Vital signs provide important health information. The most common vital signs measured are temperature, pulse, blood pressure, and respiration. Alterations in vital signs can indicate a need for further intervention. Personal care workers are responsible for accurately recording clients' vital signs according to workplace protocols and reporting any abnormalities to supervisors or medical professionals.

1. Vital Signs Provide Support to Meet Personal Care Needs Updated by Jo Lewis BHS Fiona O’Toole & Josie Ashmore

2. PERSONAL CARE WORKERS ROLE Record According to workplace protocol Report Supervisor GP

3. VITAL SIGNS Most frequent measurements taken by health care professionals Temperature, Pulse, Blood Pressure and Respiration’s Indicators of health status - measure the effectiveness of circulatory, respiratory, neural and endocrine body functions Alteration in vital signs may signal the need for further intervention

4. TEMPERATURE Oral Via Mouth, rarely used Axilla Per Axilla (underarm) Used infrequently Tympanic Most common Temple Recent introduction

5. Oral Oral: No longer used in Residential Care, may still be used in home setting 3 minutes Under tongue, lips closed No hot or cold drinks beforehand

6. Per Axilla Armpit Previously most common in aged care Used now if tympanic/temple not available 3 minutes Skin surfaces to touch bulb Record as p/a

7. Tympanic Most commonly used in aged care As per instructions for each type Apply cover Pull the ear lobe up and backwards to straighten the ear canal. Insert into canal Wait for beep

8. THE PULSE The bounding of blood flow we can feel at various points around our body Indicator of effective circulation For our cells to function normally we need continuous blood flow and volume Blood flows around the body in a continuous circuit, pumped by the heart

9. Cardiac output = volume of blood pumped by the heart in one minute Changes in heart rate alter how well the heart pumps - leads to changes in BP As heart rate increases less time for heart to fill -less volume reduces BP As heart rate decreases filling time increases - normalises BP

10. Assessing the Pulse Any artery can be used to assess pulse rate Radial and carotid easiest Carotid best in emergency situation - heart will pump blood to brain for as long as possible When cardiac output drastically reduces peripheral pulses difficult to feel

11. Carotid pulse

12. Personal Care Workers Use only the radial pulse point

13. Pulse points in the body Radial and apical locations most commonly used

14. Equipment needed: Watch with second hand Pen Documentation as per organisation protocol

15. Factors which might affect pulse rate Age Exercise Position changes Medications Temperature Emotional distress/anxiety/fear

16. The steps for taking a radial pulse Collect equipment Explain to client Wash hands Provide privacy if required Place client’s forearm alongside or across lower chest or abdomen (lying) Bend client’s forearm at 90 deg angle and support lower arm on chair Make sure palm is facing downward

18. Steps for taking a radial pulse Place the tips of your first two fingers over the groove along the thumb side (radial side) of the client’s wrist Do not use your thumb!!!! Lightly compress against the radius to feel a pumping sensation Determine the strength of the pulse - Is it strong, thready, bounding or weak ?

19. Work out the rate After pulse can be felt regularly, look at watch’s second hand and begin to count rate If pulse is regular count for 30 seconds and multiply by 2 (x2) If pulse is irregular, count rate for 60 seconds

20. Things to consider Rate Rhythm - regular, regularly irregular, irregularly irregular Strength

21. Factors influencing pulse rates Exercise Temperature - fever and heat Drugs Loss of blood ( haemorrhage ) Postural changes - sitting or standing Lung conditions - poor oxygenation

22. Normal ranges INFANT - 120-160 bpm TODDLER - 90-140 bpm SCHOOLAGE - 75-100 bpm ADOLESCENT - 60-90 bpm ADULT - 60-100 bpm

23. Respiration Our survival depends on the ability of O 2 and CO 2 to be removed from the cells Respiration exchanges gases between the atmosphere and the blood and cells Ventilation = the movement of gases in and out of the lungs Regulated by the respiratory centre in our brain

24. Normal breathing Chest wall gently rises and falls Abdominal cavity rises and falls due to diaphragmatic movement No use of accessory muscles - intercostal, muscles in neck and shoulders Accurate measurement necessary as breathing tied to numerous body systems Look at rate and depth

25. Normal rates Newborn - 30-60 Infant - 30-50 Toddler - 25-35 Child - 20-30 Adolescent - 16-20 Adult - 12-20

26. How to assess respiration Equipment: watch, Obs chart, pen Explain to client ???? Make sure chest is visible-place client arm over abdomen/ or your arm Observe complete cycle (insp and exp) Begin to count rate If regular count for 30 seconds and multiply by 2 (x2) If irregular , less than 12 or more than 20 count for full minute

27. Note depth of respirations, skin color and effort Replace linen Wash hands Record on obs chart Report abnormal findings

28. Other terms you might hear Bradypnea - slow breathing Tachypnea - fast breathing Apnoea - no breathing for several seconds Hyperventilation - fast rate and depth Hypoventilation - slow rate and depth Cheyne-stoke’s respiration - irregular -apnoea - hyperventilation - shallower - apnoea

29. Blood pressure The force applied to the inside of our artery by the blood pulsing from our heart

30. Blood pressure Can be affected by: Effectiveness of heart pumping Resistance in extremities Blood volume Thickness of the blood Elasticity of arteries and blood vessels

31. Systolic v’s Diastolic BP Systolic pressure = peak maximum pressure when heart contraction forces blood into aorta (major blood vessel to body) Diastolic pressure = the amount of blood left in the ventricles of the heart when they relax between contractions

32. Factors influencing BP Age Stress Race Medications Time of day Gender

33. Common conditions of BP Hypertension high BP Hypotension low BP Postural hypotension dropping of BP when rising to an upright position

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

36. Equipment needed Sphygmomanometer and cuff Stethoscope Obs chart and pen

37. Getting started Gather equipment Explain to client - rest 5 min if anxious Select appropriate cuff size - S - XL Client can lie or sit or stand Wash hands Expose extremity by removing constricting clothes

38. Palpate the brachial pulse (arm) Place cuff about 2.5 cm above pulse site Making sure cuff is fully deflated wrap evenly and snugly around extremity (use arrow to centre on cuff)

39. Position the manometer < 1m away from you so you can see it Place stethoscope pieces in ears and ensure sounds are clear and not muffled ? Estimate systolic pressure (30 mmHg >) Relocate pulse and place bell of the stethoscope over it (don’t cover it with clothing/cuff

41. Steps cont…. Close valve of pressure bulb clockwise until tight Rapidly inflate cuff to 30 mmHg than palpated/previous BP SLOWLY release bulb pressure valve allow mercury to fall at a rate of 2-3 mmHg per second

42. Listen carefully... Listen for the first thumping sound and note the measurement on the manometer (systolic reading) Sound increases in intensity Continue to deflate cuff and sound will become muffled/dampened and note the measurement again (diastolic reading)

43. Continue to deflate cuff gradually - listen for 10-20 mmHg after the last sound - let the rest of the air escape quickly Remove cuff Assist client to comfortable position, wash hands Document reading on obs chart Notify of abnormalities

44. What if the BP is abnormal ? Repeat the process Check on other arm Ask client how they feel Compare old readings Get someone else to check reading