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Vital Signs

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Title: 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.
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