Unit 102.2 Vital Signs Characteristics and Norms Objectives • Describe the basic body functions that produce each vital sign. • Describe normal and abnormal characteristics, normal measures, methods and sites for measuring. • Discuss related terminology. Vital Signs • Measurable, concrete indicators that pertain to and are essential for life • Vital signs are the signs of life! • They are: – Temperature – Pulse – Respirations – Blood Pressure Temperature • measured degree of body heat • balance maintained between heat produced and heat lost by the body • can’t be changed at will • lower in morning • elevated more in evenings Temperature • heat produced by oxidation of food • heat lost through – skin (perspiration) – lungs (breathing) – excretions ( urine, saliva) Fever • an elevated temperature from normal – everyone has a temperature – ill people have a fever Normal Temperature • • • • Type: oral thermometer Time: 3 minutes 98.6 F or 37 C easiest to obtain Normal Temperature • • • • Type: rectal thermometer Time: 5 minutes 99.6 F or 37.6 C most accurate Normal Temperature • • • • Type: axillary placement of thermometer Time: 10 minutes 97.6 F or 36.4 C most inaccurate Normal Temperature • • • • Type: Thermoscan Time: 1 second Ranges of 96.6 F - 99.7 F or 35.9 C - 37.6 C very accurate when circumstances and technique are correct Glass Thermometers • glass hollow tube (stem) with a bulb containing mercury, that expands and is read on scale on the stem – Fahrenheit 212 is boiling, 32 is freezing – scale measured in .20 (ea. little line represents .20) – Celsius (Centigrade) 100 is boiling, 0 is freezing – scale measured in .10 (ea. little line represents .10) Basic Rules for Glass Thermometers – rinse off glass thermometer in cold water if stored in a disinfectant – shake mercury of glass thermometer down to 94F or 35C – use disposable sheath/cover over bulb end of thermometer inserted in mouth – no cold or hot food or drinks 15 min. prior to procedure & no smoking – Keep in place for 3-5 minutes. Glass Thermometer If mercury falls between two lines, round up to next line for temperature reading Glass Thermometer Celcius thermometers are graduated in increments of 0.1 therefore, each line represents 0.1 Celcius Mercury Thermometer Glass Thermometer Fahrenheit thermometers are graduated in increments of 0.2 Fahrenheit Mercury Thermometer therefore, each line represents 0.2 How to Read Glass Thermometer • hold the thermometer at eye level, rotate until you can see the column of mercury • observe the lines on the scale at the upper side of the mercury • read the whole number and the tenths when present Key Factors Glass Thermometers – guard against breaking a mercury thermometer. Mercury is hazardous material and requires special handling for disposal – if thermometer breaks in a patient’s mouth, give them soft bread to eat and notify the physician immediately – very few glass thermometers used today because of the above hazard Oral Thermometers – always place protective sheath over oral thermometer – don’t use if patient can’t breathe through their nose – ask patient not to talk with thermometer in their mouth – place under the tongue – be sure patient has had nothing hot or cold & not smoked 15 min. prior – don’t use if patient can’t cooperate Conversion between Celsius and Fahrenheit • C = (F-32) x 5/9 • F=C x 9/5 + 32 Other Thermometers • electronic or battery operated thermometers, cover probe with plastic sheath, reads and prints out in 10-45 seconds(oral & rectal units) • disposable patches for forehead • disposable plastic strip placed in mouth, turns colors according to degree of temperature • tympanic thermometers, for the ear with results in a second Digital Oral Thermometer use according to the manufacture’s instructions lab practice Thermoscan Tympanic (ear) thermometer. Use according to manufacture’s instructions lab practice Pull pinna up an Back before inserting Tympanic Temperatures – reflects body core temperature – the eardrum shares same blood supply as hypothalmus – measures infrared heat of eardrum & surrounding tissue – scans eight (8) measurements per reading & displays highest as the temperature External Factors Influencing Accuracy – lying on ear for extended period of time – ears covered with cap, scarf, ear muffs – exposure to extreme heat/cold – recent swimming/bathing – Wait 20 minutes if the above are factors to be considered Key Factors Thermoscans – temperature should be taken in same ear for duration of an illness – ear must be free of obstructions to get an accurate reading (earwax, drainage, etc.) – if right ear is used, right hand should hold Thermoscan & visa versa on left – over age 1 year, pinna of ear should be pulled up and back – under 1 year, pinna of ear back only, NOT UP Recommendation – Take tympanic temperature 3 times in the same ear and use the highest reading when: • *the patient is an infant less than 90 days old • *a child