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    Vital signs power point black module Vital signs power point black module Presentation Transcript

    • VITAL SIGNS Tanya Napoli, RN BSN
      • Discuss the physiologic processes that affect temperature, pulse, respirations, and blood pressure.
      • Identify alterations in vital signs.
      • Educate patients/family members about assessing vital signs at home.
      • A person’s temperature, pulse, respirations, and blood pressure comprise vital signs.
      • The nurse/MA is responsible for reporting accurate vital sign data and any abnormal readings .
      • Frequency of vital sign assessment is dependent upon institutional policy and the patient’s condition.
      • The heat of the body measured in degrees.
      • Normal core body temperature ranges from 36.0 C to 37.5 C (97.0 F to 99.5 F).
      • Maintained by the thermoregulatory center in the hypothalamus
      • Body’s primary heat source is metabolism – heat is a byproduct of cellular activity
      • Body heat is lost primarily via the skin.
      • Factors affecting body temperature
        • Circadian rhythms
        • Age
        • Gender
        • Environmental temperature
          • Hypothermia – body temperature below 36.0 C
          • Hyperthermia – body temperature above37.5 C, not related to fever
      • A patient with a normal body temperature is considered afebrile.
      • An increase in body temperature due to illness or trauma is called a fever.
        • A patient with a fever is considered febrile .
        • Onset may be sudden or gradual
        • Symptoms include shivering, headache, thirst, flushing of the skin, and increased pulse rate.
      • Interventions to reduce fever
        • Administration of antipyretics (aspirin or acetaminophen)
        • Cool sponge baths or shower
        • Cool packs
        • Cooling blankets
        • Removing blankets
        • Offer/force fluids if not contraindicated
      • Equipment – types of thermometers
        • Electronic/digital
        • Tympanic membrane
        • Glass
        • Disposable
      • Assessment sites
        • Sublingual
          • Surface temperature
          • Must be able to close mouth around probe
          • Need to wait 15 to 30 minutes after drinking or smoking
          • Contraindicated?
        • Tympanic
          • Considered a core temperature
          • Easily accessed
          • Ear canal must be large enough to accommodate probe
          • Contraindicated?
      • Assessment site
        • Rectal
          • Core temperature, most accurate
          • Uncomfortable for patients
          • Contraindicated?
        • Axillary
          • Surface temperature
          • Site of choice for newborns
      • A throbbing sensation that can be palpated over a peripheral artery or auscultated over the apex of the heart (the apical pulse).
      • Pulse rate is the number of pulsations palpated or heard in one minute.
      • Normal pulse rate for adolescents and adults is 60 to 100 beats per minute.
      • What are some factors that would affect pulse rate?
      • Tachycardia – pulse rate of 100 to 180 beats per minute, sustained tachycardia will eventually lead to decreased cardiac output.
      • Bradycardia – pulse rate below 60 beats per minute.
        • Can be normal
        • May be related to medications
        • When should you be concerned about bradycardia?
      • Pulse amplitude refers to the quality of the pulse and is indicative of left ventricular strength.
      • The rhythm of the pulse is described as regular or irregular. An irregular pulse pattern is referred to as a dysrhythmia .
      • A pulse deficit occurs when the apical pulse and peripheral pulses do not match.
      • Assessment sites
        • Apical pulse is assessed over the apex of the heart using a stethoscope.
          • Count for a full 60 seconds.
          • Necessary when giving certain medications, such as digoxin
          • PMI- Point of maximal impulse- Mitral Valve/Bicuspid
        • Peripheral pulse can be palpated over several arteries.
          • When would it be important to palpate a pedal pulse?
      • A . Exercise - increased activity- heartbeat increases 20-30 beats per minute to meet the body’s needs. It should return to normal 3 minutes after activity has stopped.
      • B. Age - the younger you are, the faster the rate.
      • C. Sex - females; 10 bets per minute more rapid than a man.
      • D. Physical Condition of the body- athletes slower, as a result of a more efficient circulatory system.
      • *** Heart rate increases when the sympathetic nervous system is stimulated by feelings such as; anxiety, fear, pain or anger.
      • Radial - thumb side, inner surface of wrist.
      • Brachial - (antecubital)inner medial surface
      • of elbow.
      • - you can palpate and ausculate to listen to the BP.
      • Carotid – neck ( either side of the trachea )
      • Femoral - midway in groin
      • Dorsalis Pedis- instep of foot
      • Popliteal - back of the knee
      • A respiratory cycle involves both inspiration and expiration.
        • The number of complete cycles per minute comprise the respiratory rate.
        • Normal rate is 12 to 20 cycles per minute.
        • What are some factors that affect respiratory rate?
      • Depth and rhythm are also assessed
        • Depth of respirations varies from shallow to deep.
        • Normal respirations have a regular rhythm.
      • Tachypnea – refers to a rapid respiratory rate, usually shallow in depth.
        • Caused by increased metabolic demand
      • Bradypnea – refers to a decrease in respiratory rate.
        • May have a pathological cause or can be a side effect of certain medications
      • Apnea – refers to periods without respirations.
      • Dyspnea – refers to difficult or labored respirations
      • A measurement of the force of the blood against the arterial walls.
      • Systolic pressure – measurement of the force on the arterial walls as the left ventricle contracts.
      • * Heart Contracting- Top Number
      • Diastolic pressure – measurement of the force on the arterial walls as the left ventricle relaxes.
      • * Heart Relaxing- Bottom Number
      • Pulse pressure – the difference between the systolic an diastolic pressure.
      • The sounds heard during blood pressure assessment are called Korotkoff sounds.
        • The first sound (or beat) represents the systolic pressure.
        • A change in or cessation of the loud, distinct sounds represents the diastolic pressure.
      • Peripheral resistance describes the resistance to blood flow resulting from the arterioles always being partially contracted.
        • This allows continuous flow of blood into the capillaries.
        • The elasticity of the artery walls combined with arteriole resistance helps maintain normal blood pressure
      • Blood pressure is also affected by several hormonal and humoral mechanisms as the body attempts to maintain homeostasis.
      • Cardiac output has a direct effect on blood pressure.
        • Cardiac output is equal to the stroke volume times the heart rate.
        • An increased cardiac output results in increased blood pressure.
        • Conversely, blood pressure decreases as cardiac output decreases.
      • A “normal blood pressure” is less than 120/80 mm Hg.
        • There is a wide range of normal, therefore baseline readings are critical.
        • An elevation or fall or 20 to 30 mm Hg is significant.
      • Hypertension is sustained blood pressure above normal.
        • Major risk factor for heart disease and stroke
      • Hypotension – below normal blood pressure
        • May be normal
        • May be pathologic
        • When should you be concerned?
      • Orthostatic hypotension or postural hypotension occurs when blood pressure drops during rising to a sitting or standing position.
      • Manual blood pressure is assessed with a stethoscope and sphygmomanometer.
        • Accurate readings depend on using appropriate-size cuffs
      • Electronic blood pressure monitors sense vibrations in the artery wall to determine blood pressure.
      • Most common site is the brachial artery.
        • When would you choose an alternate site?