Vital Signs PDF - University Of Baghdad

Vital Signs University Of Baghdad Al Kindy College Of Medicine ECE module / Third stage 2023-2024  Blood Pressure Respiratory Temperature Rate Pulse Arterial Pulse The palpable pulse...

Vital Signs University Of Baghdad Al Kindy College Of Medicine ECE module / Third stage 2023-2024  Blood Pressure Respiratory Temperature Rate Pulse Arterial Pulse The palpable pulse in an artery reflects the pressure wave generated by the ejection of blood into the circulation from the left ventricle. When taking a pulse, assess: 1. Rate. 2. Rhythm. 3. Volume. 4. Character. 5. Collapsing Pulse. 6. Radioradial / Radiofemoral delay. 7. Character of blood vessel wall. The rate and rhythm of the pulse are usually determined at the radial artery; use the larger pulses (brachial, carotid or femoral) to assess the pulse volume and character. Rate Measure the pulse rate in 15 seconds and then multiply by 4 to obtain the beats per minute (bpm). Bradycardia is defined as a pulse rate of less than 60 bpm; tachycardia is a rate of greater than 100 bpm. The most common causes of bradycardia are medication, athletic conditioning and sinoatrial or atrioventricular node dysfunction. The most common cause of tachycardia is sinus tachycardia.  Rhythm The pulse may be regular or irregular. Sinus rhythm is regular but heart rate varies with the respiratory cycle, particularly in children, young adults or athletes (sinus arrhythmia). The irregularity of the rhythm could be regular irregularity or irregular irregularity. ❖ Irregularly irregular pulse occurs in atrial fibrillation and multiple ectopic beats occurring at random intervals ❖ A regularly irregular pulse occurs in 2° heart block and ectopic beats occurring at a regular interval (ventricular bigeminus) Volume A large pulse volume is a reflection of a large pulse pressure, which can occur in: ❖ physiological states such as exercise or pregnancy ❖ pathological conditions such as anemia, thyrotoxicosis, or aortic regurgitation. A Low pulse volume occurs in aortic stenosis, shock, and pericardial effusion Character 1. Collapsing (‘waterhammer’) pulses are caused by aortic incompetence, AV malformations, and a patent ductus arteriosus 2. slow-rising pulses occur in aortic stenosis 3. Bisferiens pulses occur in combined aortic stenosis and regurgitation 4. Pulsus alternans (alternating strong and weak beats) suggest Left ventricular failure 5. Jerky pulses occur in hypertrophic cardiomyopathy (HOCM) 6. Pulsus paradoxus occurs in severe asthma, pericardial constriction, or cardiac tamponade Collapsing Pulse (water hammer pulse) Grip the patient's wrist with the hand. Feel for the radial pulse and then suddenly raise the patient's arm well above the level of the heart. The pulse volume will increase if water hammer pulse is present. There will be sudden rise and fall in the amplitude of pulse. Sudden rise is due to increased stroke volume and collapsing character is due to backward leakage (in case of aortic incompetence) or due to low peripheral resistance which enhances the blood flow to the peripheral vasculature during diastolic phase. It occurs in aortic regurgitation, persistent ductus arteriosus, A-V fistula, fever and thyrotoxicosis. Radio-Radial Delay Feel both radial pulses simultaneously. In the normal state, the pulses will occur together. Any delay in the pulsation reaching the radial artery on one side may point to pathology such as an aneurysm at the aortic arch or subclavian artery stenosis. Radio-Femoral Delay Palpate the radial and femoral pulses on the same side simultaneously. They should occur together. Any delay in the pulsation reaching the femoral artery may point to aortic pathology such as coarctation. Character Of Blood Vessel Wall Character of blood vessel wall: this is examined by applying pressure on brachial artery so that radial pulse is abolished. Now try to feel the radial blood vessel by rolling beneath the fingers against the radial bone. In case of arteriosclerosis this will be felt like a cord. Examination Sequence Blood Pressure Rest the patient for 5 minutes. Ideally, measure BP in both arms (brachial arteries); the higher of the two is closest to central aortic pressure and should be used to determine treatment. With the patient seated or lying down, support their arm comfortably at about heart level, with no tight clothing constricting the upper arm. Apply an appropriately sized cuff to the upper arm, with the centre of the bladder over the brachial artery. Palpate the brachial pulse. Inflate the cuff until the pulse is impalpable. Blood Pressure Inflate the cuff another 30 mmHg and listen through the diaphragm of the stethoscope placed over the brachial artery. Deflate the cuff slowly (2–3 mmHg/s) until you hear a regular tapping sound (phase 1 Korotkoff sounds). This is the systolic pressure. Continue to deflate the cuff slowly until the sounds disappear. Record the pressure at which the sounds completely disappear as the diastolic pressure (phase 5). If muffled sounds persist (phase 4) and do not disappear, use the point of muffling as the diastolic pressure. Normal BP Measurements Respiratory Rate Quietly observe and time respiratory rate (for example, breaths in 15 s x 4) without drawing the patient’s attention to it, as this may cause it to change. Feeling the radial pulse, while timing breathing, is a common solution to this problem. At rest, the respiratory rate is normally 12 to 15 breaths/min; anxious patients may breathe at 15 to 20 breaths/min but a rate of over 20 breaths/min is abnormal for an adult. Respiratory Rate A Rapid respiratory rate more than 20 tachypnea caused by increased ventilatory drive as in fever, asthma and COPD, or reduced ventilatory capacity as in pneumonia, pulmonary edema and interstitial lung disease. A slow respiratory rate can occur with opioid toxicity, hypothyroidism, raised intracranial pressure, hypothalamic lesions, and hypercapnia. Depth of respiration; ❖ shallow indicates there is pain in the chest or pneumonia ❖ Deep indicates metabolic acidosis. Temperature The thermometer must be kept in position long enough to allow the mercury to reach body temperature. The ordinary 'half minute' thermometer should be left in position for a full one to two minutes. In conscious adults the temperature is taken in the mouth or in the axilla. Collapsed, comatosed and elderly patients should have their rectal temperature taken with a special 'low reading' thermometer. In young children the thermometer should be placed in the fold of the groin, and the thigh flexed on the abdomen; or it may be inserted into the rectum. Normal Measurements A rectal temperature is about 0.5 °C higher than an oral temperature. An axillary temperature is most often 0.5°C lower than an oral temperature. The mean normal temperature is generally considered to be 37°C (36.6°C - 37.2 °C). In a more recent study of young adults, the upper limit of normal body temperature (measured orally) was 37.2°C in the morning and 37.7°C overall. Normal body temperature varies with age, time of the day, level of activity, and phase of the menstrual cycle, among other factors. Normal Measurements A morning oral temperature >37.2°C or an afternoon temperature of >37.7°C could be considered a fever. Hyperpyrexia is the term for an extraordinarily high fever (>41.5°C), which can be observed in patients with severe infections but can also occur in patients with central nervous system (CNS) hemorrhages. While hypothermia is a body temperature < 35 °C. Thank You