Chapter 16: Vital Signs

Vital signs

Various determinations that provide information about basic body conditions of a patient

• Temperature, pulse, blood, pressure, respiration rate, pain

• Other: color of skin, pupil size, reaction to light, level of consciousness, response to stimuli (reflex)

Temperature

Measurement of the balance between heat lost and heat produced by the body

• Temperature can be measured

• Oral, rectal, axillary, aural, and temporal

Oral temperatures

Temperature taken in your mouth

• Most common and convenient

• Eating/drinking hot/cold liquids and smoking can alter temperature

Rectal temperature

Temperature taking in the rectum

• Internal measurement

• Most accurate

• Used on infants, small children, and patients with hypothermia

Axillary temperature

Temperature taken in the armpit

• External temperature

• Least accurate

Aural temperatures

Temperature taken with special tympanic thermometer placed in ear canal

• Measures infrared energy radiating from blood vessels

• Provides core temperature reading

• Can be as accurate as rectal reading

• Inaccurate reading if not used correctly

Temporal temperatures

Temperature taken with special temporal thermometer across forehead

• Measures temperature in temporal artery

Temperature range

• Normal range for body temperature: 97^o F - 99^oF (36^oC - 37^oC)

• Variations:

  • Individual differences - peoples accelerated body processes have higher temperature, slower body processes have lower temperature

  • Time of day - temperature lower in morning (after resting) and higher in evening (muscular activity and food intake)

  • Body sites - parts of the body where temperature is taken

Average and normal range

Oral

• Average: 98.6^oF

• Normal range: 97.6^oF - 99.6^oF

Rectal and Temporal

• Average: 99.6^oF

• Normal range: 98.6^oF - 100.6^oF

Axillary

• Average: 97.6^oF

• Normal range: 96.6^oF - 98.6^oF

What can increase a temperature?

• Illness

• Infection

• Exercise

• Excitement

• Temperature of environment

What can decrease a temperature?

• Starvation

• Fasting

• Sleep

• Decreased muscle activity

• Temperature of environment

Conditions that increase/decrease temperature

• Fever

• Hypothermia

• Hyperthermia

Fever

Elevated body temperature, usually above 100^oF

• Symptoms - caused by infection or injury

• Additional symptoms:

  • Sweating, chills, shivering, headache, muscle aches, loss of appetite, dehydration, general weakness

Hypothermia

Low body temperature, below 95^oF

• Prolonged exposure to cold

• Death occurs below 93^oF (death in as little as one hour)

• Additional symptoms:

  • Shivering, exhaustion, confusion, slurred speech, memory loss, bright red skin, drowsiness

Hyperthermia

Body temperature above 104^oF

• Overexertion in heat or indication of serious infection or brain damage

• Immediate action required

• 106^oF (hyperpyrexia) can cause brain damage, convulsions, and death

• Additional symptoms:

  • Fast or weak pulse, dizziness, reduced sweating, confusion, hot or cold skin, nausea, headache, fainting

Electronic thermometers

Uses heat sensor to record temperature and displays in electronic viewers

• Most common in health care facilities

• Can be used to take oral, rectal, or axillary temperature

• Disposable protective covers used

• Can be used on many patients

• Temperature always recorded to nearest two tenths of a degree

• Indicate where on body temperature was recorded

  • Rectal (R)

  • Axillary (Ax)

  • Aural (A)

  • Temporal (TA)

  • Oral (nothing)

Pulse

Pressure of blood felt against the wall of an artery as the heart contracts and relaxes (or beats)

• Throbbing of arteries caused by hear contractions

• Most easily felt in arteries close to the skin

• Major pulse sites:

  1. Temporal - either side of forehead

  2. Carotid - at the neck on either side of trachea

  3. Brachial - inner aspect of forearm in crease of elbow

  4. Radial - inner aspect of wrist above thumb

  5. Femoral - inner aspect of upper thigh where thigh joints body trunk

  6. Popliteal - behind the knee

  7. Dorsalis pedis - top of foot arch

  8. Posterior tibial - just below and behind bony part of ankle on inner side of leg

Three different factors when measuring pulse

1. Rate

2. Rhythm

3. Volume

Rate

Number of beats per minute

• Varies among individuals (gender, age, body size):

