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  • 1. 1 VITAL SIGNS Maria Teresita B. Dalusong, PTRP, MHPEd Vital Signs  Cardinal signs  Important indicators of the body’s physiologic Include  Temperature  Pulse status  Reflect the function of the internal organs  Respiration  Blood pressure Vital Signs  Factors that affect the vital signs:  time of day  exercise  age  sex  weight  metabolic conditions  general health status  pain  drug intake Why take the Vital Signs?  Establish database of values for an individual patient  Assist in goal setting and treatment l iplanning  Assist with assessment of patient response to treatment  Contribute to assessment of effectiveness of treatment activities VITAL SIGNS  Body Temperature  Pulse rate  Respiration  Blood Pressure 1. Body Temperature A. Definition B. Thermoregulatory System C. Abnormalities in BodyTemperature F t I fl i T tD. Factors InfluencingTemperature E. Types ofThermometer
  • 2. 2 1. Body Temperature  Represents a balance between the heat produced or acquired by the body, and the amount lost. Thermoregulatory System  Maintains a relatively constant internal body temperature  Monitors and acts to maintain temperatures that are optimal forp p normal cellular and vital organ function  Components:  Thermoreceptors  Regulating center  Effector organs Thermoregulatory System  Thermoreceptors  Provide input to the temperature- regulating center located in theregulating center located in the hypothalamus  Can be peripheral or central Thermoregulatory System  Regulating Center  Hypothalamus  Coordinate the heat production and loss processes  In healthy individuals, normal temperature is set at 37° C ± 1 °C (98.6 ° F ± 1.8 °F )  Sends input to the effector organs via nervous pathways of both somatic and autonomic nervous system Thermoregulatory System  Effector Organs  Respond to both increase and decrease in temperaturedecrease in temperature  Include vascular, metabolic, skeletal muscle responses (shivering), sweating Thermoregulatory System  Conservation of Body Heat  Vasoconstriction of blood vessels H th l ti t Hypothalamus activates sympathetic nerves which results into vasoconstriction of cutaneous vessels
  • 3. 3 Thermoregulatory System  Conservation of Body Heat  Decrease in sweat gland activity  To reduce or prevent heat loss by evaporation, sweat gland activity is diminished  Sweating is abolished if body temperature falls below 37° C (98.6°F) Thermoregulatory System  Conservation of Body Heat  Cutis anserina (piloerection) “H i di d”“Hair standing on end” Can trap a layer of insulating air near the skin and decrease heat loss Thermoregulatory System  Production of Body Heat  Shivering Primary motor center:y posterior hypothalamus Increased tone of muscles up to a certain threshold level Thermoregulatory System  Production of Body Heat  Hormonal Regulation Increase in norepinephrinep p and epinephrine Increase in thyroxine Thermoregulatory System  Loss of Body Heat  Radiation  Transfer of heat by electromagnetic waves from one object to another  Occurs through air between objects that are not in direct contact Thermoregulatory System  Loss of Body Heat  Conduction Transfer of heat from one objectTransfer of heat from one object to another through a liquid, solid or gas Requires direct molecular contact between the two objects
  • 4. 4 Thermoregulatory System  Loss of Body Heat  Convection T f f h t b tTransfer of heat by movement of air or liquid (water) Accomplished secondary to conduction Thermoregulatory System  Loss of Body Heat  Evaporation  Conversion of liquid to a vaporq p  Through the respiratory tract & through perspiration  Major mechanism of heat loss during exercise Abnormalities in Body Temperature  Increased BodyTemperature  Pyrexia  Elevation of normal body temperature  Caused by pyrogens Caused by pyrogens  100 degrees °F or 38°C  Signs and symptoms: general malaise, headache, increased pulse and respiratory rate, chills, piloerection, shivering, loss of appetite, flushed skin which is hot to touch, nausea, irritability, restlessness, weakness, etc. Abnormalities in Body Temperature  Increased BodyTemperature  Hyperpyrexia/ hyperthermia  Extremely high fever (above 41.1°Cy g ( or 106°F)  Patient may experience the following: Disorientation, confusion, convulsion, or comatose Abnormalities in Body Temperature  Increased BodyTemperature  Stages of fever  Invasion (onset)  Fastigium or stadium (course)  Difervescence (termination) Crisis Lysis Abnormalities in Body Temperature  Types of Fever  Intermittent – Alternates between periods of fever and periods of normal bodyT°  Remittent – Elevated bodyT° that fluctuates >2°C (3 6°F) within a 24-hour period but remain above(3.6 F) within a 24-hour period but remain above normal.  Relapsing – A.k.a. recurrent fever; periods of fever are interspersed with normal temperatures that last at least one day  Constant – bodyT° is constantly elevated with fluctuations <2°C (3.6°F)
