chapter 4 vital signs. elsevier items and derived items © 2008 by saunders, an imprint of elsevier...

CHAPTER 4CHAPTER 4VITAL SIGNS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc. 2

PRETESTPRETEST

True or False1. The heat-regulating center of the body is the

medulla.

2. A vague sense of body discomfort, weakness and fatigue that often marks the onset of a disease is known as the blahs.

3. If an axillary temperature of 100° F was taken orally, it would register as 101° F.

4. If the lens of a tympanic membrane thermometer is dirty, the reading may be falsely low.

5. Chemical thermometers should be stored in the freezer.


PRETEST, CONT.PRETEST, CONT.

True or False6. The femoral pulse site can be used to assess

circulation to the foot.

7. The term used to describe an irregularity in the heart's rhythm is dysrhythmia.

8. Pulse oximetry provides the physician with information on the amount of oxygen being delivered to the tissues.

9. Blood pressure measures the contraction and relaxation of the heart.

10. When taking blood pressure, the stethoscope is placed over the brachial artery.


Content OutlineContent Outline

1. Vital signs (VS): Objective guideposts that provide data to determine a person's state of health

2. Vital signs

a. Temperature

b. Pulse

c. Respiration

d. Blood pressure

e. Pulse oximetry: May be ordered routinely or when patient complains of respiratory problems (depending on office policy)

Introduction to Vital Signs


Introduction to Vital Signs, cont.


3. Normal ranges are finely adjusted

a. Any deviation from normal may indicate disease

4. Variations in VS may take place during the course of an illness

5. MA should be alert to significant change in VS and report it to physician

a. May indicate a change in patient's condition




6. VS usually checked during each office visit to establish:

a. Patient's state of health

b. Baseline measurements • Against which future measurements can be

compared




7. Guidelines for Measuring Vital Signs:

a. Be familiar with normal ranges for VS• Vary based on different age groups

b. Make sure equipment is in proper working condition• Ensures accurate readings




c. Eliminate or minimize factors that affect vital signs• Examples: exercise, food and beverage

consumption, emotional states

d. Use an organized approach when measuring VS• If all the VS are ordered:

– Usually start with temperature, followed by pulse, respiration, blood pressure, and pulse oximetry


Body TemperatureBody Temperature

1. Maintained by hypothalamus

a. Functions as body's thermostat

b. Only allows temperature to vary 1° to 2° F throughout day

Regulation of Body Temperature




2. Temperature maintained through a balance of:

a. Heat produced in the body

b. Heat lost from the body

3. Constant temperature range must be maintained for body to function properly


Regulation of Body Temperature, cont. Regulation of Body Temperature, cont.

4. When minor changes in temperature occur

a. Hypothalamus senses this • Makes adjustments: so temperature stays

within normal range

• Example: Playing tennis on a hot day

– Body's heat-cooling mechanism is activated

– Perspiration occurs to remove excess heat


Heat ProductionHeat Production

1. Heat produced through:

a. Voluntary and involuntary muscle contractions• Voluntary: person can control (e.g.,

movement)

• Involuntary: person cannot control (e.g., digestion, beating of heart, shivering)


Heat ProductionHeat Production

b. Cell metabolism• Heat produced when nutrients broken down in

the cells

c. Fever

d. Strong emotional states


Heat LossHeat Loss

1. Heat lost through:

a. Urine and feces

b. Water vapor from lungs

c. Perspiration: Moisture excreted through the pores of the skin

• When moisture evaporates: heat is released

– Cools body


Heat Loss, cont. Heat Loss, cont.

d. Radiation: transfer of heat in the form of waves• Body heat radiates to cooler surroundings

e. Conduction: transfer of heat from one object to another by direct contact• Heat transferred to a cooler object it touches

f. Convection: transfer of heat through air currents• Cool air currents cause body to lose heat


Heat Loss, cont. Heat Loss, cont.


Body Temperature RangeBody Temperature Range

1. Purpose of measuring body temperature:

a. Establish patient's baseline temperature

b. Monitor an abnormally high or low temperature


Body Temperature Range, cont.

Body Temperature Range, cont.

2. Normal temperature range

a. 97º to 99º F (36.1º C to 37.2º C)

3. Average body temperature

a. 98.6º F (37º C)

4. Usually recorded using Fahrenheit system


Alterations in Body Temperatures

Alterations in Body Temperatures

1. Fever (pyrexia): above 100.4º F

a. Heat being produced is greater than heat being lost

2. Low-grade fever: 99º F to 100.4º F3. Hyperpyrexia: above 105.8º F

a. Serious condition

b. Generally fatal: Above 109.4º F:


•Alterations in Body Temperatures, cont. •Alterations in Body Temperatures, cont.

• Hypothermia: below 97º F

• Classified as subnormal

• Heat being lost is greater than heat being produced

• Person usually cannot survive with a temperature below 93.2º F


Body TemperatureBody Temperature


Variations in Body Temperature

Variations in Body Temperature

1. Normal fluctuations occur throughout day

2. Factors that affect body temperaturea. Age

• Infants and young children: higher temperature than adults

– Heat-regulating system not yet fully established

• Elderly: lower temperature

– Loss of subcutaneous fat

– Loss of thermoregulatory control


Variations in Body Temperature, cont. Variations in Body

Temperature, cont.

b. Diurnal variations: during sleep body metabolism and muscle contractions slow down• Causes temperature to be lowest in morning

c. Exercise: causes increase in voluntary muscle contractions• Raises temperature

d. Emotional states: strong emotions increase temperature (crying, extreme anger)• Infants/young children often cry during

examinations


Variations in Body Temperature, cont. Variations in Body

Temperature, cont.

e. Environment• Cold weather: decreases temperature

• Hot weather: increases temperature

f. Patient's normal body temperature: some patients normally run low or high temperatures

g. Pregnancy: cell metabolism increases• Raises temperature


FeverFever

1. Common symptom of illness (particularly inflammation and infection)

2. Febrile: person who has a fever (above 100.4º F)

3. Afebrile: person who does not have a fever


Fever, cont. Fever, cont.

4. Pyrogen: any substance that produces fever (e.g., pathogens)

a. Resets hypothalamus: causes temperature to rise

5. Self-limiting fever: temperature returns to normal after disease process completed


Stages of a FeverStages of a Fever

1. Onset: when temperature begins to rise

a. May be slow or sudden

b. Patient often experiences:• Coldness

• Chills

• Increase in pulse and respiratory rate


Stages of a Fever, cont. Stages of a Fever, cont.