  • Adults: 60-100 bpm

  • Adult men: 60-70 bpm

  • Adult women: 65-80 bpm

  • Children over 7 years: 70-100 bpm

  • Children age 1-7 years: 80-110 bpm

  • Infants: 100-160 bpm

• Conditions affecting pulse

  • Bradycardia: a pulse rate under 60 bpm

    • Can be due to electrical issues in the hear, metabolic problems, medications, or heart disease

  • Tachycardia: a pulse rate over 100 bpm (except in children)

    • Can be due to fever, stress, medications, metabolic problems, or heart

Rhythm

Regularity of pulse, spacing of beats

• Described as regular or irregular

• Arrhythmia: irregular or abnormal rhythm usually caused by a defect in the electrical conduction pattern of the heart

Volume

Strength, force, intensity, or equality of pulse

• Described as strong, bounding, weak, thready

• Conditions affecting volume:

  • Increased volume from exercise, medication, fever, dehydration, shock, tension

• Decreased volume from sleep, depressant drugs, heart disease, coma, physical training

Apical pulse

Pulse taken with stethoscope at apex of heart

1. Actual heartbeat is heard and counted

2. Used when arteries are weak, rapid pulse, hardening of arteries, doctor’s orders, or on infants (due to rapid radial pulse)

Pulse deficit

Heart does not pump enought blood to produce on beat, indicates issues with hear function or efficiency

1. To determine if pulse deficit exists:

   • Apical pulse and one additional pulse location used (usually radial)

   • Subtract radial pulse from apical pulse = pulse deficit

   • Ex: apical is 130 and radial is 92

   • Pulse deficit = 38

Respirations

Process of taking in oxygen and expelling carbon dioxide from respiratory system

• One respiration = one inspiration (breathing in) and one expiration (breathing out)

Three different factors noted when measuring pulse

1. Rate - number of respirations per minute

   • Varies among individuals

     • Adults: 12-20 breaths per minute

     • Children: 16-30 breaths per minute

     • Infants: 30-50 breaths per minutes

2. Character - depth and quality of respirations

   • Described as deep, shallow, labored/difficult, and strenuous

3. Rhythm - regularity and spacing of respirations

   • Described as regular or irregular

Dyspnea

Difficult or labored breathing

• Asthma, heart failure, COPD, lung disease, anxiety, etc.

Apnea

Absence of respirations, usually a temporary period of no respirations

Tachypnea

Rapid, shallow respiratory rate above 25 respirations per minute

• Obstructions, asthma, anxiety, heart failure, allergic reactions, CO₂ poisoning, pneumonia, pulmonary embolism, etc.

Bradypnea

Slow respiratory rate, usually below 10 respirations

• High blood pressure, heart attack, electrolyte imbalance, inflammation, medications, etc.

Orthopnea

Severe dyspnea in which breathing is very difficult in any position other than standing or sitting erect

• Heart failure, pulmonary embolism, asthma, chronic bronchitis

Cheyne-Stokes

Abnormal breathing pattern characterized by periods of dyspnea by periods of apnea

• Common in dying patients

Rales

Bubbling, crackling, noisy breathing cause by fluid or mucus in air passages

Wheezing

Difficulty breathing with high-pitched whistling or sighing during exasperation, caused by narrow bronchioles

Cyanosis

Bluish discoloration of skin, lips, and/or nail beds as a result of decreased oxygen and increased CO₂ in the blood

Blood pressure

Measurement of the pressure that the blood experts on the walls of arteries during various stages of heart activity

• Measured with instrument called sphygmomanometer

• Measure in mmHg (millimeters of mercury)

• Two blood pressure measurement

  • Systolic pressure

  • Diastolic pressure

• Written as a fraction: systolic/diastolic

Systolic pressure

Pressure in the walls of arteries when the heart contracts

Diastolic pressure

Pressure in the walls of the arteries when the heart is relaxed, between contractions

Classifications of blood pressure in adults

Normal

• Systolic - 100-120

• Diastolic - 60-80

Prehypertension

• Systolic - 120-139

• Diastolic - 80-89

Hypertension stage 1

• Systolic - 140-159

• Diastolic - 90-99

Hypertension stage 2

• Systolic - >160

• Diastolic - >100

Hypertension

High blood pressure

• Can lead to stoke, kidney disease, and heart disease

Hypotension

Low blood pressure

• Less than 90 mmHg systolic and 60 mmHg diastolic