Title: Vital Signs
1Chapter 24
2Vital Signs
- Temperature
- Pulse
- Respiration
- Blood Pressure
- Pain
3Temperature
- Heat Production
- Heat Loss
4Temperature
- Core Temperature
- Surface Temperature
5Variations in Body Temperature
- Factors Affecting Body Temperature
- Circadian Rhythms
- Age and Sex
- Environmental Temperature
- Hypothermia low body temperature
- Hyperthermia high body temperature
6Normal Body Temperature
- Varies 0.3 to 0.6 degrees C (0.5-1.0 degrees F).
- Afebrile a person with a normal body temperature
7Increased 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.
8Physical 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
9Decreased 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).
10Assessing Temperature
- Equipment
- Electronic and Digital Thermometers
- Tympanic Membrane Thermometer
- Glass thermometer
- Disposable Single-Use Thermometers
- Temporal Artery Thermometer
- Automated Monitoring Devices
11Temperature
- Routes
- Oral most common
- Rectal
- Axillary
- Tympanic
- Always record site when recording temperature.
12Pulse
- 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.
13Pulse 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.
14Variations in Pulse Rate
- Pulse Rate
- Normal range 60 100
- Increased to 100 180 Tachycardia
- Decreased below 60 Bradycardia
15Variations 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)
16Variations in Pulse Rhythm
- Pulse Rhythm
- The pattern of the pulsations and the pauses
between them. - Normally regular
- Irregular pattern of heartbeats - dysrhythmia
17Assessing the Pulse
- Palpating peripheral arteries or by auscultating
the apical pulse with a stethoscope. - Equipment
- Stethoscope
18Sites 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
19Pulse
- Apical Pulse
- Apical-Radial Pulse
20Respirations
- 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.
21Respiration 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.
22Variations 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.
23Respiratory 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
24Assessing 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
25Alterations 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.
26Alterations 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.
27Oxygen 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
28Reduction of Arterial Pulsations
- PVD
- Hypothermia
- Pharmocological vasoconstrictors
- Decreased Cardiac Output and Hypotension
- Peripheral Edema
- Tight Probe
29Blood 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.
30Blood 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)
31Compliance
- 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.
32Neural 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
33Cardiac 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
34Variations in Blood Pressure
- Factors Affection BP
- Age
- Circadian rhythm
- Sex
- Food Intake
- Exercise
- Weight
- Emotional state
- Body position
- Race
- Drugs/Medications
35Increased 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
36Risk Factors for HTN
- Family history
- Sedentary lifestyle
- Obesity
- Continual stress
37HIGH 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.
38Treatment 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.
39Lifestyle Changes
- Low-calorie, low-fat diet
- Losing excess weight and maintaining weight loss
- Limiting alcohol intake
- Eliminating smoking
- Reducing salt intake
- Regular physical activity
40Decreased Blood Pressure
- Hypotension below-normal BP
- Orthostatic hypotension (Postural Hypotension)
low BP
41Assessing Blood Pressure
- Equipment
- Sphygmonmanometer
- Noninvasive BP monitors
- Doppler Ultrasound
- Direct Electronic Measurement
42Assessment Sites and Methods
- Korotkoff Sounds
- Assessing a Brachial Artery BP
- Assessing a Popliteal Artery BP
- Palpating the BP
43Blood Pressure Assessment Errors and Contributing
Causes
- See Table 24-11 on page 554.