeine, tobacco, or alcohol for 30 minutes before you measure.  Before you measure your blood pressure, sit in a chair with a back on it for 3-5 minutes.  Use the correct sized cuff for your arm.  Put the cuff in the proper place on your arm by placing the arrow or tubing on the inside of the elbow  Keep your arm at heart level while doing a blood pressure measure.