Vital signs of cardio

1. VITAL SIGNS
1

2. Introduction
◦The vital signs are body temperature, pulse,
respirations, and blood pressure
◦ are checked to monitor the functions of the
body.
◦The signs reflect changes in function that
otherwise might not be observed.
◦are compared to the client’s usual (if known)
and accepted normal standards.
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3. 3
1) Temperature
◦ Determines febrile
versus afebrile states
◦ Measured in degrees
Fahrenheit (ºF) or
Celsius (centigrade;
ºC)
◦ Four locations can be
used to measure
temperatures but the
oral route is most
commonly used
Temperature
Routes
Oral
Tympanic
Rectal Axillary

4. Temperature (cont.)
◦A thermometer is used to obtain
temperature measurements.
◦Types of thermometers include:
◦Electronic Digital
◦Tympanic
◦Disposable
4
Disposable sheaths are used to prevent cross-
contamination.

5. 5

6. Temperature (cont.)
Route Normal Range
ºF / ºC
Sites
Oral 98.6 ºF / 37.0 ºC mouth
Tympanic 99.6 ºF / 37.6 ºC ear
Rectal 99.6 ºF / 37.6 ºC rectum
Axillary 97.6 ºF / 36.6 ºC Axilla (armpit)
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◦Tympanic Temperatures
◦ Fast, easy to use, and preferred in pediatric
offices

8. ◦Oral Temperatures
◦ Must wait at least 15 minutes if patient has been
eating, drinking or smoking
◦ Thermometer is placed under tongue
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9. ◦Rectal Temperatures
◦ Gloves are donned
◦ Patient is positioned on side or stomach
◦ Lubricated tip of thermometer is slowly and
gently inserted into anus ½ inch for infants and
1 inch for adults
◦ Hold thermometer in place while temperature is
taken
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10. ◦Axillary Temperatures
◦ Place patient in seated or lying position
◦ Tip of thermometer is placed in middle of axilla
with shaft facing forward
◦ Patient’s upper arm is pressed against side and
lower arm should be crossed over stomach to
hold thermometer in place
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Pulse and Respiration
Circulatory Respiratory
Pulse and respirations are related since heart
and lung functioning work together. Normally,
increases or decreases with one causes the same
effect on the other.

12. 2) Pulse rate
◦ It represents the stroke volume output or the
amount of blood that enters the arteries with each
left ventricular contraction.
◦ Compliance of the arteries is their ability to
contract and expand. When a person’s arteries lose
their elasticity, as can happen in old age, greater
pressure is required to pump the blood into the
arteries.
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13. ◦ The peripheral pulse is a pulse located away from
the heart, for example, in the foot or wrist.
◦ • The apical pulse is a central pulse; that is, it is
located at the apex of the heart. It is also referred
to as the point of maximal impulse (PMI)
◦ The radial artery is the common pulse site to
locate in adults, and the brachial artery is used in
young children.
13

14. ◦ Is measured using fingers not your thumb since
the thumb has a pulse of its own
◦ palpating all pulse sites except the apex of the
heart ,A stethoscope is used for assessing apical
pulses
◦ The rate of the pulse is expressed in beats per
minute (BPM)
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

15. 15

16. 16

17. Taking Pulse Rates
◦ Press lightly with your index and
middle finger pads at the pulse
site to locate the pulse.
◦ Count the number of beats you
feel against your fingers in one
minute.
◦ If the pulse rate is regular your
office policy may be to count
the number of beats for 30
seconds and multiply this
number by 2 to obtain the beats
per minute.
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18. 18
Taking Pulse Rates (cont.)
Regular Pulse Rhythm
 Count for 30 seconds
then multiply by 2 (i.e.
rate of 35 beats in 30
seconds equals a pulse
rate of 70
beats/minute).
Irregular Pulse
Rhythm
 Count for one full
minute
 May also use
stethoscope to listen for
apical pulse located in the
5th intercostal space and
count for a full minute.

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• An excessively fast heart rate (e.g., over 100 BPM
in an adult) is referred to as tachycardia.
• A heart rate in an adult of less than 60 BPM is
called bradycardia.
• the pulse rhythm is the pattern of the beats and
the intervals between the beats.
• A pulse with an irregular rhythm is referred
to as a dysrhythmia or arrhythmia.

