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Vital signs

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  • Temporal - over temporal bone in head, above and lateral to eye Carotid - along medial edge of sternocledomastoid in neck Apical - 4-5th ICS at MCL Brachial - groove between bicep and triceps at antecubital fossa Radial - thumb side of forearm at wrist Ulnar - ulnar side of forearm at wrist Femoral - Below inguinal ligament, midway bt symphisis pubis and anterior iliac spine Popliteal - Behind knee Posterior tibial - inner side of ankle, below medial malleolus Dorsalis pedis - along top of foot, between extension tendons of great and first toe
  • BP levels increase as we age - the older we are the higher the BP can go - usually due to reduced elasticity in the blood vessels Anxiety, fear, pain end emotional stress can all raise BP High BP more common in indigenous Australians - genetic and E’al factors Some medications directly affect BP BP varies over day - usually lower in am Gender - Women often have higher BP after menopause than men of same age
  • Transcript

    • 1. Vital Signs Provide Support to Meet Personal Care Needs Updated by Jo Lewis BHS Fiona O’Toole & Josie Ashmore
    • 2. PERSONAL CARE WORKERS ROLE
      • Record
              • According to workplace protocol
      • Report
      • Supervisor
      • GP
    • 3. VITAL SIGNS
      • Most frequent measurements taken by health care professionals
      • Temperature, Pulse, Blood Pressure and Respiration’s
      • Indicators of health status - measure the effectiveness of circulatory, respiratory, neural and endocrine body functions
      • Alteration in vital signs may signal the need for further intervention
    • 4. TEMPERATURE
      • Oral Via Mouth, rarely used
      • Axilla Per Axilla (underarm)
      • Used infrequently
      • Tympanic Most common
      • Temple Recent introduction
    • 5. Oral
      • Oral:
      • No longer used in Residential Care, may still be used in home setting
      • 3 minutes
      • Under tongue, lips closed
      • No hot or cold drinks beforehand
    • 6. Per Axilla
      • Armpit
        • Previously most common in aged care
        • Used now if tympanic/temple not available
        • 3 minutes
        • Skin surfaces to touch bulb
        • Record as p/a
    • 7. Tympanic
      • Most commonly used in aged care
      • As per instructions for each type
      • Apply cover
      • Pull the ear lobe up and backwards to straighten the ear canal.
      • Insert into canal
      • Wait for beep
    • 8. THE PULSE
      • The bounding of blood flow we can feel at various points around our body
      • Indicator of effective circulation
      • For our cells to function normally we need continuous blood flow and volume
      • Blood flows around the body in a continuous circuit, pumped by the heart
    • 9.
      • Cardiac output = volume of blood pumped by the heart in one minute
      • Changes in heart rate alter how well the heart pumps - leads to changes in BP
      • As heart rate increases less time for heart to fill -less volume reduces BP
      • As heart rate decreases filling time increases - normalises BP
    • 10. Assessing the Pulse
      • Any artery can be used to assess pulse rate
      • Radial and carotid easiest
      • Carotid best in emergency situation - heart will pump blood to brain for as long as possible
      • When cardiac output drastically reduces peripheral pulses difficult to feel
    • 11. Carotid pulse
    • 12. Personal Care Workers
      • Use only the radial pulse point
    • 13. Pulse points in the body Radial and apical locations most commonly used
    • 14. Equipment needed:
      • Watch with second hand
      • Pen
      • Documentation as per organisation protocol
    • 15. Factors which might affect pulse rate
      • Age
      • Exercise
      • Position changes
      • Medications
      • Temperature
      • Emotional distress/anxiety/fear
    • 16. The steps for taking a radial pulse
      • Collect equipment
      • Explain to client
      • Wash hands
      • Provide privacy if required
      • Place client’s forearm alongside or across lower chest or abdomen (lying)
      • Bend client’s forearm at 90 deg angle and support lower arm on chair
      • Make sure palm is facing downward
    • 17.  
    • 18. Steps for taking a radial pulse
      • Place the tips of your first two fingers over the groove along the thumb side (radial side) of the client’s wrist
      • Do not use your thumb!!!!
      • Lightly compress against the radius to feel a pumping sensation
      • Determine the strength of the pulse -
      • Is it strong, thready, bounding or weak ?
