Vital Signs 2023 PKM.pdf

Pat Kenney-Moore EdD, PA-C Physical Diagnosis Summer 2023 1 What are the Vital Signs?     Temperature Respiratory Rate Heart Rate/Pulse Blood Pressure Other measurements often included:  Weight (kg)/ (Height m)2 BMI  SpO2 (peripheral oxygen saturation) 2 What do the Vital Signs Mean? Measurem...

Pat Kenney-Moore EdD, PA-C Physical Diagnosis Summer 2023 1 What are the Vital Signs?     Temperature Respiratory Rate Heart Rate/Pulse Blood Pressure Other measurements often included:  Weight (kg)/ (Height m)2 BMI  SpO2 (peripheral oxygen saturation) 2 What do the Vital Signs Mean? Measurement of the body’s most basic functions – They are “vital” for a reason…give information about the level of physical functioning Changes in vital signs do not always correlate with the patient’s health status – May be one of the few abnormalities found in disease – May have normal vital signs but be very ill Must be interpreted in context of patient’s condition 3 Before you start… Wash/Sanitize your hands Gain consent Some people do not know what “vital signs” or “vitals” means. – Consider explaining that you will be checking their pulse/HR, temperature, breathing, and blood pressure 4 Temperature: Factors Affecting Body Temperature  Metabolic processes Digestion Sleep Exercise  Ingestion of exogenous substances Cold or hot beverages Drugs: ecstasy, cocaine, methamphetamine, marijuana  Infectious processes Fever  Body heat loss  Environmental factors Radiation, conduction, vaporization, respiration Hypo- or hyperthermia Balance of heat production and heat loss Under the control of the hypothalamus 5 Methods of Temperature Measurement  Oral (average 98.6˚F)  pacifier thermometers for babies  Rectal (average 99.6)  most accurate measure of core temperature  generally 0.7 degrees F higher than oral  Axillary (average 97.6)  infrared thermometers available for neonates  Tympanic (average 99.6)  generally 1.6 degrees F lower than rectal  Forehead/Temporal (average 97.6)  temporal digital, Temp-a-dots, etc. 6 What is Considered a Fever? 100.4o F or 38o C Fahrenheit 96.8 98.6 100.4 102.2 104 Celsius 36 37 38 39 40 – http://accessmedicine.mhmedical.com/ViewLarge.aspx?figid=43079129 – MedCalc 7 Causes of Elevated Temperature Infection Inflammation Malignancy Drugs Heat stroke Others 8 Documentation of Temperature T: 99.1 F (oral) T: 101.2 F (axillary) T: 97.8 F (tympanic) T: 100.9 F (rectal) 9 Respiratory Rate One complete breathing cycle includes an inspiration and an exhalation Method of Measurement most accurate to view chest rise & fall for one minute OR listen to lungs for one minute, but typically done for 15 seconds and multiplied by 4 best done after counting pulse while still holding wrist don’t tell the patient; they may alter their breathing pattern Normal range for adults is 12 – 20/min 10 Assessment of Respiration Important to assess four parameters: – – – – Respiratory rate Respiratory pattern Respiratory depth Signs of respiratory distress Typically only rate is documented unless there is an abnormality in one of the above parameters – If normal, can include a comment like “breathing comfortably” or “unlabored” goodforcharting Factors affecting RR – Activity – External temperature – Emotions: fear, panic, anxiety 11 No questions asked Significance of Respirations Breathing is controlled in the brainstem. – It receives input from central and peripheral chemoreceptors as well as voluntary control from the cerebrum. – Also receives input from the chemoreceptors and adjusts the rate and tidal volume based on pH and PaCO2 of the patient's condition. Assess current physiologic status Abnormal breathing patterns suggest the possibility of an underlying injury or metabolic derangements. Early recognition of abnormal respiratory patterns can aid the clinician in early intervention to prevent further deteriorate 12 Patterns of Respiration  Apnea  absence of respiration  Tachypnea  increased respiratory rate (>20/min.)  Bradypnea  decreased respiratory rate (15 beats per minute) will suggest dehydration, volume depletion, or other transient conditions rather than neurogenic OH. 43 Orthostatic BPs The initial assessment should include BP and heart rate measurement when the patient has been supine for at least 5 minutes and ideally at both 1 and 3 minutes of standing. This approach captures immediate declines in BP, which are a risk for falls during this vulnerable period, as well as cases of delayed onset of BP decline. In a busy practice this is often not possible, and single measurements in the supine and standing postures are an alternative – some use supine and seated in patients at risk of falling 44 Pulse Oximetry An oximeter indirectly measures the amount of oxygen that is carried by the blood (SpO2) Most oximeters give a reading +/- 2% compared to an arterial blood gas. For example, if the SpO2 is 92% on the pulse oximeter, it may actually be anywhere from 90% to 94%. Used a lot in ERs and UCs, and when situation calls for it (respiratory illness, history of COPD,etc) 45 Height and weight Patient self-report is not an adequate assessment Height: standing without shoes Weight: without shoes and with few clothes Body habitus/weight is closely linked to many chronic disease states 46 Body Mass Index (BMI) Weight(kg)/Height (m2) Underweight = 30 or greater 47 Vital Signs: Take-Home Points  They’re called vital signs for a reason  Often the first objective data you have with which to evaluate a patient  Treat the patient – not the vitals – except in cases where it is necessary to treat the vitals  You are absolutely, ultimately responsible for the accurate measurement and appropriate response to your patients’ vital signs 48