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FACTORS AFFECTING THE PULSE
1.Age. As age increases, the pulse rate gradually decreases
overall.
2. Gender. After puberty, the average male’s pulse rate is
slightly lower than the female’s.
3. Exercise. The pulse rate normally increases with activity.
4. Fever. The pulse rate increases (a) in response to the
lowered blood pressure that results from peripheral
vasodilatation associated with elevated body temperature
and (b) because of the increased metabolic rate.

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5. Medications. Some medications decrease the pulse rate,
and others increase it
6. Hypovolemia. Loss of blood from the vascular system
normally increases pulse rate.
7. Stress. In response to stress, sympathetic nervous
stimulation increases the overall activity of the heart.
8. Position changes. Pooling results in a graduate
decrease in the venous blood return to the heart and a
subsequent reduction in blood pressure and increase in
heart rate.
9. Pathology. Certain diseases such as some heart
conditions or those that impair oxygenation can alter the
resting pulse rate.

22. 3) Respiration
◦ Respiratory rate is an indication of how well the
body is providing oxygen to the tissues.
◦ One respiration consists of both inhaling and
exhaling air also referred to as breathing in and
breathing out.
◦ Respiratory rates are higher in infants and children
than in adults.
22

23. Taking Respirations
◦ Most reliable method for measuring respirations is with a stethoscope to
count the number of breaths heard per minute.
◦ Other methods include:
◦Look, listen and feel for movement of air
by placing your hand over the patient’s
chest, shoulders or abdomen.
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NOTE: If patients are aware that you are counting their
respirations they may unintentionally alter their
breathing

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Temporary absence of breathing
Apnea
Dyspnea Difficult or painful
breathing
Tachypnea
Rapid breathing
Hyperpnea
Deep, rapid
breathing

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Part 2

26. 4) Blood Pressure
◦ The force at which blood is pumped against the
walls of the arteries yields blood pressure.
◦ Two pressure measurements are obtained with
blood pressure readings:
◦ Systolic pressure (measurement of pressure during
contraction of left ventricle) is the top number.
◦ Diastolic pressure is the pressure when the ventricles are
at rest>> lower pressure.
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28. 28
120/80
Systolic Pressure
• The difference between the diastolic and the
systolic pressures is called the pulse pressure. A
normal pulse pressure is about 40 mmHg but can be
as high as 100 mmHg during exercise.
Diastolic Pressure

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Hypertension  High blood pressure
readings
 Major contributor to
heart attacks and strokes
 Physicians often request a
re-check of patient’s blood
pressure within two months
or less when readings are
elevated

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types of hypertension
An elevated blood pressure of unknown cause is
called primary hypertension.
 An elevated blood pressure of known cause is
called secondary hypertension.

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Hypotension
 Low blood pressure
reading
 Is generally not a chronic
health problem and may be
normal for some patients
 Severe low blood pressure
readings occur with:
 Shock
 Heart failure
 Severe burns
 Excessive bleeding
analgesics

32. ◦Severe burn
◦ Hypovolemic shock……. Loss of blood plasma
due to severe burns, this happens due to loss of
skin and damage to the blood vessels.
◦ Septic shock………result from bacteremia leading
to sepsis which is a systemic immune response to
to the bacterial toxins, this will lead to a dramatic
drop in blood pressure leading to decrease tissue
perfusion and decrease oxygen and nutrient
supply to the tissues
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Orthostatic (postural) hypotension:
is a blood pressure that falls when the client sits or
stands (position change).
 It is usually the result of peripheral vasodilatation in
which blood leaves the central body organs, especially the
brain, and moves to the periphery, often causing the
person to feel faint.

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Special Considerations
Properly Fitting Cuff
Age
Patient
Stress or Activity
Current Circulation to Extremity Selected

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◦ DETERMINANTS OF BLOOD PRESSURE
◦1. Pumping Action of the Heart.
◦2. Peripheral Vascular Resistance.
◦3. Blood Volume.
◦4. Blood Viscosity.

36. 1. PUMPING ACTION OF THE HEART
Weak
•less blood is pumped into arteries
(lower cardiac output)>>> the blood
pressure decreases.
Strong
•the volume of blood pumped into the
circulation increases (higher cardiac
output)>>>the blood pressure
increases.