  • 5. 5 Abnormalities in Body Temperature  Lowered BodyTemperature  Hypothermia  Lowered body temperature  Signs and symptoms: decreased Signs and symptoms: decreased pulse rate and respiratory rate, cold and pale skin, cyanosis, decreased cutaneous sensation, depression of mental and muscular responses and drowsiness Abnormalities in Body Temperature  Lowered BodyTemperature  Hypothermia Thermoregulatory center Impaired at 34.4° C (94°F) Completely lost at 29.4°C (85°F) Factors Influencing Body Temperature  time of day  lowest at 4-6 AM, highest at 4-8 PM  circadian rhythm : 24 hour cycle of normal variations in body temperature  age age  emotions  exercise  menstrual cycle  Increased levels of progesterone during ovulation can cause elevation of body temperature by 0.3 to 0.5 °C (0.9° F) Factors Influencing Body Temperature  Pregnancy  Body temperature remains elevated by 0.5 °C  external environment l i f location of measurement  Rectal & tympanic > oral > axillary  Rectal/tympanic = 0.3 – 0.5° C higher than oral  axillary = 0.6° C lower than oral  ingestion of warm or cold food Types of Thermometers  Electronic thermometer  Provides a rapidp measure of body temperature  Low chance of cross- infections Types of Thermometers  Glass Mercury Thermometers  Filled with mercury  Calibrated in either (or both) Celcius or Farenheit) scales  Range is from 34° C (93.1°F) to 42.2° C (108°F)  Shapes:  Blunt, rounded  Elongated, slender
  • 6. 6 Types of Thermometers  Disposable Single-use Thermometers  Consists of calibrated dots impregnated with temperatureimpregnated with temperature sensitive chemical  Temperature- Sensitive Strips  Change in color  Readings are non- specific Practical things to know in taking Body Temp.  Sites where body temperature are obtained  Most common & convenient location: ORAL  Most accurate measurement: RECTAL  Least desirable sites:AXILLARY OR INGUINAL  Very young patients & unconscious pt who cannot hold Very young patients & unconscious pt who cannot hold the thermometer in the mouth: RECTAL OR EAR CANAL  When there is high temp, pt should not be allowed to exercise or engage in strenuous activity  One should determine the cause of a temperature that is dropping than N. 2. Pulse A. Definition B. Parameters for pulse C. Factors Affecting Pulse D. Pulse point/ sites Pulse  Wave of blood in the artery created by the contraction of the left ventricle during the cardiac cycle  Systole- highest point of pressure  Diastole- lowest point of pressure Parameters for Pulse Assessment  Rate  Number of beats per minute  Normal rate: 60 to 80 beats per minute  Rhythm  Intervals between beats Intervals between beats  Volume  Amount of blood pushed through the artery Bounding/full Weak/thready  Quality or feel of arterial wall Parameters for Pulse Assessment Grade Pulse Description 0 Absent No perceptible pulse even with maximum pressure 1 + Thready Barely perceptible; easily obliterated with slight pressure; fades in and out 2 + Weak Difficult to palpate; slightly stronger than thready; can be obliterated with light pressure 3 + Normal Easy to palpate; requires moderate pressure to obliterate 4 + Bounding Very strong; hyperactive; is not obliterated with moderate pressure
  • 7. 7 Pulse  Other variations in pulse  Pulsus alterans  Bigeminal pulse  Paradoxical pulse Factors affecting the Pulse  age  New born = 100 – 130/180 bpm  Child (1 – 7yr old) = 80 – 120 bpm d lt 60 100 b adults = 60 – 100 bpm  gender  emotional status  In response to grief, fear, anxiety and pain Factors affecting the Pulse  exercise  pulse can be a basis for exercise prescription  Important method of assessing response t ito exercise  pulse proportional to intensity of workload  Maximal heart rate: 220 minus age  systemic or local heat  body size Pulse Points  Superficial arteries located over a bony surface  Temporal  Superior and lateral to the outer canthus of the eyey  Carotid  On either side of the anterior neck below earlobe and between the SCM and trachea  Brachial  Medial aspect of the antecubital fossa Pulse Points  Radial  Radial aspect of the wrist at the base of the thumb  Femoral  Inguinal region  Popliteal  Behind the knee  Pedal  Dorsal, medial aspect of the foot Practical things in taking the pulse  Auscultation is used to determine the heart rate (over the apex of the heart with the use of stethoscope).  Most common site: radial & carotid  When measuring one’s own pulse; Carotid  PeripheralVascular disease: lower extremities pulsep p