2. Course of a fever: temperature rises and falls in one of three patterns:

a. Continuous: Body temperature fluctuates minimally—always remains elevated

b. Intermittent: Body temperature alternately rises and falls—at times returns to normal or even becomes subnormal

c. Remittent: Wide range of temperature fluctuations occurs• All are above normal


Fever Patterns Fever Patterns



• During the course of a fever:

– Increased pulse and respiratory rate

– Feels warm to touch

– May also experience:

1) Flushed appearance

2) Increased thirst

3) Loss of appetite

4) Headache

5) Malaise


Stages of a Fever, cont.Stages of a Fever, cont.

• Malaise: A vague send of body discomfort, weakness, and fatigue

– Often marks the onset of a disease

– Continues through the course of the illness



3. Subsiding stage: temperature returns to normal

a. Can return gradually or suddenly (crisis)

b. Patient perspires and may become dehydrated


Assessment of Body Temperature

Assessment of Body Temperature

1. Assessment Sites

a. Mouth

b. Axilla

c. Rectum

d. Ear

e. Forehead


Assessment of Body Temperature, cont. Assessment of Body Temperature, cont.

1. Site should have an abundant blood supply

a. So that temperature of entire body is obtained

2. Site must be as closed as possible (mouth, axilla, rectum, ear)

a. Prevents air from interfering with the reading


Assessment of Body Temperature, cont. Assessment of Body Temperature, cont.

4. Site chosen depends on:

a. Patient's age, condition, and state of consciousness

b. Type of thermometer(s) available

c. Medical office policy


Oral Temperature Oral Temperature

5. Oral Temperaturea. Convenient and one of most common

routes

b. When MA records temperature• Physician assumes taken through oral route

unless otherwise noted

c. Rich blood supply under the tongue on either side of the frenulum linguae• Site for placement of thermometer

d. Patient must keep mouth closed to provide a closed space


Oral Temperature, cont. Oral Temperature, cont.


Axillary Temperature Axillary Temperature

6. Axillary Temperature

a. Recommended for toddlers and preschoolers• Have trouble holding thermometer under the

tongue


Axillary Temperature, cont.Axillary Temperature, cont.

b. Also recommended for:• Mouth-breathing patients

• Patients with oral inflammation or oral surgery

c. Measures 1° F lower than oral route

d. Make a notation to indicate axillary route was used


Axillary Temperature Axillary Temperature


Rectal Temperature Rectal Temperature

7. Rectal Temperature

a. Rectum is highly vascular

b. Provides the most closed cavity

c. Measures 1° F higher than oral route

d. Make a notation in patient's chart to indicate rectal route used


Rectal Temperature, cont. Rectal Temperature, cont.

e. Recommended for:• Infants and young children

• Unconscious patients

• Mouth-breathing patients

• When greater accuracy is desired

f. Should not be used in newborn: danger of rectal trauma


Rectal Temperature, cont. Rectal Temperature, cont.


Aural Temperature Aural Temperature

8. Aural Temperature

a. Used with tympanic membrane thermometer

b. Closed cavity that is easily accessible

c. More comfortable for patient


Aural Temperature, cont.Aural Temperature, cont.

d. Easier to measure temperature in:• Children younger than 6 years

• Uncooperative patients

• Patients unable to have their temperature taken orally


Aural Temperature, cont. Aural Temperature, cont.


Forehead Temperature Forehead Temperature

9. Forehead Temperature

a. Temporal artery: Major artery of head • Runs laterally across forehead and down the

side of neck

• In forehead area: Located 2 mm below skin surface


Forehead Temperature, cont. Forehead Temperature, cont.

b. Ideal site to measure temperature: • Temporal artery is close to skin surface

• Easily accessible

• Constant steady flow of blood


Forehead Temperature, cont. Forehead Temperature, cont.

c. Used to measure body temperature in individuals of all ages:• Newborns

• Infants

• Children

• Adults

• Elderly


Forehead Temperature, cont.Forehead Temperature, cont.

d. Results about the same as a rectal temperature measurement• Approximately 1º F higher than oral

temperature

• Approximately 2º F higher than axillary temperature


Types of ThermometersTypes of Thermometers

1. Four types

a. Electronic

b. Tympanic

c. Temporal artery

d. Chemical


Mercury Glass Thermometer Mercury Glass Thermometer

2. Mercury glass thermometers no longer used

a. Break easily and release mercury

b. Mercury can damage the nervous system

c. If released into the environment: harmful to wildlife

d. Many cities have banned sale or use of mercury


Electronic Thermometer Electronic Thermometer

3. Electronic Thermometera. Frequently used in medical office

b. Measures oral, axillary, and rectal temperature

c. Measures temperature in 4 to 20 seconds

d. Results digitally displayed on a screen

e. Consists of interchangeable probes attached to a battery-operated portable unit• Blue probe: oral and axillary temperature

• Red probe: rectal temperature


Electronic Thermometer, cont.Electronic Thermometer, cont.

f. Disposable plastic cover placed over the probe• Prevents transmission

of microorganisms between patients


Electronic Thermometer, cont. Electronic Thermometer, cont.

g. Probe is inserted into site and is left in place until audible tone is heard

h. Temperature is displayed on screen

i. Probe cover should be ejected into regular waste container


Electronic Thermometer, cont. Electronic Thermometer, cont.


Tympanic Membrane Thermometer

Tympanic Membrane Thermometer

4. Tympanic Membrane Thermometer

a. Used at aural site

b. Detects thermal energy radiated from tympanic membrane

c. Battery-operated handheld device with a sensor probe• Disposable plastic cover placed over the probe


Tympanic Membrane Thermometer, cont.Tympanic Membrane Thermometer, cont.

d. Placed in outer third of external ear canal

e. Activation button depressed momentarily

f. Results displayed in 1 to 2 seconds on a digital screen

g. Probe cover is ejected into regular waste container


Tympanic Membrane Thermometer, cont. Tympanic Membrane Thermometer, cont.

h. Guidelines for Using a Tympanic Membrane Thermometer• Determine if the tympanic thermometer can

be used to measure the patient's temperature

– Should not be used:

1) Patient with inflammation of external ear canal (e.g., otitis externa)

2) When the ear contains a discharge such as blood or pus

3) Excessive cerumen buildup that occludes canal

a) Causes falsely low temperature reading



– Can be used:

1) Patient with otitis media

2) Normal amount of cerumen



• Determine if external factors are present that may influence temperature reading

– If present: remove individual from the situation and wait 20 minutes before taking temperature

– External factors include:

1) Has been lying on one ear or the other

2) Had ears covered (e.g., hat, ear muffs)

3) Has been exposed to very hot or very cold temperatures

4) Has been recently swimming or bathing



• Select temperature measurement system desired

– Can be displayed in Fahrenheit or Celsius

– Follow the manufacturer's instructions



• Place the probe properly in the patient's ear

– Most important factor in obtaining an accurate temperature

1) Straighten the ear canala) Ear canal has an S shape:

obstructs view of tympanic membrane

b) Straightening allows probe to obtain a clear picture of tympanic membrane



1) Seal opening of the ear

a) Insert probe tightly enough to seal opening of ear without causing patient discomfort

b) If canal not sealed: cooler external air causes thermometer to register a lower temperature



3) Position tip of probe toward opposite temple

4) Results in falsely low reading

a) Allows sensor to obtain best possible picture of tympanic membrane

b) If positioned incorrectly: may be aimed at ear canal



• Verify accuracy of temperature reading (if needed)

– Use other ear

1) Are slight but insignificant differences between right and left ear

– Before using same ear: wait 2 minutes to allow temperature to stabilize.



