Download Vital Signs aka Cardinal Signs

Vital Signs aka
Cardinal Signs
MED106
Signs
• Vital or Cardinal: temperature, pulse, respiration and blood
pressure. TPR and BP
• Anthropometric signs – height, weight, fat composition, chest
circumference
Factors That May Influence VS
• Accuracy is essential
• VS can be affected by physical and emotional factors
• Many patients are apprehensive during an office visit, which
can alter their VS
• Medical Assistant should help patient to relax as much as
possible
Normal Ranges
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Age Group
Pulse
Respirations
Blood Pressure
(mm Hg)
Newborn
120-160
30-50
60-96/30-62
Toddlers
(1-3 yr)
90-140
20-30
78-112/48-78
Preschool
(4-6 yr)
80-110
18-26
78-112/50-82
School age
(7-11 yr)
75-110
16-22
85-114/52-85
Adolescent
(12-16 yr)
60-100
14-20
94-136/58-88
Adult
60-110
12-20
100-140/60-90
Body Temperature/Fever
• Body temperature is the balance between the heat lost and
the heat produced by the body, measured in degrees.
• The increase in body temperature is thought to be the body's
defensive reaction to inhibit the growth of some bacteria and
viruses.
• Continuous fever rises and falls only slightly during the 24hour period. It remains above the patient's average normal
range and is called continuous because that is exactly what
the pattern shows.
• Intermittent fever comes and goes, or it spikes then returns to
average range.
• Remittent fever has great fluctuation but never returns to the
average range. It is a constant fever with fluctuating levels.
Temperatures Considered Febrile
•
•
•
•
Rectal or aural (ear) temperatures over 100.4° F (38° C)
Oral temperatures over 99.5° F (37.5° C)
Axillary temperatures over 98.6° F (37° C)
Fever of unknown origin (FUO) is a fever over 100.9° F (38.3°
C) for 3 weeks in adults and 1 week in children without a
known diagnosis.
• Formulas for conversion from one system to the other
• C = (F – 32) x 5/9
• F = 9 × C + 32
Rectal and Oral Readings
• Rectal temperatures, when taken accurately, are
approximately 1° F or 0.6° C higher than oral readings.
• Axillary temperatures are approximately 1° F or 0.6° C lower
than accurate oral readings.
Aural (Ototemp) Temperature
• Advantages:
• Accurate—reflection of blood temp surrounding
the hypothalamus
• Not affected by open mouth, hot or cold drinks,
etc.
• Decreased risk of spreading communicable
diseases
• Do not use in the presence of:
• Bilateral otitis externa
• Impacted cerumen
Types of Thermometers
• Digital
• Tympanic
• Disposable
• Axillary
• Rectal
Pulse
• Pulse reflects the palpable beat of the arteries as
they expand with the beat of the heart.
• With every beat, the heart pumps an amount of
blood (stroke volume) into the aorta.
• An artery close to the body surface can be
pushed against a bone for the pulse to be felt.
• Patient should be in a comfortable position, with
artery to be used at same level as or lower than
the heart, with the limb relaxed and supported.
Pulse Sites
• The most common sites are at the following
arteries: temporal, carotid, apical, brachial,
radial, femoral, popliteal, and dorsalis pedis.
• Apical pulse used with:
•
•
•
•
Infants and children
Adults with difficult radial pulse to palpate
Patients taking cardiac drugs
Arrhythmia—bradycardia, tachycardia, pulse
deficit
Characteristics of Pulse and
Three-Point Scale
• When you take a pulse, note four important
characteristics: (1) rate, (2) rhythm, (3) volume of the
pulse, and (4) condition of the arterial wall.
• Record the number of beats in 1 minute, and assess the
rate, rhythm, volume, and elasticity.
• Three-Point Scale for Measuring Pulse Volume
• 3+, full, bounding
• 2+, normal pulse
• 1+, weak, thready
Respiration
• One complete inspiration and expiration is called a
respiration.
• During inspiration, diaphragm contracts, lungs expand
and fill with air.
• During expiration, diaphragm returns to normal, elevated
position and lungs exhale waste air.
• Breathing is both an involuntary and voluntary process:
• Elevated blood carbon dioxide levels activate the
respiratory control center in the brain to stimulate
respiration.
• Can be controlled to a certain extent.
Respiratory Rate Characteristics
•
•
•
•
Rate: number of respirations per minute
Rhythm: breathing pattern
Depth: amount of air being inhaled and exhaled
Patients self-consciously alter their breathing rates
when they are being watched.
• Therefore count the respirations while appearing
to count the pulse.
• Keep your eyes alternately on the patient's chest
and your watch while you are counting the pulse
rate, and then, without removing your fingers from
the pulse site, determine the respiration rate.
Respirations Terms
• Dyspnea
• COPD
• Bradypnea
• Apnea
• Tachypnea
• Hyperpnea
• Hyperventilation
• Orthopnea
• Rales
• Rhonchi
• Stertorous
• Cyanosis
Blood Pressure
• Blood pressure reflects the pressure of the blood
against the walls of the arteries.
• Blood pressure is read in millimeters of mercury,
abbreviated mm Hg.
• Blood pressure is recorded as a fraction, with the
systolic reading in the numerator (top), and the
diastolic reading in the denominator (bottom)
(for example, 130/80).
Systolic/Diastolic BP
• The systolic measurement is the pressure of
blood against the artery walls when the heart
has just finished pumping (contracting).
• The diastolic measurement is the pressure of
blood against the artery walls between
heartbeats, when the heart is relaxed and filling
with blood.
• Korotkoff sounds - produced by the vibrations
of the arterial wall
Factors That Affect Blood Pressure
• Volume: Amount of blood in the arteries
• Peripheral resistance of blood vessels:
Relationship of the lumen or diameter of the
vessel and the amount of blood flowing through
it
• Vessel elasticity: Vessel's capability to expand
and contract to supply the body with a steady
flow of blood
• The condition of the heart muscle, or
myocardium, is of primary importance to the
volume of blood flowing through the body.
Hypertension
• Risk factors include cigarette smoking, diabetes mellitus,
hyperlipidemia, male gender, postmenopausal status,
obesity, stress, and family history.
• Fifty million Americans have hypertension that requires
treatment.
• Treatments include medications and lifestyle changes
such as weight loss, limitation of alcohol intake, smoking
cessation, aerobic exercise, and a diet low in fat and
sodium and high in fiber.
• Schedule regular follow-up visits every 3-6 months,
depending on severity
Hypertension Diagnosis
LEVEL
SYSTOLIC
DIASTOLIC
High blood pressure
140 or above
90 or above
Pre-hypertension
120 to 139
80 to 89
Normal adult (age 18 or 119 or below
older) blood pressure
79 or below
Hypotension
• Hypotension: Abnormally low blood
pressure, caused by shock, both emotional
and traumatic; hemorrhage; central
nervous system disorders; and chronic
wasting diseases.
• Persistent readings of 90/60 mm Hg or
below are usually considered hypotensive.
Causes for BP Errors
• The limb being measured is
not at the same level as the
heart.
• The rubber bladder was
not completely deflated
before starting.
• The pressure in the cuff is
released too rapidly.
• The patient is nervous,
uncomfortable, or anxious.
• The patient drank coffee or
smoked cigarettes within
30 minutes of the
elevation.
• The cuff is improperly
applied.
• The cuff is too large, too
small, too loose, or too
tight.
• The cuff is not placed
around the arm smoothly.
• The bladder is not centered
over the artery, or it bulges
out from the cover.
• The examiner did not wait
1 to 2 minutes between
measurements.
• Defective instruments were
used.