37. 2. PERIPHERAL VASCULAR RESISTANCE
◦ • Peripheral resistance can increase blood
pressure. The diastolic pressure especially is
affected.
◦ • Some factors that create resistance in the
arterial system are
◦ the capacity (internal diameter)of the arterioles
and capillaries,
◦ the elasticity of the arteries,
◦ and the viscosity of the blood.
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38. 2. PERIPHERAL VASCULAR RESISTANCE
cont’
◦ Normally, the arterioles are in a state of partial
constriction.
◦ • Increased vasoconstriction, such as occurs with
smoking>>>raises the blood pressure
◦ • Decreased vasoconstriction>>> lowers the blood
pressure.
◦ If the elastic and muscular tissues of the arteries
are replaced with fibrous tissue, the arteries lose
much of their ability to constrict
◦ and dilate>>>arteriosclerosis
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39. 3. BLOOD VOLUME
Decreased
•e.g. as a result of a hemorrhage or
dehydration>> the blood pressure
decreases because of decreased fluid in the
arteries.
Increased
e.g. as a result of a rapid intravenous
Infusion>> the blood pressure increases
because of the greater fluid volume within
the circulatory system.

40. 4. BLOOD VISCOSITY
◦ Blood pressure is higher when the blood is
highly viscous (thick) >> when the proportion of
red blood cells to the blood plasma is high.
◦ This proportion is referred to as the hematocrit.
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◦FACTORS AFFECTING BLOOD PRESSURE
◦ 1. Age. The pressure rises with age, reaching a peak at
the onset of puberty, and then tends to decline.
◦ 2. Exercise. Physical activity increases the cardiac
output and hence the blood pressure.
◦3. Stress. Stimulation of the sympathetic nervous system
increases cardiac output & vasoconstriction of the
arterioles>>increasing the blood pressure .Severe pain >>
decrease blood pressure by inhibiting the vasomotor center
and producing vasodilatation.
◦ 4. Medications.
◦ 5. Obesity. Both childhood and adult obesity predispose to
hypertension.

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◦FACTORS AFFECTING BLOOD PRESSURE
◦ 6. Diurnal variations. Pressure is usually lowest
early in the morning, when the metabolic rate is
lowest, then rises throughout the day and peaks in
the late afternoon or early evening.
◦ 7. Disease process. Any condition affecting the
cardiac output, blood volume, blood viscosity,
and/or compliance of the arteries has a direct effect
on the blood pressure.
◦ 4. Gender. After puberty, females usually have
lower blood pressures than males of the same age;
this difference is thought to be due to hormonal
variations. After menopause, women generally have
higher blood pressures than before.

43. Blood Pressure Equipment
◦A sphygmomanometer is the
instrument used to measure blood
pressures consisting of a cuff, pressure
bulb, and manometer.
◦Three types of sphygmomanometers:
◦Mercury
◦Aneroid
◦Electronic
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45. 45

46. Stethoscope
◦Amplifies body
sounds
◦Consists of
earpieces,
binaurals, tubing
and a chestpiece
(bell and
diaphragm)
46
Earpieces
Binaurals
Rubber or plastic
tubing
Bell
Chestpiec
e
Diaphrag
m

47. Stethoscope (cont.)
◦Bell
◦ Cone-shaped side of
chest piece
◦ Amplifies low-pitched
sounds such as heart
sounds
◦ Must be held lightly
against skin for proper
amplification
◦ Diaphragm
◦ Larger flat side of the
chest piece
◦ Amplifies high-
pitched sounds like
bowel and lung
sounds
◦ Must be held firmly
against skin for
proper amplification
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48. Measuring Blood Pressure
◦ The cuff must be placed on the upper arm above
the brachial pulse site.
◦ Palpate the brachial pulse then place stethoscope
over this site.
◦ Inflate cuff about approximately 180 mmHg to
200 mmHg.
◦ Release the air in cuff and listen for the first
heartbeat (systolic pressure) and the softest or
last heartbeat (diastolic pressure).
◦ Record results with systolic being top number and
diastolic being bottom number (i.e. 120/76).
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49. Measuring Blood Pressure (cont.)
◦ Wait 15 minutes before taking readings if patient
has been engaged in strenuous exercise or has
ambulatory disabilities.
◦ Be sure cuff is properly fitted and placed on the
extremity or inaccurate readings may result.
◦ DO NOT TAKE BP’s IN AN EXTREMITY IF:
◦ Injury or blocked artery is present
◦ History of mastectomy on that side
◦ Implanted device is under the skin
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End of Chapter