• Check probe lens before taking temperature

– Probe is covered with a lens that is transparent to heat waves

– To ensure accuracy: keep lens clean and intact

– Before taking a temperature: check to make sure lens is shiny and clear

– Fingerprints, cerumen, and dust: reduce transparency of lens

1) Results in falsely low temperature reading

– If lens is damaged: thermometer cannot be used (must be repaired)



• Respond appropriately to digital messages

– Message displayed during following circumstances:

1) An attempt is made to take temperature without changing cover

2) An attempt is made to take temperature with no probe cover in place.

3) Battery is low.

4) Thermometer in need of repair



• Care for thermometer properly

– Probe lens

1) Dust and other debris can build up on lens

2) Clean as part of routine maintenance or when it becomes dirty

a) Gently wipe surface with alcohol wipe

b) Immediately wipe dry with cotton swab

c) After cleaning: allow at least 5 minutes before taking temperature



– Thermometer casing

1) Clean casing periodicallya) Wipe dry with soft cloth

dampened with warm water and mild detergent or germicidal cleaner.

b) Make sure cloth is damp but not wet: prevents cleaning solution from running inside thermometer (could damage it)



• Store thermometer properly

– Keep away from temperature extremes: could damage thermometer

– Should not be exposed to:

1) Excessive heat (more than 95° F, or 35° C)

2) Excessive cold (less than 60° F, or 15.6° C)


What Would You Do?What Would You Not Do?



Temporal Artery ThermometerTemporal Artery Thermometer

5. Temporal Artery Thermometer

a. Newest method for measuring body temperature

b. Electronic device: Probe attached to a portable unit


Temporal Artery Thermometer, cont.


c. To perform procedure:• Scan button is continually depressed

• Probe slowly moved across forehead




– Probe sensor scans the forehead for heat given off by temporal artery

– Probe sensor captures highest temperature: peak temperature

1) Represents the temperature given off by the temporal artery (body temperature)

– Probe sensor also measures ambient temperature: surrounding air temperature

1) Small heat loss from the forehead due to cooling by ambient temperature.

– Thermometer automatically corrects for any effect from ambient temperature

1) Displays an accurate body temperature reading




d. Avoiding Errors• Sweating of the forehead: causes inaccurate

temperature reading

• Causes skin of forehead to cool: results in falsely low temperature reading

• Occurs when:

– A fever breaks

– Skin is clammy

1) Sweating may not be readily visible




• To avoid problem:

– Temperature of neck area behind earlobe is measured (after scanning forehead)

1) Less affected by sweating than forehead

– During sweating: arteries behind the earlobe dilate

1) Results in a constant, steady flow of blood

2) Provides an accurate measurement of body temperature when patient is sweating




– If patient's forehead has cooled from sweating

1) Temperature behind earlobe automatically registers as peak temperature

2) Overrides forehead temperature

– Area behind earlobe does not normally provide an accurate body temperature measurement

1) Only supercedes the forehead measurement when patient is sweating




e. Care and Maintenance• Store in clean, dry area

• Protect from:

– Extremes in temperature

– Direct sunlight

– Dust




e. Care and Maintenance• Clean casing periodically

– Damp cloth moistened with disinfectant

– Never splash water on or immerse the unit in water

1) Could damage the thermometer




• Probe lens must be clean and shiny

– Dirty lens: Falsely low reading

– To clean lens:

1) Wipe with alcohol wipe

2) Immediately wipe dry with cotton-tipped applicator stick




f. Temporal Artery Thermometer Guidelines• Operating environmental temperature: 60º to

104º F

• Do not take temperature over scar tissue, open sores or abrasions

• Make sure the side of the head to be measured is exposed to the environment




• A falsely low temporal artery reading can result from:

– A dirty probe lens

– Sweating of the forehead

1) Earlobe measurement becomes overriding temperature reading

– Scanning the forehead too quickly.

– Not keeping the button depressed

1) While scanning forehead and area behind the earlobe


Chemical Thermometer Chemical Thermometer

6. Chemical Thermometers

a. Contain chemicals that are heat-sensitive

b. Primarily used by patients at home

c. Less accurate than other thermometers

d. Store in cool area (below 86° F)

e. Do not expose to direct sunlight


Chemical Thermometer, cont. Chemical Thermometer, cont.

• Disposable Chemical Single-Use Thermometers

– Contain small chemical dots that change color



– Wrapper is peeled back to expose handle

– Thermometer is inserted under patient's tongue (usually 60 seconds)

– Dots are observed for change in color

– Read by noting the highest reading among dots that have changed color



• Temperature-Sensitive Strips

– Reusable plastic strip

– Contains heat-sensitive crystals

– Placed on forehead and held in place until color stops changing (generally 15 seconds)

– Results are read by:

1) Observing color change

2) Noting the corresponding temperature indicated on strip


PulsePulse

1. When the left ventricle of the heart contracts: blood is forced into the aorta

a. Aorta: major trunk of the arterial system • Aorta is already filled with blood

• Must expand to accept blood from left ventricle

• Creates a pulsating wave that travels from the aorta through the walls of the arterial system

• Wave is known as the pulse

Mechanism of the Pulse


Mechanism of the Pulse, cont.Mechanism of the Pulse, cont.

2. Pulse rate is measured by counting number of "taps" or beats per minute

3. Heart rate is determined by taking pulse rate


Factors Affecting Pulse RateFactors Affecting Pulse Rate

1. Age: As age increases, pulse rate decreases

a. Children have a faster pulse rate than adults


Factors Affecting Pulse Rate, cont.