    • 19. Work out the rate
      • After pulse can be felt regularly, look at watch’s second hand and begin to count rate
      • If pulse is regular count for 30 seconds and multiply by 2 (x2)
      • If pulse is irregular, count
      • rate for 60 seconds
    • 20. Things to consider
      • Rate
      • Rhythm - regular, regularly irregular, irregularly irregular
      • Strength
    • 21. Factors influencing pulse rates
      • Exercise
      • Temperature - fever and heat
      • Drugs
      • Loss of blood ( haemorrhage )
      • Postural changes - sitting or standing
      • Lung conditions - poor oxygenation
    • 22. Normal ranges
      • INFANT - 120-160 bpm
      • TODDLER - 90-140 bpm
      • SCHOOLAGE - 75-100 bpm
      • ADOLESCENT - 60-90 bpm
      • ADULT - 60-100 bpm
    • 23. Respiration
      • Our survival depends on the ability of O 2 and CO 2 to be removed from the cells
      • Respiration exchanges gases between the atmosphere and the blood and cells
      • Ventilation = the movement of gases in and out of the lungs
      • Regulated by the respiratory
      • centre in our brain
    • 24. Normal breathing
      • Chest wall gently rises and falls
      • Abdominal cavity rises and falls due to diaphragmatic movement
      • No use of accessory muscles - intercostal, muscles in neck and shoulders
      • Accurate measurement necessary as breathing tied to numerous body systems
      • Look at rate and depth
    • 25. Normal rates
      • Newborn - 30-60
      • Infant - 30-50
      • Toddler - 25-35
      • Child - 20-30
      • Adolescent - 16-20
      • Adult - 12-20
    • 26. How to assess respiration
      • Equipment: watch, Obs chart, pen
      • Explain to client ????
      • Make sure chest is visible-place client arm over abdomen/ or your arm
      • Observe complete cycle (insp and exp)
      • Begin to count rate
      • If regular count for 30 seconds and multiply by 2 (x2)
      • If irregular , less than 12 or more than 20 count for full minute
    • 27.
      • Note depth of respirations, skin color and effort
      • Replace linen
      • Wash hands
      • Record on obs chart
      • Report abnormal findings
    • 28. Other terms you might hear
      • Bradypnea - slow breathing
      • Tachypnea - fast breathing
      • Apnoea - no breathing for several seconds
      • Hyperventilation - fast rate and depth
      • Hypoventilation - slow rate and depth
      • Cheyne-stoke’s respiration - irregular -apnoea - hyperventilation - shallower - apnoea
    • 29. Blood pressure
      • The force applied to the inside of our artery by the blood pulsing from our heart
    • 30. Blood pressure
      • Can be affected by:
      • Effectiveness of heart pumping
      • Resistance in extremities
      • Blood volume
      • Thickness of the blood
      • Elasticity of arteries and blood vessels
    • 31. Systolic v’s Diastolic BP
      • Systolic pressure = peak maximum pressure when heart contraction forces blood into aorta (major blood vessel to body)
      • Diastolic pressure = the amount of blood left in the ventricles of the heart when they relax between contractions
    • 32. Factors influencing BP
      • Age
      • Stress
      • Race
      • Medications
      • Time of day
      • Gender
    • 33. Common conditions of BP
      • Hypertension high BP
      • Hypotension low BP
      • Postural hypotension dropping of BP when rising to an upright position
    • 34. Normal values > 110 mm hg > 180 mm hg Severe Hypertension > 90 – 110 mm hg >140 mm hg – 180 mmhg Hypertension < 85 mm hg <130mm hg Normal <80 mm hg < 120 mm hg Optimal Diastolic Systolic Category
    • 35.  
    • 36. Equipment needed
      • Sphygmomanometer and cuff
      • Stethoscope
      • Obs chart and pen
    • 37. Getting started
      • Gather equipment
      • Explain to client - rest 5 min if anxious
      • Select appropriate cuff size - S - XL
      • Client can lie or sit or stand
      • Wash hands
      • Expose extremity by removing constricting clothes
    • 38.
      • Palpate the brachial pulse (arm)
      • Place cuff about 2.5 cm above pulse site
      • Making sure cuff is fully
      • deflated wrap evenly and
      • snugly around extremity
      • (use arrow to centre on cuff)
    • 39.
      • Position the manometer < 1m away from you so you can see it
      • Place stethoscope pieces in ears and ensure sounds are clear and not muffled
      • ? Estimate systolic pressure (30 mmHg >)
      • Relocate pulse and place bell of the stethoscope over it (don’t cover it with clothing/cuff
    • 40.  
    • 41. Steps cont….
      • Close valve of pressure bulb clockwise until tight
      • Rapidly inflate cuff to 30 mmHg than palpated/previous BP
      • SLOWLY release bulb pressure valve allow mercury to fall at a rate of 2-3 mmHg per second
    • 42. Listen carefully...
      • Listen for the first thumping sound and note the measurement on the manometer (systolic reading)
      • Sound increases in intensity
      • Continue to deflate cuff and sound will become muffled/dampened and note the measurement again (diastolic reading)
    • 43.
      • Continue to deflate cuff gradually - listen for 10-20 mmHg after the last sound - let the rest of the air escape quickly
      • Remove cuff
      • Assist client to comfortable position, wash hands
      • Document reading on obs chart
      • Notify of abnormalities
    • 44. What if the BP is abnormal ?
      • Repeat the process
      • Check on other arm
      • Ask client how they feel
      • Compare old readings
      • Get someone else to check reading
    • 45.