is less than 3 years & has a compromised immune system. A fever is critical in these situations, therefore one must be sure • *if you are an inexperienced user of the Thermoscan thermometer When NOT to use Thermoscan – *blood/drainage present in external ear canal – *ear is painful/swollen/red – *ear is plugged with earwax – *ear drops are being used – *facial deformities involving the ear – *when hearing aids are present (must wait 20 minutes after removing for an accurate temperature) Rectal Temperature • use in young children and mentally disabled individuals who may bite • patients having difficulty breathing • confused patients • unconscious patients • patients on oxygen • the Thermoscan thermometer could be used for above situations & reduce risk of rectal tears Key Factors Rectal Temperature • apply a lubricating jelly, K-Y, Vaseline, or even shortening (not a medicated jelly like Vicks) to approximately 1/2 of length • have adults lay on their side • infants lay on stomach or over parent’s knees • insert the thermometer gently • 1 1/2” into rectum • hold gently in place for 5 minutes Key Factors Rectal Temperature • wipe from stem to bulb • wash thermometer with cool water and soap, rinse , dry and place in container with disinfectant • Rectal temperature is the most accurate temperature. Key Factors Axillary Temperature • use on infants with diarrhea and/or well infants • axillary area should be dry (DO NOT rub) • 10 minutes required for accurate reading • could be used for someone unable to tolerate or understand the concept of oral thermometers Signs & Symptoms of Fever • Early Signs: – shivering – increased metabolism – increased pulse – feeling cold – goose bumps Signs & Symptoms of Fever • Later Signs: – skin warm to the touch – flushed – dehydration • dry skin, sunken dull eyes, poor skin turgor – diaphoresis • profuse sweating, indicating hypovolemic shock – weakness – thirsty – rapid respirations Documentation • when recording temperature on chart indicate: – – – – the degree whether it is Fahrenheit or Celsius whether the left or right ear was used what site was used. Oral is universal, if other sites used, an indicator must be shown • R for rectal • A for axillary • T with circle around it for tympanic Pulse • a rhythmic beat or vibration detected by palpating an artery over a bony prominence that indicates the heart rate • should be the same at all arterial pulse sites Pulse Sites • areas where you can compress an artery against a bone • Temporal – side of the head Pulse Site • Carotid – neck Pulse Site • Brachial (not shown) – distal upper arm, just above elbow, medial aspect • Radial – wrist, thumb side – Most common site for conscience adult patients Pulse Sites • Apex – point of heart • Femoral – groin • Popliteal – behind knee • Dorsalis pedis – top of the foot Normal Pulse Range • varies with age, gender, activity, physical conditions • General rule: The younger the patient the faster the heartbeat Pulse Ranges Normal • Prenatal – 120-160 • Infant – 115-130 • Child – 80-115 • Adult – 60-100 Tachycardia • Definition: pulse rate greater than 100 – Causes of tachycardia: • • • • • • • • stimulant drugs coffee, tea, soda elevated temperature pain anxiety shock diseases like hyperthyroidism digestion and exercise Bradycardia • Definition: heart rate less than 60 – Causes of bradycardia: • • • • • poisons sleeping pills, tranquilizers resting or fasting accidents or disease causing brain pressure mental depression Force of Pulse • How does the pulse force feel against your finger pressure? – Weak or thready (difficult to detect) – Strong (easily detected) – Bounding (very strong, so much so that your fingers feel as though they are being pushed off the artery) Pulse Rhythm • Definition: Intervals between heart beats should be regularly spaced – when describing the rhythm on chart, note whether the rhythm is regular or irregular directly after the rate Arrhythmia • Definition: Irregular heart beat Apical Pulse • apex of heart is the pointed end of heart or its’ base • found at the 5th intercostal space at mid left chest just below left nipple • heard with a stethoscope • frequently used with infants or when a pulse is difficult to detect Procedure Reminders • never use your thumb to detect & count pulse (thumb has own pulse) • Use a watch with a second hand and count pulse for 60 seconds – this may vary in some facilities. You may count for 30 seconds and multiply by 2, or 15 seconds and multiply by 4, etc. Know protocol • when an arrhythmia is detected, the pulse must be taken for 60 seconds Respirations • the act of inhaling oxygen and exhaling carbon dioxide – Inspiration= breathing in – Expiration= breathing out Normal Respirations Rates • Adult – 12-20 • Child/Infant – 20-30 • Newborn – 35-50 Factors that Affect Respirations • Increases rate: – – – – – – – – – diseases of lungs & circulatory system hemorrhage pain shock fever vigorous exercise