2. Gender: Women tend to have faster pulse rates than men

3. Physical activity: Increases pulse rate temporarily




4. Emotional states: Increase pulse rate temporarily

a. Anxiety

b. Fear

c. Excitement

d. Anger




5. Metabolism: Increased body metabolism increases pulse rate

a. Example: During pregnancy

6. Fever: Increases pulse




7. Medications: May increase or decrease pulse

a. Examples:• Digitalis: decreases pulse

• Epinephrine: increases pulse


Pulse Sites Pulse Sites

1. Pulse felt most strongly when superficial artery held against a firm tissue (bone)


Radial Pulse Radial Pulse

2. Radial (radial artery)

a. Most common site

b. Located in a groove on the inner aspect of the wrist just below the thumb

c. Easily accessible


Radial Pulse, cont. Radial Pulse, cont.

d. Used by individuals monitoring their own heart rate:• Athletes

• Patients taking heart medications

• Individuals starting exercise program


Radial PulseRadial Pulse


Apical Pulse Apical Pulse

3. Apical (apex of the heart)

a. Stronger beat: more easily heard than other pulse sites

b. Should be taken if:• Having difficulty feeling radial pulse

• Pulse is abnormally slow or rapid


Apical Pulse, cont.Apical Pulse, cont.

c. Often used for infants and children

up to 3 years• Other sites are difficult to palpate


Apical Pulse, cont. Apical Pulse, cont.

d. Is measured using a stethoscope• Chestpiece placed over apex of heart

– Location: Fifth intercostal space at left midclavicular line


Brachial Pulse Brachial Pulse

4. Brachial (brachial artery)

a. Located in antecubital space• Location: space at the front of the elbow


Brachial Pulse, cont. Brachial Pulse, cont.

b. Used to:• Take blood pressure (BP)

• Measure pulse in infants during

cardiac arrest

• Assess circulation to lower arm


Ulnar Pulse Ulnar Pulse

5. Ulnar

a. Location: little finger side of the wrist

b. Used to assess circulation to hand


Temporal Pulse Temporal Pulse

6. Temporal

a. Location: front of ear just below eye level

b. Used when radial is not accessible


Carotid Pulse Carotid Pulse

7. Carotid

a. Location: anterior side of neck• Slightly to one side of midline

b. Best site to find a pulse quickly


Carotid Pulse Carotid Pulse

c. Used to:• Measure pulse in children and

adults during cardiac arrest

• Monitor pulse during exercise


Femoral Pulse Femoral Pulse

8. Femoral

a. Location: middle of the groin

b. Used to:• Measure pulse in infants, children,

and adults during cardiac arrest

• Assess circulation to lower leg


Popliteal Pulse Popliteal Pulse

9. Popliteal

a. Location: back of the knee

b. Used to:• Measure BP when brachial not

accessible

• Assess circulation to lower leg


Posterior Tibial Posterior Tibial

10.Posterior tibial

a. Location: inner space of ankle, posterior to ankle bone

b. Used to assess circulation to foot


Dorsalis Pedis Pulse Dorsalis Pedis Pulse

11. Dorsalis pedis

a. Location: upper surface of foot between first and second metatarsal bones

b. Used to assess circulation to foot


Assessment of PulseAssessment of Pulse

1. Purpose of measuring pulse

a. Establish patient's baseline pulse rate

b. Assess pulse following special procedures, medications, or disease processes that affect the heart


Assessment of Pulse, cont. Assessment of Pulse, cont.

2. Palpation used to locate pulse (except for apical site)

a. Apply moderate pressure with the pads of the three middle fingers

b. Use of excessive pressure: can obstruct pulse

c. Too little pressure: may not be able to detect pulse


Assessment of Pulse, cont.Assessment of Pulse, cont.

d. Do not use thumb: has a pulse of its own• Would result in measurement of MA's pulse


Assessment of Pulse, cont. Assessment of Pulse, cont.

3. Assessment of pulse includes:

a. Pulse rate

b. Rhythm

c. Volume


Pulse RatePulse Rate

1. Number of heartbeats in 1 minute

a. Measured in beats per minute (bpm)

2. Normal adult range: 60 to 100 bpm

a. Average falling between 70 and 80 bpm


Pulse Rate, cont. Pulse Rate, cont.

3. Tachycardia: An abnormally fast heart rate of more than 100 bpm

a. Occurs during:• Hemorrhaging

• Heart disease

• Normally during vigorous exercise

• Strong emotional states


Pulse Rate, cont. Pulse Rate, cont.

4. Bradycardia: An abnormally slow heart rate falling below 60 bpm

a. Normally occurs:• During sleep

• Trained athlete

• Some medications

5. If patient exhibits tachycardia/bradycardia during radial pulse measurement:

a. Measure patient's apical pulse


Pulse Rhythm and VolumePulse Rhythm and Volume

1. Pulse rhythm: time interval between heartbeats

a. Normal rhythm: same interval between beats

b. Dysrhythmia: unequal or irregular intervals between beats• Also termed arrhythmia

• Physician may order:

– Apical-radial pulse

– Electrocardiogram

– Holter monitoring


Pulse Rhythm and Volume, cont.


2. Apical-radial pulse

a. Performed to determine if a pulse deficit is present

b. Taking an apical-radial pulse• Measuring the apical pulse at the same time

as the radial pulse

– For one full minute




c. Pulse deficit: Radial pulse rate is less than the apical pulse rate

• Example:

– One medical assistant measures an apical pulse rate of 88 bpm

– Another medical assistant simultaneously measures a radial pulse rate of 76 bpm

– Results in a pulse deficit of 12 beats




• Means that not all of the heartbeats are reaching the peripheral arteries

• Caused by an inefficient contraction of the heart

– Not strong enough to transmit a pulse wave to peripheral pulse site

• Frequently occurs with atrial fibrillation (dysrhythmia)




3. Pulse volume: strength of the heartbeat

a. Amount of blood pumped into aorta by each contraction• Should remain constant

b. Normal pulse feels strong and full




c. Thready pulse: blood volume decreases• Pulse feels weak

d. Bounding pulse: blood volume increases• Pulse feels extremely strong and full




4. Record abnormalities in rhythm or volume

5. Normal pulse: Record as regular and strong


RespirationRespiration

1. Purpose of respiration

a. Exchange of oxygen (O2) and carbon dioxide (CO2) between the atmosphere and blood

Mechanism of Respiration


Mechanism of Respiration, cont.


2. Divided into two phases:

a. Inhalation• Diaphragm descends

• Lungs expand

• Causes air containing O2 to move into lungs


Inhalation and ExhalationInhalation and Exhalation




b. Exhalation• Diaphragm ascends

• Lungs return to original state

• Causes air containing CO2 to be expelled (see Figure 4-11)

3. One complete respiration: one inhalation and one exhalation


Inhalation and ExhalationInhalation and Exhalation




4. Classified as:

a. External respiration: exchange of O2 and CO2 between alveoli and blood• Alveoli: Thin-walled air sacs of the lungs in

which the exchange of O2 and CO2 takes place




• Blood located in small capillaries:

– Comes in contact with alveoli

– Picks up oxygen

– Carries it to the cells of the body




b. Internal respiration: exchange of O2 and CO2 between body cells and blood

• O2 is given off to the cells

• CO2 is picked up

– Transmitted as a waste product to lungs


Control of RespirationControl of Respiration

1. Involuntary respiration

a. Controlled by medulla oblongata

b. Buildup of CO2 sends message to medulla• Triggers respiration to occur automatically


Control of Respiration, cont.Control of Respiration, cont.

