Vital Signs (9/13/23 & 9/18/2023)

What is another term for vital signs?

What is another term for vital signs?

cardinal signs

Why do we take vital signs?

to establish a baseline; to reveal first clue of adverse reactions to treatments/procedures

What are vital signs?

signs that indicate a person’s homeostasis

Define homeostasis

constancy in the internal environment of the body, naturally maintained by adaptive responses that promote healthy survival

What are the 6 vital signs we measure?

1. Temperature (T)

2. Respiration (R)

3. Pulse Oxygen (SpO2)

4. Pulse (P)

5. Blood Pressure (BP)

6. Pain

Define body temperature

the degree of heat of the deep tissues of the human body

Define thermo-regulation

the body’s maintenance of heat production and loss

Thermo-regulation is regulated by the ___

hypothalamus

How does the hypothalamus regulate thermo-regulation?

• initiates peripheral vasodilation and sweating (diaphoresis) to dissipate body heat

• initiates shivering to generate heat and vasoconstriction to conserve heat

What are the 5 common ways to take body temperature?

1. oral

2. axillary

3. tympanic

4. temporal

5. rectal

How is oral temperature obtained? Describe the thermometer used

obtained by placing a thermometer under the patient’s tongue; thermometer has a slender, pointed tip

How is axillary temperature obtained? When is it used?

obtained by placing thermometer high between upper arm and torso; primarily used on infants and children

How is tympanic temperature obtained? When is it used?

obtained by placing a tympanic membrane thermometer in the ear; used in infants and adults when oral temperatures are not achievable

How is temporal temperature obtained?

obtained by the temporal artery (TA; lies superficial in the temporal region of the skull)

How is rectal temperature obtained? Describe the thermometer used

obtained by placing the tip of the thermometer in the rectum; tip of thermometer is more rounded

What is the most accurate reflection of core body temp?

rectal temperature

What is the normal temperature range for a healthy person?

96.8^o-99.8^o F (36^o-38^o C)

Define hyperthermia (febrile or pyrexia)

the condition of having a body temperature greatly above normal

What are some symptoms of hyperthermia?

increased metabolism, increased pulse, increased respiration, achy, flushed/dry skin, chills, loss of appetite, dizziness, comatose

Define hypothermia

a medical emergency that occurs when body loses heat faster than it can produce heat, causing a dangerously low body temperature

What are some symptoms of hypothermia?

shivering, slurred speech/mumbling, shallow breathing, weak pulse, clumsiness, drowsiness, confusion/memory loss, loss of consciousness, red/cold skin (in infants), decreased body temp

Temperatures outside of the normal range may be a result of ___

disease, infection, exercise, prolonged exposure to heat/cold, hormonal changes

What is the respiratory system responsible for?

delivering oxygen from the environment to the tissues and eliminating carbon dioxide from the tissues to the environment

Define respiration

the exchange of carbon dioxide and oxygen between the alveoli and red blood cells in the lungs

What determines tidal volume?

the depth of breath

Define tidal volume

the volume of air inhaled and exhaled during one respiratory cycle

What is the major muscle of ventilation?

the diaphragm

On inspiration, the diaphragm ___

contracts (moves downward in the abdominal cavity)

How are respirations counted?

by observing the movement of the abdomen or the rise (inspiration) and fall (expiration) of the chest

How long should you count respirations for?

a minimum of 1 minute

A measurement of respiratory rate includes observing and recording ___

1. rate (breaths per minute)

2. depth (shallow, normal, deep)

3. rhythm (regular or irregular)

What is the normal respiratory rate for adults?

12-20 breaths/min

What is the normal respiratory rate for children?

20-30 breaths/min

Define tachypnea

rapid breathing (>20 breaths per minute)

What are some signs of tachypnea?

panting, lightheadedness, chest pain, rapid breathing, fever

What are some causes of tachypnea?

exercise, anxiety, infection, chest trauma, CNS disease, fever, pain, heart failure

Define bradypnea

slow or decreased respiratory rate (<12 breaths per minute)

Is tachypnea or bradypnea more common?

tachypnea

What are some signs of bradypnea?

cyanosis, restlessness, apprehension, altered level of awareness

What are some causes of bradypnea?

drug OD, hypothermia, injury

Define dyspnea

difficulty breathing

Define orthopnea

difficulty breathing unless sitting or standing

Define apnea

absence of spontaneous ventilation

Define pulse

the regular expansion of an artery caused by the ejection of blood into the arterial system by the contractions of the heart

Measurement of the pulse includes recording the ___

• rate in beats per minute (fast or slow)

• strength (shallow, normal, deep)

• regularity (regular or irregular)

What are the three most common pulse sites, and which among them is the most common?

radial artery (MOST COMMON), brachial artery, and carotid artery

What are some less common, but still recognized, pulse sites?

femoral, popliteal, and apical

What is the most common pulse site during CPR?

carotid artery

What type of blood vessel is best for finding pulse?

superficial arteries

What is the normal pulse range for adults?

60-100 beats/minute

What is the normal pulse range for children?

