VITAL-SIGNS-PAIN-MEDS PRESENTATTION.pdf

1. VITAL
SIGNS

2. ✔The Vital Signs also known as
CARDINAL SIGNS.

3. ✔ IMPORTANT INDICATORS OF HEALTH STATES
OF THE BODY.
✔ PROVIDE INFORMATION ABOUT THE BASIC
BODY CONDITIONS OF A PATIENT.
✔ FOUR MAIN VITAL SIGNS: TEMPERATURE,
PULSE, RESPIRATION, BLOOD PRESSURE.
✔ PAIN IS OFTEN REFERRED TO AS THE 5TH
VITAL SIGN
VITAL SIGNS!

4. TEMPERATURE
Perspiration, respiration,
excretion
LOST
PRODUCED
Metabolism of food,
muscle and gland activity

5. TEMPERATURE
HOMEOSTASIS – balance
❑ Ability to maintain a
constant internal
environment in response to
environmental changes
.

7. TEMPERATURE
NORMAL RANGE (36◦C - 37
◦C )
INDIVIDUAL DIFFERENCES –
some people run cooler or hotter
REASONS FOR
VARIATIONS IN
RANGE
TIME OF DAY– higher in evening
BODY SITE– different areas of the
body run hotter or cooler

8. TEMPERATURE
Running a fever above 101
◦F (38.8◦)
Taken by mouth
Placement time 2-3 minutes
Without fever
Rectum
Placement for 2 minutes
Afebrile
Rectal 99.5◦F
(37.5◦C)
FEBRILE
Oral Temperature 98.6◦F (37
◦C)
Axillary (97.6◦F
(37◦C)
Armpit
Placement for 5 minutes
Aural (tympanic) 99.5◦F
(37.5◦C)
Ear

9. DIFFERENT WAYS IN TAKING THE TEMPERATURE

10. Most reliable method of
temperature
Rectal Thermometer
insertion
Best route of temperature in
children
Position for rectal temperature
Axillary
Left Lateral
Rectal route
Adult: 1.5 inch
Infant/child: 1
inch
Some important
point:

11. Electronic thermometers:
A. institutional model
B. one-piece home
electronic thermometer
Types of Thermometer

12. Infrared or Tympanic thermometer

13. Mercury-in-glass
thermometer
Infrared
thermometer

14. Temporal artery thermometer

15. Chemical dot thermometers

17. Temperature
(T)
CAUSES OF INCREASED TEMPERATURE
❑ INFECTION
❑ EXERCISE
❑ EXCITEMENT
❑ HIGH TEMPERATURE IN THE
ENVIRONMENT

18. Temperature
(T)
CAUSES OF DECREASE TEMPERATURE
❑ STARVATION
❑ SLEEP
❑ DECREASED MUSCLE ACTIVITY
❑ EXPOSURE TO COLD TEMPERATURE
(ENVIRONMENT)
❑ CERTAIN DISEASES
(HORMONAL/THYROID/ADDISONS)

19. Temperature
(T)
HYPOTHERMIA
❑ Below 95◦F (35 ◦C)
❑ Caused by prolonged exposure to cold
❑ Death when temp below 93◦F (33.88 ◦C)
HYPERTHERMIA
❑ Above 104◦F(40 ◦)
❑ Caused by prolonged exposure to hot temperatures, brain
damage, or serious infection.

20. REVIEW

21. Define the following
terms:
❑ Afebrile
❑ Hypothermia
❑ Febrile
❑ Hyperthermia
❑ Homeostasis
❑ What are the four
vital signs?
❑ What is the normal
range for
temperature?

22. PULSE
❑ The pressure of the blood
pushing against the wall
of an artery as the heart
beats and rests.

23. PULSE
❑ More easily felt in arteries that lie close to the
skin and can be pressed against a bone by the
fingers.
✔ Temporal – side of head
✔ Carotid – Neck
✔ Brachial – Wrist
✔ Femoral – Upper thigh (groin)
✔ Popliteal – behind knee
✔ Dorsalis pedis – top of the foot

24. Average Range of
Pulse
❑ ADULT: 60 – 100 BPM
❑ CHILDREN OVER 7yrs : 70 – 100
BPM
❑ CHILDREN 1 yr – 7 yrs: 80 – 110
BPM
❑ INFANTS: 100 – 160 BPM

25. Pulse Rate Terms
❑ BRADYCARDIA – pulse rate below normal range
(60BPM)
✔ CAUSES: medications, severe lack of oxygen
❑ TACHYCARDIA – pulse rate over normal range
(100 BPM)
✔ CAUSES: physical/mental stress, pain, exercise,
infection, lack of oxygen, low blood pressure.