2. Voluntary respiration

a. Person can control (e.g., singing, talking)

b. Breath can only be held a certain length of time• Medulla stimulated: causes respiration to

occur involuntarily


Assessment of RespirationAssessment of Respiration

1. Measure respiration without patient's knowledge

a. Patient can control respiration

2. Ideal time: after pulse is taken


Respiratory RateRespiratory Rate

1. Normal adult range: 12 to 20 respirations per minute

2. Ratio of 1 respiration for every 4 pulse beats

a. Example:• If respiratory rate is 18/minute

• Pulse rate would be 72 bpm

• (4 ×18 = 72)


Respiratory Rate, cont. Respiratory Rate, cont.

3. Tachypnea: abnormal increase of more than 20 breaths/minute

4. Bradypnea: abnormal decrease of fewer than 12 breaths/minute

3. Factors that affect respiratory rate

a. Age: As age increases, respiratory rate decreases• Respiratory rate of a child: faster than adult

(see Table 4-5)


Respiratory Rate, cont.Respiratory Rate, cont.

b. Physical activity: increases rate temporarily

c. Emotional state: increases rate

d. Fever: increases rate

e. Medications: increase or decrease rate (depends on type of medication)


Rhythm and Depth of Respiration

Rhythm and Depth of Respiration

1. Rhythm should be:

a. Even and regular

b. Pauses between inhalation and exhalation should be equal


Rhythm and Depth of Respiration, cont.


2. Depth of respiration: amount of air inhaled or exhaled

a. Described as• Normal: depth is the same

• Deep: large volume of air is inhaled and exhaled

• Shallow: exchange of small volume of air

b. Determined by observing the amount of movement of chest




3. Eupnea: normal respiration

a. Rate: 12 to 20 breaths/minute

b. Rhythm: even and regular

c. Depth: normal




4. Hyperpnea: abnormal increase in rate and deptha. Patient exhibits very deep, rapid, and

labored breathing

b. Occurs normally in exercise

c. Occurs abnormally in fever and pain

d. Also occurs with any condition in which supply of oxygen is inadequate• Heart disease

• Lung disease




5. Hyperventilation: abnormally fast and deep breathing

a. Usually associated with acute anxiety (e.g., hysteria, panic attacks)

b. Individual is "overbreathing"

c. Causes dizziness and weakness




6. Hypopnea: abnormal decrease in rate and depth

a. Depth: Approximately half of normal respirations

b. Often occurs with sleep disorders


Color of the PatientColor of the Patient

1. Observe color while taking respirations2. Hypoxia: A reduction in the oxygen

supply to the tissues

a. Results in cyanosis


Color of the Patient, cont. Color of the Patient, cont.

3. Cyanosis: bluish coloration of skin and mucous membranes

a. First observed in nailbeds and lips• Blood vessels lie close to the skin in these

areas

b. Occurs in patients with:• Advanced emphysema

• Cardiac arrest


Color of the Patient, cont. Color of the Patient, cont.

4. Apnea: temporary absence of respirations

a. May occur during sleep • Known as sleep apnea

b. Serious if breathing ceases for more than 4 to 6 breaths/minute• Patient could suffer brain damage and death


Respiratory AbnormalitiesRespiratory Abnormalities

1. Dyspnea: difficulty breathing or shortness of breath

a. Normal during vigorous exercise

b. Abnormal in patients with:• Emphysema

• Asthma


Respiratory Abnormalities, cont.

Respiratory Abnormalities, cont.

2. Orthopnea: The condition in which breathing is easier when an individual is in a sitting or standing position

a. Occurs with disorders of heart and lungs:• Asthma

• Emphysema

• Pneumonia

• Congestive heart failure


Breath SoundsBreath Sounds

1. Caused by air moving through respiratory tract

2. Normal breath sounds: quiet and barely audible

3. Adventitious sounds: abnormal breath sounds

a. Indicate presence of respiratory disorder


Abnormal Breath SoundsAbnormal Breath Sounds


Pulse OximetryPulse Oximetry

1. Painless and noninvasive procedure2. Used to measure oxygen saturation of

hemoglobin in arterial blood

a. Hemoglobin• Complex compound found in red blood cells

• Function: transports oxygen


Pulse Oximetry, cont.Pulse Oximetry, cont.

3. Pulse oximetry provides information on:

a. Cardiorespiratory status• Amount of oxygen being delivered to tissues


Pulse Oximetry, cont. Pulse Oximetry, cont.

4. Pulse oximeter

a. Computerized device

b. Measures oxygen saturation

c. Consists of cliplike probe connected to a monitor

d. Also measures pulse rate in b/m• Beep is emitted with each pulse beat


Pulse Oximetry, cont. Pulse Oximetry, cont.


Mechanism of ActionMechanism of Action

1. Probe attached to peripheral pulsating capillary bed (fingertip)

2. Light emitting diode (LED):

a. Transmits infrared light and red light through tissues to a photodetector (light detector)


Mechanism of Action, cont.Mechanism of Action, cont.


Mechanism of Action, cont. Mechanism of Action, cont.

3. Bright red hemoglobin:

a. High oxygen content (oxygen-rich)

b. Absorbs infrared light from LED

4. Dark red hemoglobin:

a. Low in oxygen (oxygen-poor)

b. Absorbs red light from LED



5. Computer of oximeter:

a. Calculates light transmitted from oxygen-rich and oxygen-poor hemoglobin (hgb)• From this ratio: determines oxygen

saturation of hgb

– Measurement converted to a percentage

– Displayed on screen of monitor



6. SpO2: Saturation of peripheral oxygen

a. Pulse oximeter measures oxygen saturation of peripheral capillaries

b. Abbreviation used when a pulse oximeter is used to measure oxygen saturation level


Mechanism of Action, cont.Mechanism of Action, cont.

7. SaO2: Saturation of arterial oxygen

a. Arterial blood gas (ABG) analysis• More complete, but invasive measurement of

oxygen saturation

• Requires drawing a blood specimen from an artery

b. Abbreviation (SaO2 ) used when ABG analysis is used to measure oxygen saturation level


Interpretation of ResultsInterpretation of Results

1. Pulse oximetry reading: represents percentage of hgb saturated with oxygen

a. Each molecule of hgb: can carry four oxygen molecules• 100 molecules of hgb: fully saturated with

oxygen

– Would be carrying 400 molecules of oxygen

– Oxygen saturation reading: 100%


Interpretation of Results, cont.Interpretation of Results, cont.

