318 - CH. 18: Measuring Vital Signs Slides

Facility Standards for Monitoring?

• Hospital: Every 4 to 8 hours

• Home health setting: Each visit

• Clinic: Each visit

• Skilled nursing facilities (SNFs): Weekly to monthly

Range for normal core temperature

97.9 to 99.8ºF

• can be as slow as 95.5ºF

• there is variance with age and gender

Surface Temperature

• use axillary and oral methods

• lower than core temp

What part of the brain controls temperature?

Hypothalamus

• thermOstat (hypOstat)

How can temperature occur?

• Radiation: emissions from surfaces to colder air

• Convection: transfer thru air or water

• Evaporation: sweat and respiration

• Conduction: direct contact (ice pack)

Fever

core body temp higher than 100ºF

• immune response to pyrogens (e.g., bacteria)

  • induce secretion of prostaglandins that make a new, higher hypothalamic temp for body’s set point

Hyperpyrexia

REALLY high body temp

• greater than 105.8ºF

Hypothermia

core body temp lower than 95ºF

• associated with expose to cold

Course of Fever

• Initial: Febrile episode

• Second: Course

• Third: Defervescence or crisis

Pulse Rate

measured in bpm (beats per minute)

Normal Adult bpm

60 to 100 bpm

Average is around 70 to 80 bpm

Systole

Contraction of the heart

Diastole

Resting phase of the heart

Stroke Volume

Q# of blood pumped out by each contraction of the L. Ventricle

Cardiac Output

Stroke Volume X Pulse (heart) Rate

What regulates the heart rate?

Automatic Nervous System

What is the most accurate location to obtain a pulse rate?

Apical Surface of the heart

Common Pulse Points

• Radial

• Brachial

• Carotid

• Temporal

• Dorsalis Pedis

• Femoral

• Popliteal

• Apical

When to measure an Apical Pulse?

• Radial pulse is weak or irregular

• Rate is less than 60bpm or greater than 100bpm

• Pt is taking cardiac meds (e.g., digitalis)

• Pt is an infant or child up to age 3 (peripheral pulses may be difficult to palpate)

Pulse Deficit

Heart beat is heard but not felt at the pulse point

Bradycardia

Rate is less than 60bpm

Tachcardia

Pulse is greater than 100 bpm

Pallor

Paleness of skin when compared with another part of the body due to compromised circulation

Cyanosis

Bluish or grayish discoloration of the skin due to excessive CO2 and deficient O2 in the blood due to compromised circulation

2 types of Respiration

Mechanical & Chemical

Mechanical Respiration

• Pulmonary Ventilation (breathing)

  • Active movement of air in and out of the respiratory system

Chemical Respiration

Xchange of O2 & CO2

• Transport of O2 & CO2 throughout the body

• Xchange of gases between capillaries and tissues

Respiration Rate varies by…

Age, Exertion, Emotions, other factors..

What regulates Respiration?

• Level of CO2 in the blood

• Central chemoreceptors (medulla oblongata)

• Peripheral chemoreceptors (blood vessels)

Mechanics of Inspriatrion

• Drawing air into the lungs

• Involves ribs and diaphragm → creation of negative pressure and allowing air to flow into the lungs

Mechanics of Expiration

• Relaxation of thoracic muscles and diaphragm

• Is passive and normally takes 2 to 3 seconds

Factors that Influence Respirations

• Developmental Level

• Exercise

• Pain

• Stress

• Smoking

• Fever

• Hemoglobin

• Disease

• Medication

• Positions

How to Count the Respiration

*You should count the RR after taking the radial pulse

• Pt can alter the rate and patter of respirations

• RR must be accurate, especially in older adults

Variations in Respiration Rates

Apnea: Cessation of breathing

Bradypnea: Abnormally Slow

Tachypnea: Abnormally Fast

Variations in Depth of Respirations

• Deep

• Shallow

• Normal

Variations in Respiration Rhythm

Abnormal

• Cheyne-Stokes

• Biot’s

Variation in Respiration Effort

• Dyspnea: labored breathing

• Orthopnea: inability to breathe when horizontal

Variations in Breath Sounds

• Wheeze

• Rhonchi

• Crackles

• Stridor

• Stertor

Wheeze

High-pitched continuous musical sounds, usually heard on expiration

Rhonchi

Low-pitched continuous sounds caused by secretions in the large airways

Crackles

Discontinuous sounds usually heard on inspiration; may be high-pitched popping sounds or low-pitched bubbling sounds

Stridor

Piercing, high-pitched sound heard primarily during inspirations

Stertor

Labored breathing that produces a snoring sound

Tools to Measure Oxygenation

• Arterial Blood Gases

• Pulse Oximetry

Arterial Blood Gases (ABGs)

Directly measures the partial pressures of O2, CO2, and blood pH

Pulse Oximetry

• Noninvasive methods of monitoring respiratory status

• Uses an external device that measures oxygen saturation

Hyperventilation

Rapid and deep breathing resulting in excess loss of CO2 (hypocapnea)

• patient may complain of feeling light-headed and tingly

Hypoventilation

The rate and depth of respirations are decreased and CO2 is retained

Systolic Pressure

Peak pressure exerted against arterial walls as the ventricles contract and eject blood

Diastolic Pressure

Minimum pressure exerted against arterial walls between cardiac contractions when the heart is at rest

How is BP measured?

• mmHg

• Systolic / Diastolic

What is Pulse Pressure?

Difference between the Systolic and Diastolic Pressures (Sys - Dys)

What influences BP regulation?

1. Cardiac f(x)

2. Peripheral Vascular Resistance

3. Blood Volume

Factors that Influence BP

• Developmental stage

• 5ex

• Family History

• Lifestyle

• Exercise

• Body Position

• Stress

• Pain

• Race

• Obesity

• Diurnal Variations

• Medications

• Diseases

• Genetic Variations

Indirect or Noninvasive Methods of Measuring BP

• most common

• Accurate Estimate of Arterial Blood Pressure obtained by EXTERNAL measuring devices

Direct Methods of Measuring BP

• Only in an In-patient setting

• Catheter is threaded into an artery under sterile conditions

• Attached to tubing that is connected to an electronic monitoring system

• Pressure is constantly displayed as a waveform on the monitor screen

Equipment for Indirect BP measurment

Sphygmomanometer

• vinyl or cloth cuff, pressure bulb with regulating valve, and a manometer

Stethoscope

• used to auscultate the Systolic and Diastolic Pressures

When is hypertension diagnosed?

when BP is persistently higher than normal when taken on two or more occasions

What is considered elevated for Systolic BP? Diastolic BP?

Systolic: 120 to 129 mmHg

Diastolic: ≥80 mmHg

What are the ranges for HTN Stage 1?

Systolic BP: 130-139 mmHg

Diastolic BP: 80-89 mmHg

What are the ranges for HTN Stage 2?

Systolic BP: 140 mmHg or greater

Diastolic BP 90 mmHg or greater

What can HTN lead to?

Heart, renal, cerebral, or respiratory complications

Primary or essential Hypertension

• Diagnosed when there is no known cause for the increase

• accounts for at least 90% of all cases of HTN

• Pts may not know they have HTN

Average Respiratory Rate for a healthy adult

12 to 20 breaths/min