26. RESPIRATORY
RATE ❑ RESPIRATORY – process of
taking in oxygen and expelling
carbon dioxide from the lungs
and respiratory tract.
❑ Inhalation + exhalation = 1
breath
❑ RATE = breaths per minute

27. Respiratory Rate
❑ Measure the rise and fall of the chest adults.
❑ Measure the rise and fall of the abdomen in
young children.
❑ Normal respiration rate
✔ Adult = 12-20 RR
✔ Child = 16-30 / 20 - 28RR
✔ Infant = 30-50 / 30 -60RR

28. Abnormal Respirations
❑ EUPNEA – Normal breathing
❑ APNEA – absence of respiration
(usually temporary)
❑ TACHYPNEA – rapid, shallow
respiration rate (above 25 RR / 30
RR)
❑ BRADYPNEA – slow respiratory
rate (below 10 RR)

29. Blood Pressure
What does blood
pressure tell us
about a person’s
health?

30. Blood Pressure (BP)
❑ (BP) – Measurement of pressure that the
blood exerts on the walls of the arteries
as blood pulsates through.
❑ Blood Pressure reading is measure in
millimeters (mm) of mercury (Hg)
❑ Sphygmomanometer – instrument used to
measure blood pressure.

31. Types of Blood Pressure
Measurements
❑ SYSTOLIC – pressure that occurs when
the heart is contracting.
❑ DIASTOLIC – pressure that is present
when the heart is at rest.
❑ BP is recorded as a fraction.
❑ Systolic reading is the top number
❑ Diastolic reading is the bottom number

32. Blood Pressure Measurements
❑ Normal Range
✔Systolic: 100 – 120 mm Hg)
✔Diastolic: 60-80mm Hg
❑ Hypertension – High blood pressure
✔ Systolic: >140mm Hg
✔ Diastolic: >90mm Hg
❑ Hypotension – low blood pressure
✔ Systolic: <90mm Hg
✔ Diastolic> <60mm Hg

33. Prehypertension – warning
that high blood pressure will
develop unless steps are
taken to prevent it.
✔ Systolic: 121 – 139mm hg
✔ Diastolic: 81-89mm Hg
Blood Pressure
Measurements

34. Causes of Hypertension
❑ Stress
❑ Anxiety
❑ Obesity
❑ High Salt intake
❑ Aging
❑ Kidney disease
❑ Vascular
conditions
Hypertension is often
called the “silent killer”
❑ Why do you think??

35. Causes of Hypotension
❑ Heart Failure
❑ Dehydration
❑ Severe Burns
❑ Hemorrhage
❑ Shock

36. Sites for Taking Blood Pressure
❑ Common areas for BP
✔ Brachial – taken in upper arm
✔ Radian – taken on the lower arm
✔ Popliteal – taken on the thigh
✔ Doralis Pedis – taken on the lower leg

37. PAIN
ASSESSMENT

38. ✔ IT DESCRIBES UNPLEASANT SENSATION IN THE BODY.
✔ IT CAN BE FROM DULL ACHE TO SHARP STAB AND CAN
RANGE FROM MILD TO EXTREME.
✔ IT CAN BE FROM ONE PART OF THE BODY OR
WIDESPREAD
✔ DUE TO INJURY, SURGERY, MEDICAL CONDITIONS,
CANCER, ARTHRITIS.
✔ THE PAIN CAN BE CLASSIFIED AS ACUTE
AND CHRONIC PAIN
PAIN

39. ACUTE PAIN
PAIN
CHRONIC PAIN
✔NORMAL RESPONSE TO AN
INJURY
✔STARTS SUDDENLY
✔USUALLY SHORT-LIVED
✔CONTINUES BEYOND THE
TIME
✔LAST FOR LONGER THAN
3 MONTHS

40. PAIN SCALE
✔THERE ARE SEVERAL WELL DESIGNED PAIN SCALES
USED TO ASSESS THE SEVERITY OF ONE’S PAIN
✔CONSCIOUS PATIENTS WE CAN USE UNIDIMENSIONAL
SCALE.
✔A WAY OF PEOPLE TO RATE THE INTENSITY OF THEIR
PAIN is BY NUMBERS, WORDS, IMAGE OR
DESCRIPTION

41. ⮚ MOST COMMONLY USED
⮚ PERSON RATES THEIR PAIN ON 0 TO 10
⮚ 0 MEANS NO PAIN
⮚ 10 MEANS WORT POSSIBLE PAIN
1. NUMERICAL PAIN SCALE