• 100 molecules of hgb: carrying 360 molecules of oxygen

– Oxygen saturation reading: 90%

b. The more hgb saturated with oxygen: the higher the oxygen saturation


Interpretation of Results, cont. Interpretation of Results, cont.

2. Oxygen saturation of healthy individuals: 95% to 99%

a. Air is only 21% saturated with oxygen• Unusual for hgb to be 100% saturated with

oxygen

• Patients on supplemental oxygen may have a reading of 100%


Interpretation of Results, cont.Interpretation of Results, cont.

b. Oxygen saturation below 95%: • Results in inadequate amount of oxygen

reaching tissues

• Some patients with chronic pulmonary disease are able to tolerate lower saturation levels

c. Oxygen saturation between 85% and 90%: respiratory failure resulting in tissue damage

d. Oxygen saturation of 75%: cyanosis appears

e. Oxygen saturation below 70%: life-threatening


Interpretation of Results, cont. Interpretation of Results, cont.

3. Hypoxemia: decrease in the oxygen saturation of the blood

a. Can lead to hypoxia4. Hypoxia: a reduction in the oxygen supply

to tissues

a. If not treated: tissue damage and death

b. Symptoms: headache, mental confusion, nausea, dizziness, shortness of breath, tachycardia

c. Tissues most sensitive to hypoxia: brain, heart, pulmonary vessels and liver


Purpose of Pulse OximetryPurpose of Pulse Oximetry

1. Performed on patients c/o respiratory problems (e.g., dyspnea)

2. Decreased SpO2 reading (along with further testing and clinical signs and symptoms)

a. Assists physician in diagnosis and treatment • May include drug therapy and oxygen therapy


Purpose of Pulse Oximetry, cont.


3. Decreased SpO2 value (hypoxemia) caused by:

a. Acute pulmonary disease (pneumonia)

b. Chronic pulmonary disease (emphysema, asthma, bronchitis)

c. Cardiac problems (congestive heart failure, coronary artery disease)




4. Pulse oximetry used to assess:

a. Effectiveness of oxygen therapy

b. Patient tolerance to activity

c. Effectiveness of treatment such as bronchodilators

d. Patient tolerance to analgesia and sedation




5. Most often used for 'spot-check' measurement of oxygen saturation (single measurement)

6. Occasionally used for short-term continuous monitoring:

a. Patient experiencing an asthmatic attack

b. Sedated patient during minor office surgery


Components of the Pulse Oximeter

Components of the Pulse Oximeter

1. Handheld pulse oximeter: used by most offices

a. Portable and lightweight

b. Usually battery operated

2. Stand-alone oximeter

a. Used in a hospital setting• Continuous bedside monitoring of oxygen

saturation

3. Pulse oximeter also measures pulse rate


MonitorMonitor

1. Contains controls, indicators and displays

a. On/Off Control: Turns oximeter on and off

b. SpO2% Display: Digital display of oxygen saturation • Expressed as a percent

• Updated with each pulse beat


Monitor, cont.Monitor, cont.

c. Pulse Rate Display: Indicates pulse rate in b/m • Updated with each pulse beat

• Oximeter emits a constant-pitch audible beep with each pulse beat



d. Pulse Strength Bar Graph Indicator: Display of pulse strength

• Consists of a segmented display of bars

• Stronger the pulse: the more segments light up

e. Pulse Search Indicator: Lights when oximeter is searching for pulse

f. Adjustable Volume Control: Adjusts the beep that sounds with each pulse beat

• Settings: high, low and off



g. Low Battery Indicator: Warns that battery is getting low

• Lights up and sounds an alarm when 30 minutes of battery use remain

h. Alarm Messages: Audible beeps that indicate a problem or condition which may affect the reading

• Must not be ignored

• Must be corrected before continuing


Monitor, cont. Monitor, cont.

2. Power-on self test (POST): automatically occurs when oximeter is turned on

a. Takes approximately 3 to 5 seconds

b. Oximeter checks its internal systems to make sure functioning properly

c. If problem detected: alarm sounds and monitor displays an error code• Refer to troubleshooting section of user manual

– For interpretation of code and action to take



3. Oximeter begins searching for a pulse

a. Pulse search indicator lights up

b. Takes several seconds to:• Locate a pulse

• Calculate and display SpO2 reading



4. Oximeter is unable to detect pulse or pulse is too weak to provide necessary data needed to calculate oxygen saturation:

a. Alarm sounds

b. Oximeter may automatically shut off

c. Reposition probe or move probe to another finger• Perform procedure again


Probes Probes

1. Reusable or disposable

a. Most offices use reusable clip-on probes• Convenient to use

• Easy to apply

• More susceptible to inaccurate readings from patient movement

• Must be cleaned and disinfected after use


Probes, cont. Probes, cont.

b. Disposable probes• Expensive to use

• Used for long-term monitoring of oxygen saturation in hospital

• Made of adhesive bandage-like material

• Discarded after use



2. Handle reusable probe carefully

a. Hitting probe against hard object or dropping it: may damage it

b. Use probe designed for oximeter being used• Mixing probes from different manufacturers:

can result in inaccurate reading



3. Probe must be attached to a peripheral site that is:

a. Highly vascular

b. Skin is thin• Most common site: fingertip

• Other sites: toe and earlobe



4. Cable connects probe to monitor

a. Probe may be permanently attached to cable

b. Or may be a separate device• Requires connection to the cable



c. Never lift or carry monitor by the cable• Could damage the cable connections

• Monitor could fall on floor or on patient


Factors Affecting Pulse Oximetry

Factors Affecting Pulse Oximetry

1. Fingernail polish or artificial nails:

a. Opaque coating on fingernail: may result in falsely low reading• Interferes with light transmission through

finger

• The darker the coating: more likely SPO2 reading is affected

– Blue, black, and green nail polishes: cause the most problems

• Remove nail polish with acetone or fingernail polish remover


Factors Affecting Pulse Oximetry, cont.


