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VITAL SIGNS

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BY Georges Metellus, M.D., M.P.H Are considered the baseline indicators of a patient s health status. They may be measured early in the physical examination. – PowerPoint PPT presentation

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Title: VITAL SIGNS


1
VITAL SIGNS
  • BY
  • Georges Metellus, M.D., M.P.H

2
VITAL SIGNS
  • Are considered the baseline indicators of a
    patients health status. They may be measured
    early in the physical examination.
  • Pulse
  • Respiration
  • Blood Pressure
  • Temperature

3
Pulse
  • The pulse may provide information about the rate,
    strength, and rhythmicity of the heartbeat.
  • The pulse may be palpated in several different
    areas. The nine major pulse points are named
    after the arteries over which they are felt.
  • To feel a pulse, you must place the pads of your
    second and third fingers over an artery that lies
    near the surface of the body and over a bone or a
    firm base.

4
Pulse Points
  • 1. Over the superficial temporal artery in front
    of the ear.
  • 2. The common carotid artery in the neck along
    the front edge of the sternocleidomastoid muscle.
  • 3. Over the facial artery at the lower margin of
    the mandible at a point below the corner of the
    mouth.
  • 4. In the axilla over the axillary artery
  • 5. Over the brachial artery at the bend of the
    elbow along the inner or medial margin of the
    biceps brachii muscle
  • 6. At the radial artery at the wrist (radial
    pulse). It is the most frequently monitored and
    easoly accessible in the body
  • 7. Over the femoral artery in the groin.
  • 8. At the popliteal artery behind and just
    proximal to the knee
  • 9. At the dorsalis pedis artery on the front
    surface of the foot, just below the bend of the
    ankle joint

5
Arterial pulse abnormalities
  • Type/description
  • Associated conditions
  • Pulsus alternans regular rate amplitude varies
    from beat to beat with weak and strong beats
  • Bigeminal pulse Two beats in rapid succession
    followed by longer interval easily confused with
    alternating pulse.
  • Pulsus bisferiens Two strong systolic peaks
    separated by a midsystolic dip.
  • Left ventricular failure
  • Regularly occuring ventricular premature beats
  • Aortic regurgitation alone or with stenosis

6
Arterial Pulse Abnormality cont
  • Type/description
  • Associated conditionS
  • Bounding pulse increase pulse pressure contour
    may have rapid rise, brief peak, rapid fall.
  • Bradycardia rate lt60
  • Artherosclerosis, aortic rigidity, patent ductuc
    arteriosus, fever, anemia, hyperthyroidism,
    anxiety, exercise
  • Hypothermia, Hypothyroidism, drug intoxication,
    impaired cardiac conduction, exellent physical
    conditioning

7
Arterial pulse Abnormalities cont
  • Type/Description
  • Associated conditions
  • Paradoxic pulse Amplitude decreases on
    inspiration
  • Pulsus differens Unequal pulses between left and
    right extremities
  • Tachycardia Rate over 100
  • Chronic obstructive disease, constrictive
    pericarditis, peircardial effusion
  • Impaired circulation, usually from unilateral
    local obstruction
  • Fever, hyperthydoidism, anemia, shock, Heart
    disease, anxiety, exercise

8
Arterial pulse abnormalities cont
  • Type/description
  • Associated conditions
  • Trigeminal pulse three beats followed by a
    pause.
  • Water-hammer pulse (corrigan pulse) Jerky pulse
    with full expansion followed by sudden collapse
  • Often benign, such as after exercise but may
    occur with cardiomyopathy, severe ventricular
    hypertrophy, severe aortic stenosis,
    dysfunctional right ventricle.
  • Aortic regurgitation

9
Blood pressure
  • Blood pressure is the pressure or push of blood
    as it flows through the circulatory system. It is
    a peripheral measurement of cardiovascular
    function.
  • Indirect measures of blood pressure are made with
    a stethoscope and a sphygmomanometer (aneroid or
    mercury) or with electronic sphygmomanometers
    which do not require the use of a stethoscope

10
Factors That Influence Blood Pressure
  • Blood Volume
  • The strength of each heart contraction
  • Heart rate
  • The thickness of blood (viscosity)
  • Rigidity of the arteries

11
Blood Pressure and blood volume
  • The larger the volume of blood in the arteries,
    the more pressure the blood exerts on the walls
    of the arteries.
  • The less blood in the arteries, the lower the
    blood pressure tends to be. (Hemorrhage
    demonstrates this relation between blood volume
    and blood pressure)

12
Strength of Heart Contraction and Blood Pressure
  • A stronger heartbeat increases blood pressure and
    a weaker beat decreases it.
  • Cardiac output is also influenced by the strength
    of the contraction of the heart

13
Heart Rate and Blood Pressure
  • The rate of the heart also affect arterial Blood
    pressure. When the heart beats faster, more blood
    enters the aorta, therefore the arterial blood
    volume and blood pressure would increase.
  • The stroke volume is to be considered because it
    might determine whether or not the blood pressure
    is going to change in one way or another

14
Blood Viscosity and Blood pressure
  • If blood becomes less viscous than normal, blood
    pressure decreases. (if a person suffers a
    hemorrhage, fluid moves into the blood from the
    interstitial fluid. This dilutes the blood and
    decreases its viscosity, and blood pressure)
  • In a condition called Polycythemia, the number of
    red blood cells increases beyond normal and thus
    increases blood viscosity. This in turn increases
    blood pressure.

