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
  • Vital signs

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