42. ⮚ 10CM LINE PRINTED ON A PAPER
⮚ PERSON MARKS A SPOT OR X ON THE LINE TO
SHOW THEIR PAIN INTEGRITY
⮚ THEN MEASURE THE LINE TO GET THE PAIN SCORE
2. VISUAL ANALOG SCALE (VAS)

43. ⮚ SIMPLE WAY TO RATE PAIN INTENSITY
⮚ USING VERBAL OR VISUAL DESCRIPTION
⮚ MILD, DISCOMFORT, DISTRESSING, HORRIBLE, EXCRUCIATING
⮚ FOR CHILDREN RATE THE PAIN INTENSITY USING THE IMAGES
OF FACES
3. CATEGORICAL SCALE

44. Nosso Currículo
Artes
É o planeta mais
próximo do Sol
20%
Esportes
Marte é um lugar
realmente frio
30%
Ciências
Júpiter é um
gigante gasoso
15%
Geografia
É o planeta mais
distante do Sol
35%

46. MANAGEMENT OF PAIN
ACUPUNCTURE
TEN (TRANSCUTANEOUS
ELECTRICAL STIMULATION)
COGNITIVE BEHAVIOURS
THERAPY
C
B
A HEAT OR COLD
APPLICATION
PHYSICAL THERAPIES
MASSAGE SOFT INJURIES,
AVOID IN JOINTS)
D
E
F
G PARACETAMOL, ASPIRIN
H NSAID’S (IBUPROFEN AND
INFLAMMATION)
OPOIDS (SEVERE & CANCER

47. Medication
Administration

48. Medication
Administration
The process by which a medicine is
administered to a patient therapeutically.
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49. Medications or Medicines
▸ are chemicals that are used for diagnosis, treatment and prevention of disease/s
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50. Routes of
Administration
For small therapeutic
molecules, various routes for
drug administration are
parenteral (intravenous,
intramuscular, and
subcutaneous), oral, nasal,
ocular, transmucosal (buccal,
vaginal, and rectal), and
transdermal.
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51. Oral Route
Advantages include:
▸ Most convenient
▸ Usually least expensive
▸ Safe, does not break skin
barrier
▸ Administration usually does
not cause stress
▸ Some new oral medications
are designed to rapidly
dissolve on the tongue,
allowing for faster
absorption and action
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52. Oral Route
Disadvantages include:
▸ Drug may have unpleasant taste
or odor
▸ Inappropriate when GI tract has
reduced motility
▸ Drug may discolor teeth, harm
tooth enamel
▸ Drug may irritate gastric mucosa
▸ Drug can be aspirated by seriously
ill clients
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53. Sublingual and Buccal Ruote
Advantages include:
▸ Same as for oral, plus:
▸ Drug can be administered for local
effect
▸ More potent than oral route because
drug directly enters the blood and
bypasses the liver
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54. Liquid
▸ Aqueous Solution (Liquid
Medicine)
▸ Aqueous Suspension
(Liquid Medicine with
Granules)
▸ Syrup - elixir
▸ Extract – olive leaf
▸ Tincture – herbal
Drug Preparation for these routes:
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55. Used in oral medications:
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56. Used in oral medications:
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DO NOT CRUSH
SUSTAINED-RELEASE AND
ENTERIC COATED TABLETS
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57. Topical Route
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Inhalations
03
✔ Administered into the respiratory tract by a
nebulizer or positive pressure breathing
apparatus. Air, oxygen, and vapor are
generally used to carry the drug into the lungs.
Instillations and irrigations
02
✔ Applied into body cavities or orifices,
such as the urinary bladder, eyes,
ears, nose, rectum, or vagina
Dermatologic preparations
01 ✔ Applied to the skin
Topical applications are those applied to a circumscribed surface area of the body. They
affect only the area to which they are applied. Topical applications include the following:

58. Topical Route
Advantages include:
▸ Few side effects
▸ Painless
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Disadvantages include:
▸ Drug can enter body through abrasions
and cause systemic effects
▸ Leaves residue on the skin that may soil
clothes

59. Transdermal Route
Advantages include:
▸ Prolonged systemic effect
▸ Few side effects
▸ Avoids GI absorption problems
▸ Onset of drug action faster than oral
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Disadvantages include:
▸ Rate of delivery may be variable
▸ Verify that the previous patch has been
removed and disposed of appropriately
to avoid overdose
▸ Medication leaves an oily or pasty
substance on skin sometimes soiling
the clothes