anxiety, excitement altitude atropine Factors that Affect Respirations • Decreases Rate: – sleep or relaxation – narcotic analgesics • morphine – kidney failure – brain tumors – injuries Respiratory Terminology – Pnea • respirations – Eupnea • normal respirations – Bradypnea • slow respirations – Tachypnea • fast respirations – Apnea • Cessation or absence of respirations – Hyperventilation • rapid breathing depleting carbon dioxide Various Qualities of Respirations • Shallow – very little air inhaled – little chest movement • Deep – – – – more air inhaled seen in brain injuries often chest pathology in progress seen with exersion • Full – viewed as normal breathing Procedure Reminders – patients can alter breathing pattern, – count respirations without the patient being aware – count for 60 seconds while still appearing to take pulse – record rate & quality of breathing Immediately begin counting respirations after counting pulse with NO perceivable break What to do if Breathing is Difficult to Detect • while appearing to take pulse, watch chest rise and fall • place arm across chest, take pulse, and then count each rise and fall of chest • assume patients breathing pattern and count your own • watch abdomen rise and fall Vital Signs View Video KHO 17 “Temperature, Pulse, Respirations” approximately 23 minutes Blood Pressure • the force of blood pushing against the walls of the arteries Blood Pressure Terminology • Systolic – greatest force exherted as heart is contracting “heart at work” – top number – quick to change – affected by • • • • • exercise emotions illness medications illegal drugs Blood Pressure Terminology • Diastolic – least force exherted during relaxation phase of cycle “heart at rest” – bottom number – affected by • disease • medications • slower to change Blood Pressure Adult Normal Ranges • Systolic – 90-140 • Diastolic – 60-90 • record as a fraction systolic/diastolic and in even numbers, unless using digital BP equipment Abnormalities • Hypertension – Elevated or high blood pressure – usually greater then 140/90 • Hypotension – decreased blood pressure – usually less than 90/60 Factors that Increase Blood Pressure – loss of elasticity of arteries (disease) – exercise, eating – stimulants like coffee, caffinated beverages, drugs – emotional disturbances – gender (females often not affected until after menopause) – excess weight (not hard rule) – family history Factors that Decrease Blood Pressure • • • • depressants like sleeping pills narcotic pain relievers, tranquilizers fasting shock caused from blood or body fluid losses Sphygmomanometer (Blood Pressure Cuff) • measures arterial pressure in mm of mercury (Hg) or its equivalent • rubber bladder covered with unyielding material • hand bulb with stop cock to inflate cuff • aneroid dial or mecurial column to measure cuff inflated 180 - 200 mm Hg release at rate of 4 mm Hg per second and listen for first heat beat & last heartbeat Key Factors Blood Pressure – remove clothing from above the elbow when possible – cuff size should be 2/3 length of upper arm (humerus) • too small of a cuff may give false high blood pressure reading • too large of a cuff may give false low blood pressure reading • The valve is turned clockwise to inflate the cuff – support extremity at heart level to get an accurate reading – listen over brachial artery pulse site – if repeating is necessary, wait 1 full minute before reinflating the cuff Stethoscope – bell and/or diaphragm placed on organ/vessel to auscultate – the diaphragm must be in full contact with organ/vessel for maximum audibility – use two fingers, NOT thumb only to make contact diaphragm Key Factors Stethoscope – diaphragm (flat side) is used to auscultate blood pressure, lung sounds, bowel sounds, bruits – bell is used for heart sounds and pediatric patient assessment – ear pieces point to nose when in ears – minimize tube noise to maximize ability to hear sounds – clean the diaphragm/bell between patients (do not transmit germs this way) & keep ear tips clean Vital Signs Unit 102.3 Recording Vitals • Record findings – charting shows comparisons quickly – Narrative • write down pulse rate (beats per minute), quality of pulse, and rhythm • write down respiration rate (breaths per minute) & quality of breath • describe abnormal (be specific) • To correct an error – DO NOT erase or obliterate any info Correction of a Handwritten Entry • draw line through the error • insert correction above or immediately following the error • in the margin, write “correction” or “corr”, your initials and date Knowledge Assessment • Give normal temperatures for oral, rectal, and axillary temperatures. • List and describe the different types of thermometers. • Define pulse and list all pulse sites. • Define respirations, normal rates, and factors that affect respiration counts. • Contrast systolic and diastolic. • Define blood pressure, give normal ranges, abnormalities, and equipment.