15
Increase of Arteriolar Resistance and Blood
Pressure
  • Increased arteriolar resistance is the most
    common cause of hypertension. This increase may
    occur secondarily to
  • 1. Endocrine causes
  • Tumor of the adrenal medulla (
    Pheochromocytomas) produces epinephrine and
    norepinerphrine and may give rise to paroxysmal
    form of hypertension
  • 2. Renal Causes
  • a) Renal parenchyma
  • Chronic glomerulonephritis
  • Pielonenephritis
  • Polycystic disease
  • B) Renal vasculature
  • vascular lesions due to congenital
    or acquired malformation of the renal artery or
    to small vessels disease as such in lupus
    erythematosus.
  • 3. Essential Hypertension is the most cause
    of a pathologically elevated blood pressure. The
    disease shows a marked familial tendency, and it
    appears commonly in middle-aged people. It is one
    of the most common causes of left ventricular
    Hypertrophy.

16
Hypotension
  • Hypotension results from
  • 1. Decrease of cardiac output
  • In Addisons disease, myocarditis, myocardial
    infarction, pericarditis with effusion, and
    following Hemorrhage
  • 2. Decrease in peripheral resistance
  • Vasomotor collapse, may occur in
  • Pneumonia
  • Septicemia
  • Acute Adrenal insufficiency (waterhouse-Frederi
    chsen syndrome)
  • Drug intoxication
  • ( a sudden drop in blood pressure should be
    regarded as a grave sign)

17
Respiration
  • Respiration means exchange of gases( oxygen and
    carbon dioxide) between a living organism and its
    environment
  • Respirations are counted and evaluated by
    inspection. Observe the rise and the fall of the
    patients chest and the ease with which breathing
    is accomplished. Count the number of respiratory
    cycles (inspiration and expiration) per minute.
  • Observe the regularity and rhythm of the
    breathing pattern.
  • Note the depth of respirations and whether the
    patient uses accessory muscles.

18
Respiratory Patterns
  • Tachypnea Is a persistent respiratory rate
    approaching 25 respirations per minute. Certain
    patients with fibrosis of the lung, pulmonary
    edema, pleural disease, or rib cage fixation may
    breathe rapidly and shallowly. Other patients may
    increase the minute ventilation to accommodate an
    increased gas exchange that is necessitated by
    exercise, fever, hypermetabolic states, or anxiety

19
Respiratory Patterns Cont
  • Bradypnea rate slower than 12 respiration per
    minute. May indicate neurologic ( i.e
    intracraneal pressure hemorrhage, tumor) or
    electrolyte disturbance, infection or a sensible
    response to protect against the pain of pleurisy
    or other irritative phenomena (it may also mean
    splendid level of cardiorespiratory fitness)
  • Kussmaul Respiration deep, rapid and labored
    respiration associated with metabolic acidosis.
    May indicate decompensated diabetes with profund
    acidosis renal diseases or drug causing
    acidosis. Diseases of the central nervous system,
    such as meningitis, may increase minute
    ventilation

20
Respiratory Patterns cont
  • Cheyne-Stokes respiration A regular periodic
    pattern of breathing, with intervals of apnea
    followed by a crescendo/decrescendo sequence of
    respiration. It occurs in patients who are
    seriously ill, particularly those with brain
    damage at the cerebral level or with drug-caused
    respiratory compromise.
  • Biot Respiration Consists of somewhat irregular
    respirations varying in depth and interrupted by
    intervals of apnea. It is usually associated with
    severe and persistent increase intracranial
    pressure, respiratory compromise resulting from
    drug poisoning, or brain damage at the level of
    the medulla.

21
Temperature
  • The assessment of body temperature may often
    provide an important clue to the severity of a
    patients illness. Temperature measurement can be
    accomplished through several different routes,
    most commonly
  • oral,
  • rectal,
  • axillary,
  • tympanic membrane (less common)
  • In the case of bacterial infection it may
    well be the most critical diagnostic indicator,
    especially with infants, toddlers, and the elderly

22
Temperature Cont
  • Important conditions related to body
    temperature
  • 1. Fever Is an unsually high body
    temperature associated with a systemic
    inflamatory response. In the case of infections,
    chemical called Pyrogens cause the thermostatic
    control centers of the hypothalamus to produce
    fever.
  • 2. Malignant hyperthermia Is an inherited
    condition characterized by an abnormally
    increased body temperature and muscle rigidity
    when exposed to certain anesthestics
  • 4. Heat exhaustion Occurs when the body
    loses a large amount of fluid resulting from
    heat-loss mechanism. This usually happens when
    environmental temperatures are high. The loss of
    water and electrolytes can cause weakness,
    vertigo, nausea, heat cramps and possibly loss of
    consciousness

23
Important conditions related to body temperature
  • Heatstroke or sunstroke is a severe condition
    resulting from the inability of the body to
    maintain a normal temperature in an extremely
    warm environment. Such thermoregulatory failure
    may result from factors such as old age, disease,
    drugs that impair thermoregulation, or simply
    overwhelming elevated envinonmental temperatures.

24
Temperature Cont
  • Hypothermia is the inability to maintain a
    normal body temperature in extremely cold
    environments. Hypothermia is characterized by
    body temperature lower than 35C (95F), shallow
    and slow respirations, and a faint, slow pulse.
  • Frostbite is local damage to tissues caused by
    extremely low temperatures. Necrosis and even
    gangrene can result from frostbite.
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