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Vital Signs
Chapter 30
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Vital Signs


The measurement of vital signs is an important aspect
of every visit to the medical office.
These signs, the human body's indicators of internal
homeostasis, represent the patient’s general state of
health.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 2
Variations

Accuracy is essential. Variations may indicate the
presence or disappearance of a disease process and
therefore a change in treatment.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 3
Cardinal Signs

The vital signs are the patient's temperature, pulse,
respiration, and blood pressure. These four signs are
abbreviated TPR and BP, referred to as cardinal
signs.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 4
Other Measurements

Anthropometric measurements include height,
weight, and other body measurements, such as fat
composition and head and chest circumference.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 5
Factors That May Influence Vital Signs



The vital signs are influenced by many factors, both
physical and emotional.
Most patients are apprehensive during an office visit,
which may alter the vital signs.
The medical assistant must help the patient relax
before taking any readings.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 6
Normal Ranges for Vital Signs

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
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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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 7
Temperature


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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 8
Fever



Continuous fever rises and falls only slightly during
the 24-hour 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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 9
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 10
Temperature Readings


A clinical thermometer measures body temperature and
is calibrated in either the Fahrenheit or the Celsius
scale.
The Fahrenheit (F) scale has been used most frequently
in the United States to measure body temperature, but
hospitals and many ambulatory care settings often use
the Celsius scale.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 11
Conversion Formulas

Formulas for conversion from one system to the other
C = (F – 32) x 5/9
F = 9 × C + 32
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 12
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 13
Types of Thermometers

Digital

Tympanic

Disposable

Axillary

Rectal
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Slide 14
Digital Thermometer
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Slide 15
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 16
Pulse

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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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 17
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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 18
Pulse Sites

TEMPORAL PULSE.

CAROTID PULSE.

BRACHIAL PULSE.

RADIAL PULSE
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 19
Characteristics of Pulse


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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 20
Three-Point Scale for Measuring Pulse
Volume

3+, full, bounding

2+, normal pulse

1+, weak, thready
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 21
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 22
Respiratory Rate

Note three important characteristics:
– Rate: number of respirations per minute
– Rhythm: breathing pattern
– Depth: amount of air being inhaled and exhaled
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 23
Respiration Terms

Dyspnea
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Hyperventilation
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COPD
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Orthopnea
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Bradypnea
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Rales

Apnea

Rhonchi

Tachypnea

Stertorous

Hyperpnea

Cyanosis
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 24
Counting Respirations


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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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 25
Respiration Rate


Count the respirations for 30 seconds, and multiply the
number by 2.
Note and record any variation or irregularity in the rate.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 26
Respiration Rate
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 27
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 28
Recording BP



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).
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 29
Factors Affecting 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
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 30
Factors Affecting Blood Pressure (cont’d)

The condition of the heart muscle, or myocardium, is of
primary importance to the volume of blood flowing
through the body.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 31
Hypertension



Fifty million Americans have hypertension that requires
treatment.
Prevalence increases with age; it occurs more
frequently in African Americans.
Risk factors include cigarette smoking, diabetes
mellitus, hyperlipidemia, male gender, postmenopausal
status, obesity, stress, and family history.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 32
Hypertension (cont’d)


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 to 6 months
depending on the severity of the hypertension.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 33
Hypertension Diagnosis
LEVEL
SYSTOLIC
DIASTOLIC
High blood pressure
140 or above
90 or above
Prehypertension
120 to 139
80 to 89
Normal adult (age 18 or 119 or below
older) blood pressure
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
79 or below
Slide 34
Hypertension (cont’d)


Millions of people whose blood pressure was previously
considered borderline high (130-139/85-89 mm Hg) or
normal (120/80) now fall into the "prehypertension"
range, based on new, more aggressive high blood
pressure guidelines.
Because new studies show that the risk of heart
disease and stroke begins to increase at lower blood
pressures than previously believed, health experts
lowered the acceptable normal range to promote more
aggressive and earlier treatment of high blood
pressure.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 35
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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 36
Measuring BP



The sphygmomanometer must be used with a
stethoscope.
Use the inflatable cuff to obliterate (cause to disappear)
circulation through an artery.
Place the stethoscope over the artery just below the
cuff, then slowly deflate the cuff to allow the blood to
flow again.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 37
Measuring BP (cont’d)


As blood flow resumes, cardiac cycle sounds are heard
through the stethoscope, and gauge readings are taken
when the first (systolic) and the last (diastolic) sounds
are heard.
Korotkoff sounds—produced by the vibrations of the
arterial wall
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 38
Palpatory BP Method

Systolic pressure can be palpated.
– Place the cuff in position.
– Palpate the radial pulse.
– Inflate the cuff until pulse disappears, and add 30 mm Hg
more inflation.
– Keep fingers positioned over the radial pulse.
– Slowly release the pressure in the cuff.
– Watch the gauge and record the first pulse felt as the systolic
reading (document as the number over P).
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 39
BP Devices
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 40
Personal BP Systems



Home system finger cuff.
Digital blood pressure home system arm
cuff.
Wrist cuff.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 41
Causes for BP Errors

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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.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.






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.
Slide 42
Anthropometric Measurement

Height

Weight

BMI
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 43
Anthropometric Measurement (cont’d)
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 44
Conversion Formulas

To convert kilograms to pounds:
– 1 kg = 2.2 lb
– Multiply the number of kilograms by 2.2.
– Example: If a patient weighs 68 kg, multiply 68 by
2.2 = 149.6 lb.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 45
Conversion Equations

To convert pounds to kilograms:
– 1 lb = 0.45 kg
– Multiply the number of pounds by 0.45 or divide the
number of pounds by 2.2 kg.
– Example: If a patient weighs 120 lb, multiply 120 by
0.45 = 54 kg, or divide 120 by 2.2 = 54.5 kg.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 46
Body Mass Index (BMI)

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
The BMI is one of the most accurate ways to determine
whether or not an adult is overweight.
BMI is calculated by dividing a person's weight (in
kilograms) by his or her height (in meters, squared).
BMI can also be calculated by multiplying weight (in
pounds) by 705, then dividing by height (in inches)
twice.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 47
Disease Indicators

BMI of 24 or less is considered to be an ideal weight.

BMI of 25 to 29.9 is considered to be overweight.


Individuals who fall into BMI range of 25 to 34.9 and
have a waist size of over 40 inches for men and 35
inches for women are considered to be at especially
high risk for obesity-related health problems, such as
diabetes, high blood pressure, and heart disease.
A BMI over 40 indicates that a person is morbidly
obese. This can increases a person's risk of death from
any cause by 50% to 150%.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 48
Patient Education



Patient education regarding vital signs includes
confirming the ability of the patient to monitor vital
signs at home as needed.
Be sure to provide assistance in working home-based
equipment.
Confirm patient understanding of the need to comply
with physician recommendations.
Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Slide 49