  • 8. 8 3. Respiration A. Definition B. Respiratory System C. Regulatory Mechanism D Factors influencing RespirationD. Factors influencing Respiration E. Parameters of Respiration F. Breath Sounds G. Patterns of Respiration Respiration  Supply the body with oxygen for metabolic activity and to remove carbon dioxide The Respiratory System  Inspiration  contraction of the diaphragm and intercostal muscles  increases the intrathoracic space to give space for the lungs to expand The Respiratory System Expiration passive during relaxed accessory muscleaccessory muscle recoil of the lungs Regulatory Mechanisms  Respiratory center  Lies in the pons and medulla  Provides control of both the rate and the depth of breathing in response to the metabolic needs of the body Regulatory Mechanisms  Afferent inputs :  Central Chemoreceptors  located in the respiratory center sensitive to carbon dioxide and hydrogeny g ion levels  Peripheral Chemoreceptors  in the carotid bifurcation and arch of aorta  sensitive to partial pressure of oxygen
  • 9. 9 Factors Influencing Respiration  Age  Newborn: 30 to 50 breaths per minute  Adults: 12 to 18/20 breaths per minute  body position  environment  emotion and stressbreaths per minute  body size  stature  exercise stress  drug intake Parameters of Respiratory Assessment  rate  number of breaths per minute  depth  volume of air exchanged with each breath  rhythm  regularity of inspirations and expirations  character  deviation from normal quiet effortless breathing Breath Sounds  wheezing  whistling sound produced by air passing through a narrowed bronchi  stridor stridor  harsh high pitched sound due to narrowing of glottis or trachea  rales  rattling, crackling due to secretions in air passage Breath Sounds  sigh  deep inspiration followed by prolonged audible expirationprolonged audible expiration  stertorous  snoring due to secretions on trachea and large bronchi Patterns of Respiration  Dyspnea  difficult or labored breathing  Tachypnea Tachypnea  increase in RR (> 24 bpm)  Bradypnea  decreased RR (< 10 bpm) Patterns of Respiration  Apnea  Absence of respirationp  Hyperventilation  Increased rate and depth of respiration
  • 10. 10 Patterns of Respiration  Cheyne-Stokes respiration  Gradual increase in rate and depth,p , followed by a gradual decrease  Biot’s respiration  Alternating periods of apnea and hyperapnea Patterns of Respiration  Kussmaul’s respirations  Gasping, labored pattern  Apneustic breathing  Prolonged inspiration Prolonged inspiration followed by short, ineffective expiration  Paradoxical respiration  Lung inflation during expiration, deflation during inspiration 4. Blood Pressure 1. Definition 2. Classification of Blood Pressure 3. Regulatory Mechanism 4. Factors Affecting BPg 5. Equipment Used 6. Karotkoff’s Sound Blood Pressure  Refers to the force the blood exerts against a vessel wall  Measured at both the highest and lowest points in the pulse  Arteries > capillaries > veins  Pulse pressure Blood Pressure Blood Pressure  Normal range of systole:  90 – 135/140mmhg  Normal range of diastolic:  60 – 80mmhg 60 80mmhg  Normal systolic/diastolic value:  120/80mmHg  Hypertensive range:  90++mmHg/135 – 140mmHg
  • 11. 11 FACTORS ASSOCIATED TO HYPERTENSION:  Obesity  Physical inactivity  Excessive use of nicotine, alcohol, salt  Arteriosclerosis  DM DM  Oral contraceptives  Advance age  Kidney Disease Regulatory Mechanisms  Vasomotor center  Located at the lower pons and upper medulla  Tonically active; produces a slow, continuous firing in all vasoconstrictor nerve fibers  Provides a normal vasomotor tone Regulatory Mechanisms  Afferent inputs  baroreceptors (pressoreceptors) i i h f sensitive to stretch of a vessel wall  highly concentrated at the :  internal carotid arteries above the bifurcation  walls of the arch of aorta Regulatory Mechanisms  Afferent Inputs  chemoreceptors  sensitive to decreased arterial oxygen concentration, increase in carbon, dioxide and increase in hydrogen ion concentrations.  lie close to the baroreceptors at the carotid artery (carotid body) and the aortic arch (aortic body)  cranial nerves IX and X Factors Affecting Blood Pressure  blood volume  diameter or elasticity of the arteries  cardiac output Factors Affecting Blood Pressure  age  Normal average adult BP: 120/80mmHg  Exercise Exercise  Valsalva maneuver  Arm position
  • 12. 12 Equipment  Blood pressure cuff  Airtight, flat rubber bladder that can be inflated with air  Adult cuff:  width- 4.5 to 5.5 inches  length: 9 inches Equipment  Sphygmomanometer  Aneroid  Circular calibrated dial  Mercurial  Mercury- filled calibrated cylinder  View the meniscus at eye level Equipment  Stethoscope  Used to listen to the soundsthe sounds  Has a diaphragm and 2 earpieces Korotkoff’s Sounds  series of sounds heard through the stethoscope during BP assessment  has 5 phases Korotkoff’s Sounds  Phases :  Phase 1: 1st clear, rhythmic, tapping sound, corresponds to systole  Phase 2: murmur or swishing soundg  Phase 3: sounds become crisp and louder  Phase 4: abrupt muffling, 1st diastole  Phase 5: sounds disappear, 2nd diastole For the Lab Session:  Bring your materials forVital Signs Assessment:  Sphygmomanometer  Stethoscope Stethoscope  Thermometer  Watch
  • 13. 13 Practical Application  Baseline values of pt – to takeVS at rest  Type of patients whose base line are important to determine.  AbnormalValues at rest and its consequences