Download VITAL SIGNS - 龍紋天珠,STERLINGWEAR OF BOSTON

BY
Georges Metellus, M.D., M.P.H
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Are considered the baseline indicators of a
patient’s health status. They may be measured
early in the physical examination.
Pulse
Respiration
Blood Pressure
Temperature
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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.
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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
TYPE/DESCRIPTION
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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.
ASSOCIATED
CONDITIONS
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Left ventricular failure
Regularly occuring
ventricular premature
beats
Aortic regurgitation
alone or with stenosis
TYPE/DESCRIPTION
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Bounding pulse:
increase pulse pressure;
contour may have rapid
rise, brief peak, rapid
fall.
Bradycardia: rate <60
ASSOCIATED
CONDITIONS
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Artherosclerosis, aortic
rigidity, patent ductuc
arteriosus, fever, anemia,
hyperthyroidism, anxiety,
exercise
Hypothermia,
Hypothyroidism, drug
intoxication, impaired
cardiac conduction,
exellent physical
conditioning
TYPE/DESCRIPTION
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Paradoxic pulse:
Amplitude decreases on
inspiration
Pulsus differens: Unequal
pulses between left and
right extremities
ASSOCIATED
CONDITIONS
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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
TYPE/DESCRIPTION
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Trigeminal pulse: three
beats followed by a pause.
Water-hammer pulse
(corrigan pulse): Jerky
pulse with full expansion
followed by sudden
collapse
ASSOCIATED
CONDITIONS
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Often benign, such as
after exercise; but may
occur with
cardiomyopathy, severe
ventricular
hypertrophy, severe
aortic stenosis,
dysfunctional right
ventricle.
Aortic regurgitation
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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
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Blood Volume
The strength of each heart contraction
Heart rate
The thickness of blood (viscosity)
Rigidity of the arteries
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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)
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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
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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
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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.
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.
Hypotension results from:
1. Decrease of cardiac output:
In Addison’s 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-Frederichsen syndrome)
Drug intoxication
( a sudden drop in blood pressure should be regarded as a grave sign)
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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
patient’s 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.
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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
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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
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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.
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The assessment of body temperature may often
provide an important clue to the severity of a patient’s
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
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
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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.
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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.