Title: VITAL SIGNS
1VITAL SIGNS
- BY
- Georges Metellus, M.D., M.P.H
2VITAL 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
3Pulse
- 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.
4Pulse 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
5Arterial pulse abnormalities
- 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
6Arterial Pulse Abnormality cont
- 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
7Arterial pulse Abnormalities cont
- 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
8Arterial pulse abnormalities cont
- 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
9Blood 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
10Factors That Influence Blood Pressure
- Blood Volume
- The strength of each heart contraction
- Heart rate
- The thickness of blood (viscosity)
- Rigidity of the arteries
11Blood 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)
12Strength 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
13Heart 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
14Blood 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.
15Increase 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.
16Hypotension
- 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)
17Respiration
- 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.
18Respiratory 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
19Respiratory 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
20Respiratory 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.
21Temperature
- 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
22Temperature 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
23Important 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.
24Temperature 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.