Vital Signs

1
Chapter 24

• Vital Signs

2
Vital Signs

• Temperature
• Pulse
• Respiration
• Blood Pressure
• Pain

3
Temperature

• Heat Production
• Heat Loss

4
Temperature

• Core Temperature
• Surface Temperature

5
Variations in Body Temperature

• Factors Affecting Body Temperature
• Circadian Rhythms
• Age and Sex
• Environmental Temperature
• Hypothermia low body temperature
• Hyperthermia high body temperature

6
Normal Body Temperature

• Varies 0.3 to 0.6 degrees C (0.5-1.0 degrees F).
• Afebrile a person with a normal body temperature

7
Increased Body Temperature

• Pyrexia (fever) Febrile a person with an
  increased body temperature.
• Hyperpyrexia a high fever, usually above 41
  degrees C (105.8 degrees F).
• Hyperthermia- differs from pyrexia hypothalamic
  set point is not changed, but in extreme heat
  exposure or excessive heat production, the
  mechanisms that control body temp are
  ineffective.
• Neurogenic fever result of damage to the
  hypothalamus from intracranial trauma,
  intracranial bleeding, or increased intracranial
  pressure.

8
Physical Effects of Increased Body Temperature

• Loss of appetite, headache, hot, dry skin,
  flushed face, thirst, and general malaise.
• Young children may experience delirium or
  seizures
• Assess for potentially dangerous manifestations
  of a fever, such as dehydration, decreased
  urinary output, and rapid heart rate.
• Methods of reducing

9
Decreased Body Temperature

• Hypothermia body temp below the lower limit of
  normal.
• Death may occur when temp falls below 34 degrees
  C (93.2 degrees F).

10
Assessing Temperature

• Equipment
• Electronic and Digital Thermometers
• Tympanic Membrane Thermometer
• Glass thermometer
• Disposable Single-Use Thermometers
• Temporal Artery Thermometer
• Automated Monitoring Devices

11
Temperature

• Routes
• Oral most common
• Rectal
• Axillary
• Tympanic
• Always record site when recording temperature.

12
Pulse

• Throbbing sensation that can be palpated over a
  peripheral artery or auscultated (listened to )
  over the apex of the heart.
• Results as a wave of blood is pumped into the
  arterial circulation by the contraction of the
  left ventricle.

13
Pulse Physiology

• Pulse regulated by the ANS through the cardiac SA
  node (pacemaker).
• Parasympathetic stimulation via the vagus nerve
  decreases the HR, and sympathetic stimulation
  increased the HR and force of contraction.
• Pulse rate is the number of pulsations felt over
  a peripheral artery or heard over the apex of the
  heart in 1 minute.

14
Variations in Pulse Rate

• Pulse Rate
• Normal range 60 100
• Increased to 100 180 Tachycardia
• Decreased below 60 Bradycardia

15
Variations in Pulse Amplitude and Quality

• Pulse Amplitude and Quality
• Quality of pulse in terms of its fullness and
  reflects the strength of left ventricular
  contraction.
• Assessed by the feel of the blood flow through
  the vessel.
• Amplitude is normally strong in areas where an
  artery can be palpated.
• Absent (0), Thready (1), Weak (2), Normal (3),
  Bounding (4)

16
Variations in Pulse Rhythm

• Pulse Rhythm
• The pattern of the pulsations and the pauses
  between them.
• Normally regular
• Irregular pattern of heartbeats - dysrhythmia

17
Assessing the Pulse

• Palpating peripheral arteries or by auscultating
  the apical pulse with a stethoscope.
• Equipment
• Stethoscope

18
Sites and Methods of Assessing the Pulse

• Peripheral Arterial Pulses place the middle
  three fingers over the artery and lightly
  compress the artery so pulsations can by felt and
  counted.
• Temporal
• Carotid during emergency situations
• Brachial used for infants who have had a
  cardiac arrest
• Radial most commonly used in children and
  adults
• Femoral
• Popliteal
• Posterior tibial
• Dorsalis pedis

19
Pulse

• Apical Pulse
• Apical-Radial Pulse

20
Respirations

• Pulmonary ventilation (or breathing) is movement
  of air in and out of the lungs inspiration (or
  inhalation) is the act of breathing in, and
  expiration ( or exhalation) is the act of
  breathing out.
• External respiration is the exchange of oxygen
  and carbon dioxide between the alveoli of the
  lungs and the circulating blood through
  diffusion.
• Internal respiration is the exchange of oxygen
  and carbon dioxide between the circulating blood
  and tissue cells.

21
Respiration Physiology

• Rate and depth of breathing can change in
  response to body demands.
• Increase in carbon dioxide is the most powerful
  respiratory stimulant, causing an increase in
  respiratory depth and rate.
• The cerebral cortex of the brain allows voluntary
  control of breathing.

22
Variations in Respiratory Rate and Depth

• Normally smooth, effortless, and without
  conscious effort.
• Factors Affecting Respiration
• Respiratory Rate (12 to 20 times each minute)
• Normal eupnea (1 resp to 4 heartbeats)
• Increased tachypnea occurs inresponse to the
  increased metabolic rate during fever (pyrexia).
• Decreased bradypnea occurs in some pathologic
  conditions.

23
Respiratory Depth and Rhythm

• Normally from shallow to deep.
• Apnea no breathing
• If lasts longer than 4 to 6 minutes, brain damage
  and death might occur.
• Dyspnea difficult or labored breathing

24
Assessing Respirations

• Rate, Depth, and Rhythm by inspection (observing
  and listening) or by listening with the
  stethoscope.
• Monitoring arterial blood gas results and using a
  pulse oximeter to determine oxygenation of blood.
• Depth assessed by observing the degree of
  excursion or movement in the chest wall.
• Rhythm

25
Alterations in Respirations

• Bradypnea - lt10 rate reg but abn slow.
• Tachypnea - gt 24 rate reg but abn rapid.
• Hyperpnea resp labored, increase in depth,
  increase in rate gt 20 (occurs normal in
  exercise).
• Apnea respirations cease for several second.
  Persistent cessation results in respiratory
  arrest.

