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Chapter 24
Vital Signs and Measurements
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The Importance of Accuracy
Vital signs may be altered by many
factors:
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The Importance of Accuracy
• Anxiety
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The Importance of Accuracy
• Anger
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The Importance of Accuracy
• Food Intake
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The Importance of Accuracy
• Apprehension
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The Importance of Accuracy
• Mood
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Temperature
• Heat production and heat loss maintain
and regulate (via brain) body
temperature
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Body temperature measured in degrees
and influenced by several factors
• There is no “normal” temperature
• “Average” temperature: adult 98.6°F
or 37.0°C
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Terms used to describe body temperature
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Afebrile : Absence of a fever
Febrile: Fever is present
Fever (pyrexia): Body temp increase.
Onset: Time fever started
Lysis: when body temp returns to normal after a period
of time.
Crisis: Sudden decrease or increase in fever.
Intermittent: Fluctuates but returns to or below normal.
Remittent: Fluctuating fever that does not return to
normal baseline, fluctuates but remains increased.
Continuous
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Phase-out of mercury thermometers
and other mercury-containing
equipment
– Mercury toxicity
– When thermometers break or are disposed of
improperly, mercury can enter atmosphere
– Even small mercury spills should be cleaned up as
soon as possible
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Types of thermometers
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Disposable strips
Electronic/digital
Tympanic
Temporal artery
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Measuring
temperature
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Oral
Aural (Tympanic)
Rectal
Axillary
Temporal artery >>
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Recording temperature
– Scale used for results designated F for Fahrenheit
and C for Celsius
– R for rectal
– A for axillary
– Tym for tympanic
– TA for temporal artery
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
• Cleaning and storage of thermometers
– Oral and rectal thermometers separated
– Digital, electronic, tympanic, temporal artery
thermometers cleaned according to
manufacturer’s directions
– Disinfect by wiping with mild disinfectant as
instructed by manufacturer
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Temperature
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Pulse
• Pulse rate consists of two phases of
heart action
• Felt when compressing an artery
• Pulse and heartbeat usually identical
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Pulse
• Pulse sites
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Radial
Carotid
Temporal
Brachial
Femoral
Popliteal
Dorsalis pedis
Apical
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Pulse
• Measuring and evaluating a pulse
– Note rate, rhythm, volume of pulse
– Rate is number of pulsations felt for 1 minute
– Pulse rates vary according to age, activities,
general health, sex, emotions, pain, medications
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Pulse
• Measuring and evaluating a pulse
– Rhythm of pulse: time between pulsations and
regularity of beat
– Arrhythmias (abnormal rhythms) may indicate
heart disease
– Volume of pulse: strength of beat felt
• Full, strong, hard, soft, thready, weak
• Normal artery feels soft and elastic
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Pulse
• Normal pulse rates
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Birth: 120–170 beats per minute
Infants: 100–150 beats per minute
1 year: 120–160 beats per minute
2 years: 80-140 beats per minute
3 years: 70-120 beats per minute
7–14 years: 50–90 beats per minute
Adults: 60–100 beats per minute
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Pulse
• Pulse abnormalities
– Bradycardia
• Pulse rate less than 60 beats per minute
– Tachycardia
• Pulse rate greater than 100 beats per minute
– Premature ventricular contraction (PVC)
• Pulsation felt before expected
– Sinus arrhythmia
• Variation of rhythm sometimes occurs during respiration
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Pulse
• Recording pulse rates
– Record after temperature
– Unusual findings recorded and reported to
provider
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Respiration
• Exchange of gases oxygen and carbon
dioxide
• Involuntary act controlled by medulla
oblongata of brain
• Respiratory rate: number of respirations
per minute
• Varies with age, activities, illness,
emotions, drugs
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Respiration
• Average respiration rate to pulse rate is
1:4, one respiration to four pulse beats
• Respiratory rhythm: pattern of breathing
• Depth of respiration: amount of air
inspired and expired with each
respiration
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Respiration
• Respiration rate
– Measured by counting breaths for 30 seconds and
doubling amount
– Important patients not be aware you are
measuring their respirations
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Respiration
• Abnormalities
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Apnea
Tachypnea
Bradypnea
Cheyne-Stokes
Orthopnea
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Hypoventilation
Hyperpnea
Hyperventilation
Sleep apnea
Narcolepsy
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Respiration
• Breath sounds
– Presence or absence can indicate respiratory
problems
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Rales: Pronounced Rawles, clicking or rattling
Rhonchi: Similar to snoring
Wheezes: High pitched musical sounds
Stridor: Crowing sound such as croup, or obstruction
Stertorous: snoring sound with labored breathing.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Measures force of blood exerted on
peripheral arteries during cardiac cycle
or heartbeat
– Systole: force exerted on arterial walls during
cardiac contraction
– Diastole: force exerted during cardiac relaxation
– Recorded as fraction: systole/diastole
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Factors that affect blood pressure
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Blood volume
Peripheral resistance
Vessel elasticity
Condition of heart muscle
Genetics
Diet and weight
Activity
Emotional state
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Equipment for
measuring blood
pressure
– Auscultatory (listening)
method uses
sphygmomanometer and
stethoscope
An electronic
sphygmomanometer can
measure pulse and other vital
signs simultaneously >>
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Equipment for measuring blood
pressure
– Pulse oximeter: non-invasive method for
measuring amount of oxygen saturating
hemoglobin molecules contained in red blood cell
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Measuring blood pressure
– Korotkoff sounds heard during blood pressure
measurement
– Phases of Korotkoff sounds
• Phase I—first sound is systolic reading
• Phase II—more blood passes through vessels
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Measuring blood pressure
– Phases of Korotkoff sounds
• Phase III—rhythmic tapping sound; cuff deflated
• Phase IV—may be used to record diastolic pressure in
children and those patients where a tapping sound is
heard to zero
• Phase V—blood flowing freely; sounds disappear;
recorded as diastolic pressure
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Measuring blood pressure
– Auscultatory gap
• In some patients all sounds disappear between Phases I
and II or III
• Easily missed; blood pressure measurement incorrect
– Pulse pressure: difference between systolic and
diastolic measurements
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Recording blood pressure measurement
– On patient chart or EMR in fraction format
• Normal blood pressure readings
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Child 10 years: 100/65
Adolescent 16 years: 118/75
Adult: Systolic less than 120/diastolic less than 80
Prehypertension: 120–139/80–89
High blood pressure: Above 140/90
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Blood Pressure
• Blood pressure abnormalities
– Hypertension: blood pressure consistently above
normal
• Primary or essential, secondary, benign, malignant, white
coat
– Hypotension: blood pressure consistently below
normal
• Less than 90/60
• Usually result of various shock-like conditions
• Orthostatic hypotension
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Height and Weight
• Height not considered vital sign
• Many providers prefer height and weight
measured as part of yearly physical
• Height measured with measuring bar
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Height and Weight
• Weight measured on calibrated balance
beam scale or digital scale
• Occasionally, MA required to convert
pound weight to kilogram weight
• Significance of weight: provides insight
into metabolic, nutritional, emotional
problems
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Measuring Chest Circumference
• Done on patients with emphysema and
as requirement for insurance and truck
driver licenses
• Two measurements taken: one on
deepest inspiration; one on deepest
expiration
• Comparison made to ascertain chest
capacity
© 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied
or duplicated, or posted to a publicly accessible website, in whole or in part.