60. Mucous Membranes Route
Advantages include:
▸ Therapeutic effects provided by local
application to involved sites
▸ Aqueous solution readily absorbed and
capable of systemic effects
▸ Potential route of administration when
oral route is contraindicated
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Disadvantages include:
▸ Mucous membranes are highly
sensitive to some medication
concentrations
▸ Patients with ruptured eardrum cannot
receive ear irrigations
▸ Insertion of vaginal and rectal
suppositories can be embarrassing.
Includes: Intranasal, Otic, Opthalmic,
Intraocular, Vaginal, Rectal Routes
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61. ▸ Aqueous Solution (Liquid
Medicine)
▸ Aqueous spray or foam
▸ Cream
▸ Gel / Jelly
▸ Ointment
▸ Lotion
▸ Suppositories
▸ Vaginal Tablets
Drug Preparation for these routes:
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Given via:
✔ Inhalation
For aqueous spray
Intranasal (can be oral*)
✔ Instillation
Dropping medicine into the
mucous membrane
✔ Irrigation
Flushing mucous membranes with
large amounts of medicine
✔ Insertion
Inserting medicines into the
vagina or rectum
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62. PARENTERAL ROUTE

63. IM

64. SQ

65. Intradermal

66. IVTT- Intravenous therapy technique

67. Medication Tickets
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Pink
Ticket
Nebulization and
Procedures
Red Ticket
STAT and Now meds
(PO or IVTT)
White Ticket
oral meds
(Standing or PRN)
Blue
Ticket
Parenteral medications
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68. Dosage
Calculations
✔ Math calculations done for preparing appropriate doses of medicines, taking into
account conversions of WEIGHTS AND MEASURES. Mistakes are one of the
sources of MEDICATION ERRORS.
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69. Dosage Calculations…
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1. Be familiar with
the systems of
measurement
2. Check the
available dose
and the desired
dose
3. Check if there is
a need for
conversion
*always round off
to the nearest
tenths for decimal CMFiel

70. Understanding Medication Order
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71. Medication Order
● A written direction provided by a prescribing practitioner for
a specific medication to be administered to an individual.
Should contain:
• Full name of the client
• Date and time the order is written
• Name of the drug to be administered
• Dosage of the drug
• Frequency of administration
• Route of administration
• Signature of the person writing the order
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72. Types of Medication Order
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Standing/Routine Order
✔ may or may not have a termination date. A standing order may be carried out
indefinitely until an order is written to cancel it, or it may be carried out for a
specified number of days
As needed Order (PRN order)
✔ permits the nurse to give a medication when, in the nurse’s
judgment, the client requires It. The nurse must use good
judgment about when the medication is needed and when it
can be safely administered.
✔ Often ordered with the term “PRN” or a condition (“for”)
Single Dose Order ✔ Medication to be given once at a specified time or situation
Stat Order
✔ indicates that the medication is to be given immediately and
only once
Now Order
✔ Used when a patient needs a medication quickly but not
right away as in a STAT order
✔ The nurse has a maximum of 90 minutes to complete a
Now order given only at one time CMFiel

73. ✔ Paracetamol 500mg/tab 1tab
PO q4 RTC
✔ KCl drip of PNSS 1L + 40
Meqs KCl to run for 8 hours x
3 cycles
✔ Furosemide 40mg IVTT q8
with BP precautions
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Standing /
Routine
Order
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74. ✔ Clonidine 75mcg/tab 1tab SL
q6 for BP ˃ 150/90 mmHg
✔ Metoclopromide 10mg IVTT
q8 PRN for vomiting
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As needed/
PRN Order
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75. ✔ Ranitidine 50mg/ampule 1
ampule IVTT 1 hour prior to
surgery
✔ Diphenhydramine HCl
50mg/capsule 1 capsule 30
minutes prior to blood
transfusion
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Single Dose
Order
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76. ✔ Tranexamic Acid 500mg/
ampule 2 ampules IVTT
STAT
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Stat Order
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77. ✔ Tranexamic Acid
500mg/ampule 2 ampules
IVTT now
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Now Order
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79. Checking of Medication
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80. Medication Administration Steps
1. Wash your hands and gather the
necessary supplies.
2. Remove the patient’s medication
from the storage area.
3. Check the label on the bottle or
card and pick the medication to be
administered.
4. Compare the medication
administration record with the label
to make sure they correlate.
5. Identify the patient and explain what
you’re going to do.
6. Observe the patient to see if there is
anything that needs to be reported to
the doctor before administering the
medication.
7. Do not touch the medication with
your hands.
8. Follow the specific instructions listed
for each type of medication to be given
9. Throw away used disposable
supplies.
10. Place the patient’s medications
back in the medication storage area
and secure them.
11. Wash your hands.
12. Chart the medication you
administered on the medication
administration record.

81. 10 Rights in Medication Administration
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82. Thanks!
☺
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