26
Alterations in Respirations

• Hyperventilation increased rate and depth
• Hypoventilation decreased rate and depth
  irregular
• Cheyne-Stokes Respirations Alternating periods
  of deep, rapid breathing followed by periods of
  apnea.
• Kussmaulss Respirations abnormally deep
  regular and increase in rate.
• Biolts Respirations varying depth and rate of
  breathing, followed by periods of apnea.

27
Oxygen Saturation

• Measures diffusion and perfusion.
• 95 - 100 - of hemoglobin that is bound with
  oxygen in the arteries is the of saturation of
  hemoglobin (SaO2).
• Pulse oximeter indirect measurement
• Interferance with Light Transmission

28
Reduction of Arterial Pulsations

• PVD
• Hypothermia
• Pharmocological vasoconstrictors
• Decreased Cardiac Output and Hypotension
• Peripheral Edema
• Tight Probe

29
Blood Pressure

• The force of the blood against arterial walls.
• Maximum blood pressure is exerted on the walls of
  arteries when the left ventricle of the heart
  pushes blood through the aortic valve into the
  aorta at the beginning of systole.
• Pressure rises as the ventricle contracts and
  falls as the heart relaxes.
• This continuous contraction and relaxation of the
  left ventricle creates a pressure wave that is
  transmitted through the arterial system.

30
Blood Pressure

• Systolic pressure (numerator) the highest
  pressure
• Diastolic pressure (denominator) the lowest
  pressure
• Pulse pressure the difference between Systolic
  and Diastolic pressure.
• Measured in millimeters of mercury (mm Hg) and
  recorded as a fraction. (Example 120/80
  systolic 120, diastolic 80, pulse pressure 40)

31
Compliance

• Arteries have a considerable quantity of elastic
  tissue that allows them to stretch and distend.
• Constant state of pressure in arteries which
  offers the resistance.
• Elasticity of walls resistance of the
  arterioles maintain normal blood pressure.
• With age, walls of arterioles less elastic,
  decreased ability to stretch and dilate.
  Ultimately limits adequate blood flow and
  contributes to rising pressure.

32
Neural and Humoral Mechanisms

• ANS mediates control mechanisms that function to
  maintain short-term regulation of BP
• Hormones and humoral mechanisms regulate BP
• Renin-angiotensin-aldosterone system controls
  vasoconstriction to increase peripheral vascular
  resistance and also increases sodium and water
  retention bythe kidneys to increase circulatory
  fluid volume increased BP
• ADH 0 Antidiuretic hormone vasopressin- is
  release from the posterior pituitary when
  stimulated by decreased blood volume and blood
  pressure, or by an increased osmolarity of the
  blood water is retained to increase circulatory
  fluid volume - increase BP

33
Cardiac Output

• Stroke Volume quantity of blood forced out of
  the left ventricle with each contraction
• Cardiac Output is the amount of blood pumped per
  minute, and averages from 3.5L to 8.0 L/min in a
  healthy adult.
• CO SV X HR
• Increases during exercise, decreases during
  sleep.
• Varies depending on body size and metabolic
  needs.
• Increased CO arteries distend more, increased
  BP.
• Decreased CO BP falls

34
Variations in Blood Pressure

• Factors Affection BP
• Age
• Circadian rhythm
• Sex
• Food Intake
• Exercise
• Weight
• Emotional state
• Body position
• Race
• Drugs/Medications

35
Increased Blood Pressure

• Hypertension BP is above normal for a sustained
  period
• Most common health problems in adults and the
  leading cause of cardiovascular disorders.
• Primary or essential HTN without know cause.
• Secondary HTN with know pathology.
• Major risk factor for heart disease, and most imp
  risk factor for stroke.
• Silent Killer
• Few symptoms beyond the HTN 22 million dont know

36
Risk Factors for HTN

• Family history
• Sedentary lifestyle
• Obesity
• Continual stress

37
HIGH RISK FACTORS

• Cigarette smoking
• Alcohol consumption
• High salt intake
• High-fat, high-calorie diet
• Twice as common in African Americans as in
  Americans of European descent.

38
Treatment of HTN

• Medications
• Antihypertensive medication
• Diuretics to decrease fluid volume.
• Beta-adrenergic blockers to block sympathetic
  stimulation and decrease cardiac output.
• Vasodilators and calcium channel blockers to
  relax smooth muscles of arterioles and decrease
  peripheral vascular resistance.
• ACE inhibitors to prevent vasoconstriction by
  angiotensin II and decrease circulatory fluid
  volume by reducing aldosterone production.

39
Lifestyle Changes

• Low-calorie, low-fat diet
• Losing excess weight and maintaining weight loss
• Limiting alcohol intake
• Eliminating smoking
• Reducing salt intake
• Regular physical activity

40
Decreased Blood Pressure

• Hypotension below-normal BP
• Orthostatic hypotension (Postural Hypotension)
  low BP

41
Assessing Blood Pressure

• Equipment
• Sphygmonmanometer
• Noninvasive BP monitors
• Doppler Ultrasound
• Direct Electronic Measurement

42
Assessment Sites and Methods

• Korotkoff Sounds
• Assessing a Brachial Artery BP
• Assessing a Popliteal Artery BP
• Palpating the BP

43
Blood Pressure Assessment Errors and Contributing
Causes

• See Table 24-11 on page 554.