1. Fingernail polish or artificial nails:

a. Patient has artificial fingernails• Use another site such as the earlobe or toe

b. Avoid areas with bruises, burns, stains, or tattoos

c. Darkly pigmented skin and jaundice • Do not affect reading




2. Ambient (surrounding) light shining directly on probe:

a. Examples: bright fluorescent light, direct sunlight, overhead examination light

b. May result in inaccurate reading

c. Ambient light may be picked up by photodetector




d. Corrected by:• Turning off light

• Moving probe away from light source

• Covering probe with opaque material (washcloth)




3. Patient movement: a. Common cause of inaccurate reading

b. Motion affects ability of light to travel from LED to photodetector

c. Prevents probe from picking up pulse signal

d. Instruct patient to remain still during procedure

e. Occasionally patient movement cannot be eliminated (tremors of hands)• Measure at a site less affected by motion (toe or

earlobe)




4. Incorrect positioning of probe:

a. Light is transmitted from LED to photodetector• Must be aligned directly opposite to each

other

– Automatically occurs when probe is applied




b. Alignment of probe may not be possible with:• Patients with very small fingers (such as a thin

patient or a child)

• Patients with very large fingers (such as an obese patient)

– Use another site: earlobe

– Pediatric probes can be used with thin patients or children




5. Poor peripheral blood flow: a. Pulse oximeter works best when there is a

good strong pulse in finger to which probe is applied

b. Poor blood flow may cause pulse to be so weak that oximeter cannot obtain a reading

c. Conditions resulting in poor blood flow:• Peripheral vascular disease

• Vasoconstrictor medications

• Severe hypotension

• Hypothermia




5. Poor peripheral blood flow:

d. Use earlobe: less affected by decreased blood flow

e. Patients with cold fingers (but not hypothermic) • May have enough constriction that it

interferes with obtaining a reading

• Ask patient to warm finger by rubbing hands together




f. Never attach probe to: • Finger of an arm to which an automatic blood

pressure cuff is applied

– Blood flow to finger cut off when cuff inflates: results in loss of pulse signal


Cleaning and MaintenanceCleaning and Maintenance

1. Monitor and cable

a. Clean periodically with damp cloth and nonabrasive cleaner• Do not allow water or detergent to run into

monitor

– Could damage internal components


Cleaning and Maintenance, cont.


2. Probe

a. Clean periodically with soft cloth moistened in water and mild detergent• Removes dirt and grime

– Could interfere with light transmission




• Disinfect by wiping thoroughly with isopropyl alcohol and allow to dry

• Never soak or immerse in liquid solution

– Would damage probe

b. Probe is heat-sensitive: cannot be autoclaved

c. Store pulse oximeter: at room temperature in a dry environment


Blood PressureBlood Pressure

1. Blood pressure: Measurement of force exerted by the blood on the walls of the arteries

2. Systole: phase in the cardiac cycle in which the ventricles contract

a. Blood is pushed out of heart and into aorta and pulmonary artery, exerting pressure on their walls

3. Systolic pressure: point of highest pressure on arterial walls

a. Recorded during systole

Mechanism of Blood Pressure


Mechanism of Blood Pressure, cont.

Mechanism of Blood Pressure, cont.

4. Diastole: phase in cardiac cycle in which the heart relaxes between contractions

5. Diastolic pressure: point of lesser pressure on arterial walls

a. Recorded during diastole

b. Pressure is lower because the heart is relaxed


Interpretation of Blood Pressure

Interpretation of Blood Pressure

1. Blood pressure: abbreviated BP2. Measurement expressed as a fraction:

a. Numerator: systolic pressure

b. Denominator: diastolic pressure

3. Measured in millimeters of mercury (mm Hg)


Interpretation of Blood Pressure, cont.


4. New guidelines from NHLBI:

a. Normal BP: Less than 120/80 mm Hg

b. Prehypertension: • Sustained systolic: 120 to 139 mm Hg

OR

• Sustained diastolic: 80 to 89 mm Hg




5. BP should be taken at every office visit

a. Several readings taken on different occasions • Provide a good index of baseline BP

b. Rise or fall of 20 to 30 mm Hg in baseline BP is significant• Even if still in normal range




6. Hypertension: high blood pressure

a. Hyptertension Stage I:• Sustained systolic: 140 to 159 mm Hg

OR

• Sustained diastolic: 90 to 99 mm Hg




b. Hypertension Stage 2:• Sustained systolic: 160 or higher mm Hg

OR

• Sustained diastolic: 100 mm Hg or higher

c. Caused by excessive pressure on arterial walls

d. Most common condition that causes an abnormal BP reading




7. Hypotension: low blood pressure

a. Reduced pressure on arterial walls

b. BP reading below 95/60 mm Hg




8. Pulse Pressure: difference between systolic and diastolic pressures

a. Determined by subtracting smaller number from larger number • Example: If BP is 110/70 mm Hg, pulse

pressure is 40 (110 to 70 mm Hg)

b. Normal range: between 30 and 50 mm Hg


Factors Affecting Blood Pressure

Factors Affecting Blood Pressure

1. Age: as age increases BP gradually increases

*In Children and adolescents, hypertension is defined as blood pressure that is, on repeated measurement, at the 95th percentile or greater adjusted for age, height, and gender (NHBPEP, 1997).

From the National High Blood Pressure Education Program (NHBPEP); National Heart, Lung, and Blood Institute; National Institutes of Health; The seventh report of the Joint National Committees on Detection, Evaluation, and Treatment of High Blood Pressure, JAMA 239:2560, 2003.


Factors Affecting Blood Pressure, cont.


2. Gender: after puberty women have a lower BP than men of same age

a. After menopause: BP is higher in women

3. Diurnal variations: BP is lower in morning and higher in afternoon

a. During sleep: • Decreased metabolism

• Decreased physical activity




4. Emotional states: increase BP

a. Calm patient before taking BP

5. Exercise: temporarily increases BP

a. If a patient has been involved in physical activity• Allow patient to rest 20 to 30 minutes before

taking BP




6. Body position: BP varies based on position

a. Make a notation if position is other than sitting• L: lying

• St: standing




7. Medications: may increase or decrease BP (depending on type of medication)

a. Important to record prescription and over-the-counter medications in patient's chart

8. Also increases BPa. Recent meal

b. Smoking

c. Bladder distention

d. Pain


Assessment of Blood PressureAssessment of Blood Pressure

1. Equipment needed:

a. Stethoscope

b. Sphygmomanometer


Stethoscope Stethoscope

2. Stethoscope: An instrument for amplifying and hearing sounds produced by the body

a. Consists of four parts:• Earpieces

• Sidepieces (binaurals)

• Plastic or rubber tubing

• Chestpiece


StethoscopeStethoscope


Stethoscope, cont. Stethoscope, cont.

3. Stethoscope Chestpiece

a. Types• Diaphragm: large flat disc

– Most useful for hearing high-pitched sounds

1) Lung sounds

2) Bowel sounds


Stethoscope, cont.Stethoscope, cont.

• Bell: bowl-shaped appearance

– Most useful for hearing low-pitched sounds

1) Heart sounds

2) Vascular system sounds


ChestpieceChestpiece


Stethoscope, cont. Stethoscope, cont.

b. If chestpiece consists of both: • Must rotate desired

piece into position before use

– Otherwise cannot hear sounds


SphygmomanometerSphygmomanometer

1. Sphygmomanometer: An instrument for measuring arterial blood pressure

1. Consists of:a. Manometer: scale for registering the

pressure of air in the bladder

b. Inner inflatable bladder surrounded by a covering (cuff)

c. Pressure bulb with a control valve: To inflate and deflate inner bladder


Sphygmomanometer, cont.Sphygmomanometer, cont.


