copyright © 2007 by saunders, inc., an imprint of elsevier inc. vital signs chapter 30

Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.

Vital Signs

Chapter 30

Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2

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.


Variations

Accuracy is essential. Variations may indicate the presence or disappearance of a disease process and therefore a change in treatment.


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.


Other Measurements

Anthropometric measurements include height, weight, and other body measurements, such as fat composition and head and chest circumference.


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.


Normal Ranges for Vital Signs

Blood Pressure Age Group Pulse Respirations (mm Hg)

Newborn 120-160 30-50 60-96/30-62

Toddlers 90-140 20-30 78-112/48-78(1-3 yr)

Preschool 80-110 18-26 78-112/50-82 (4-6 yr)

School age 75-110 16-22 85-114/52-85 (7-11 yr)

Adolescent 60-100 14-20 94-136/58-88 (12-16 yr)

Adult 60-110 12-20 100-140/60-90


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.


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.


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.


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.


Formulas for conversion from one system to the other

C = (F – 32) x 5/9

F = 9 × C + 32

Conversion Formulas


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.


Types of Thermometers

Digital

Tympanic

Disposable

Axillary

Rectal


Digital Thermometer


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


Pulse

Pulse reflects the palpable beat of the arteries as they expand with the beat of the heart.

With every beat, the heart pumps an amount of blood (stroke volume) into the aorta.

An artery close to the body surface can be pushed against a bone for the pulse to be felt.

Patient should be in a comfortable position, with artery to be used at same level as or lower than the heart, with the limb relaxed and supported.


Pulse Sites

The most common sites are at the following arteries: temporal, carotid, apical, brachial, radial, femoral, popliteal, and dorsalis pedis.

Apical pulse used with:– Infants and children

– Adults with difficult radial pulse to palpate

– Patients taking cardiac drugs

– Arrhythmia—bradycardia, tachycardia, pulse deficit


TEMPORAL PULSE.

CAROTID PULSE.

BRACHIAL PULSE.

RADIAL PULSE

Pulse Sites


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.


Three-Point Scale for Measuring Pulse Volume

3+, full, bounding

2+, normal pulse

1+, weak, thready


Respiration

One complete inspiration and expiration is called a respiration.

During inspiration, diaphragm contracts, lungs expand and fill with air.

During expiration, diaphragm returns to normal, elevated position and lungs exhale waste air.

Breathing is both an involuntary and voluntary process:

– Elevated blood carbon dioxide levels activate the respiratory control center in the brain to stimulate respiration.

– Can be controlled to a certain extent.


Respiratory Rate

Note three important characteristics:

– Rate: number of respirations per minute

– Rhythm: breathing pattern

– Depth: amount of air being inhaled and exhaled


Respiration Terms

Dyspnea

COPD

Bradypnea

Apnea

Tachypnea

Hyperpnea

Hyperventilation

Orthopnea

Rales

Rhonchi

Stertorous

Cyanosis


Counting Respirations

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.


Respiration Rate

Count the respirations for 30 seconds, and multiply the number by 2.

Note and record any variation or irregularity in the rate.


Respiration Rate


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.


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.


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


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.


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.


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.


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 older) blood pressure

119 or below 79 or below


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.


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.


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.


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


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).


BP Devices


Personal BP Systems

Home system finger cuff.

Digital blood pressure home system arm cuff.

Wrist cuff.


Causes for BP Errors

The limb being measured is not at the same level as the heart.

The rubber bladder was not completely deflated before starting.

The pressure in the cuff is released too rapidly.

The patient is nervous, uncomfortable, or anxious.

The patient drank coffee or smoked cigarettes within 30 minutes of the elevation.

The cuff is improperly applied.

The cuff is too large, too small, too loose, or too tight.

The cuff is not placed around the arm smoothly.

The bladder is not centered over the artery, or it bulges out from the cover.

The examiner did not wait 1 to 2 minutes between measurements.

Defective instruments were used.


Anthropometric Measurement

Height

Weight

BMI


Anthropometric Measurement (cont’d)


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.


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.


Body Mass Index (BMI)

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.


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%.


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. vital signs chapter 30

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