Sphygmomanometer, cont. Sphygmomanometer, cont.

3. Aneroid sphygmomanometer

a. Gauge with a round scale calibrated in millimeters• Needle points to calibrations

• Needle must be at zero before taking BP


Sphygmomanometer, cont.Sphygmomanometer, cont.

b. MA should be no farther than 3 feet from the scale of the manometer• To ensure an accurate reading

c. Position manometer for direct viewing

d. Recalibrate manometer every year to ensure accuracy


Sphygmomanometer, cont. Sphygmomanometer, cont.

4. Mercury sphygmomanometera. Vertical tube filled with mercury and

calibrated in millimeters

b. More accurate than aneroid

c. Use is discouraged; mercury is a hazardous chemical

d. MA should be no further than 3 feet from scale

e. Mercury must be on zero before taking BP

f. Inflation of inner bladder: causes mercury to rise in tube

g. BP is read at the top of the meniscus


Mercury SphygmomonometerMercury Sphygmomonometer


Cuff SizesCuff Sizes

1. Variety of sizes: measured in centimeters (cm)

2. Size of cuff: refers to inner bladder rather than outer covering


Cuff Sizes, cont. Cuff Sizes, cont.

3. Inner bladder of cuff should:

a. Encircle 80% of arm circumference

b. Be wide enough to cover two thirds of distance from axilla to antecubital space• Cuff must fit properly to ensure an accurate

reading



4. Child cuff often used for adult with thin arms

5. Adult cuff used for average-sized adult arm

6. Thigh cuff used for thigh or adults with large arms



7. If cuff too small: reading is falsely high8. If cuff too large: reading is falsely low9. Center of inflatable bag should be

directly over brachial artery

a. To allow complete compression of the brachial artery

10.Velcro is used to secure the cuff


Korotkoff SoundsKorotkoff Sounds

1. Used to determine systolic and diastolic BP readings

a. When bladder of the cuff is inflated:• Brachial artery is compressed

• No audible sounds heard


Korotkoff Sounds, cont.Korotkoff Sounds, cont.

b. As cuff is deflated:• Sounds become audible

• When blood flows freely, sounds can no longer be heard


Guidelines to Prevent Errors in Blood Pressure Measurement

Guidelines to Prevent Errors in Blood Pressure Measurement

1. Before BP instruct patient not to:

a. Consume caffeine

b. Use tobacco • For 30 minutes before BP

2. Patient should be seated in a quiet room for at least 5 minutes before BP


Guidelines to Prevent Errors in Blood Pressure Measurement,

cont.


cont.

3. Always use proper cuff size

a. Cuff that is too small: • May come loose as the cuff is inflated

• Reading may be falsely high

b. Cuff that is too large• Reading may be falsely low



cont.


cont.

c. Inner inflatable bladder of cuff should:• Encircle at least 80% of

patient's arm

• Cover two thirds of distance from axilla to antecubital space



cont.


cont.

4. Never take BP over clothing

a. Interferes with ability to hear Korotkoff sounds• Could result in inaccurate BP

b. Roll up patient's sleeve approx 5 inches above elbow• If sleeve is too tight after being rolled up:

remove arm from sleeve

– Tight sleeve: causes partial compression of brachial artery



cont.


cont.

5. Position patient's arm properly

a. At heart level• Well supported

• Palm facing upward

b. If above heart level: BP may be falsely low



cont.


cont.

6. Avoid extraneous sounds from cuff: interferes with accurate measurement

a. Position cuff 1 to 2 inches above bend in elbow

b. Prevents stethoscope from touching cuff



cont.


cont.

7. Compress brachial artery completely

a. Center bladder of cuff directly over artery to be compressed• Most cuffs: labeled with arrows indicating

center of bladder for right and left arms

b. Centering allows for complete compression of the brachial artery



cont.


cont.

8. Apply equal pressure over brachial artery

a. Apply cuff so that it fits smoothly and snugly around patient's arm • Prevents bulging or slipping

• Permits application of equal pressure over brachial artery

b. Loose-fitting cuff: falsely high reading



cont.


cont.

9. Position earpieces so you can hear sounds clearly

a. Place in ears with earpieces directed slightly forward• Allows earpieces to

follow direction of ear canal: facilitates hearing



cont.


cont.

10.Avoid extraneous sounds from tubing

a. Tubing of stethoscope should hang freely• Do not permit to rub against any object

b. If tubing rubs against an object: extraneous sounds may be picked up• Could interfere with accurate measurement



cont.


cont.

11.Position chestpiece properly

a. Palpate brachial pulse to provide good positioning of chestpiece over brachial artery



cont.


cont.

b. Place chestpiece firmly, but gently, over brachial artery• Assists in transmitting clear and audible

sounds

c. Do not allow chestpiece to touch cuff• To prevent extraneous sounds from being

picked up

– Could interfere with accurate measurement



cont.


cont.

12. Release pressure at a moderate steady ratea. 2 to 3 mm Hg per second:

to ensure an accurate BP

a. Releasing pressure too

quickly or too slowly• Could cause falsely low

systolic reading and falsely

high diastolic reading



cont.


cont.

13.Avoid venous congestion

a. If you need to take the blood pressure in the same arm again• Wait 1 to 2 minutes

– Allows blood trapped in veins (venous congestion) to be released

b. Venous congestion: can result in falsely high systolic reading and a falsely low diastolic reading.



cont.


cont.

14.Measure and record BP in both arms during the initial assessment of a new patient

a. May normally be a difference of 5 to 10 mm Hg between the two arms

b. During return visits: BP should be measured in the arm with higher initial reading


POSTTESTPOSTTEST

True or False1. A temperature of 100° F is classified as a low-

grade fever.2. The rectal site should not be used to take the

temperature of a newborn.3. A tympanic membrane thermometer should not be

used to measure temperature on a patient who has a normal amount of cerumen in the ear.

4. A temporal artery temperature reading is the same as an oral reading.

5. Excessive pressure should not be applied when measuring pulse because it could obstruct the pulse.


POSTTEST, CONT.POSTTEST, CONT.

True or False6. A child has a faster pulse rate than an adult.7. The normal respiratory rate of an adult ranges

between 10 and 18 respirations per minute. 8. The term used to describe a bluish discoloration of

the skin due to a lack of oxygen is hypoxia.9. The oxygen saturation level of a healthy individual

falls between 85% and 90%.10. When measuring blood pressure, the patient's

arm should be positioned above the level of the heart.

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