70-120 beats/minute

Define tachycardia

rapid pulse/heart rate (>100 BPM)

What are some causes of tachycardia?

exercise, anemia, CHF, shock/pain, anger, anxiety/fear, fever, respiratory disorders, hypoxemia, medications

What are some symptoms of tachycardia?

SOB, lightheadedness, rapid pulse rate, heart palpitations, chest pain, fainting/syncope

Define bradycardia

slow pulse/heart rate (<60 BPM)

What are some causes of bradycardia?

heart tissue damage, pain, physical fitness, hypothermia, infection of the heart, hypothyroidism, sleep apnea, inflammatory disease, medications

What are some symptoms of bradycardia?

fainting, dizziness, fatigue, SOB, chest pains, confusion, memory problems, easily tiring

What is a pulse oximeter?

a noninvasive device used to provide ongoing assessment of the hemoglobin oxygen saturation of arterial blood

What is normal pulse oxygen on a healthy person?

95-100%

Define blood pressure

a measure of the force exerted by blood on the arterial walls during contraction and relaxation of the heart

How is blood pressure measured?

with systolic measurement over diastolic measurement (measured in mmHg)

Define systolic

contraction of the left ventricle

Define diastolic

relaxation of the heart

What are the steps for taking blood pressure?

1. wrap cuff around upper left arm

2. lightly press stethoscope over brachial artery

3. rapidly inflate cuff to 180mmHg

4. release air at 3mm/sec

5. listen with stethoscope and observe sphygmomanometer

6. the first knocking sound (Korotkoff) is the systolic pressure

7. disappearance of knocking sound is diastolic pressure

What is the most common use of the stethoscope?

hearing lung sounds

What is a normal systolic blood pressure?

What is a normal diastolic blood pressure?

Systolic: <120mmHg

Diastolic: <80 mmHg

Define prehypertension

consistent systolic pressure of 120-139 mmHg and diastolic pressure of 80-89 mmHg

Define hypertension

persistent elevation of blood pressure above 140/90 (may be asymptomatic, but can cause damage to the brain in minutes; also effects heart, kidneys, lungs, etc.)

Define hypotension

blood pressure less than 95/60

What are some symptoms of hypotension?

dizziness, confusion, blurred vision

What are some causes of hypotension?

shock, severe bleeding, burns, vomiting, diarrhea, trauma, heat exhaustion (all of which cause loss in total blood volume)

Define orthostatic hypotension

a condition in which blood pressure drops suddenly when standing up from a seated or lying position

How long can you go without oxygen before irreversible brain damage happens?

6 minutes

What percent of atmospheric gases is oxygen?

21%

Explain the flammability of oxygen

oxygen IS NOT flammable, but it does support combustion

When is it okay for a rad tech to remove an oxygen device from a patient?

ONLY when granted permission from physician or nurse

Define hypoxemia

decreased oxygen tension (concentration) in the blood

concentration much less than 21%

Hypoxemia can lead to ___

hypoxia

What are some causes of hypoxemia?

• high altitudes

• sleep apnea

• kyphosis

• lung disease

• heart problems

• anemia

• medications

What are some symptoms of hypoxemia?

• confusion

• cough

• fast heart rate

• rapid breathing

• shortness of breath

• slow heart rate

• sweating

• wheezing

Define hypoxia

a state of oxygen deficiency at the tissue (cellular) level that increases heart rate, blood pressure, and respiratory rate

What are the 4 tissues most sensitive to hypoxia?

heart, lungs, brain, liver

What part of the wall oxygen supply needs to be replaced after each patient (per OSHA)?

the Christmas tree

Describe low flow oxygen delivery devices

• allows for some room air

• device doesn’t meet the entire inspiratory needs of the patient

• unknown amount of room air is entrained through the mouth/nose

Explain nasal cannula

• low flow system

• flow rates of 0.25-8 LPM

A flow rate over ___ LPM can dry out nose and potentially cause problems such as nose bleeds

6

Explain the simple face mask

• low flow system

• short term use

• flow rates (5-10 LPM)

• potential to not fit the patient

• aspiration risk if patient vomits

Explain the non-rebreathing mask

• low flow system

• one way valve to prevent exhaled air from being rebreathed

• flow rate of at least 10 LPM

Explain the aerosol mask

• low flow system

• flow rate of at least 8 LPM

• sterile water or saline added to air flow path to increase humidification

Describe high flow oxygen delivery devices

• delivers accurate concentration of oxygen

• function on an air entrainment principle

Explain the air-entrainment mask

• high flow system

• propels high velocity of air through a narrow opening into mask

• ~10-15 LPM

Explain the oxygen tent

• high flow system

• good for pediatric patients who need oxygen therapy and additional humidity

• 12-15 LPM

Explain the oxyhood

• high flow system

• good for infants who need oxygen therapy and additional humidity

• less than 7 LPM

Explain the ventilator

• mechanical device that “breathes” for the patient

• delivers a minimum set respiratory rate or oxygen percentage

Explain endotracheal (ET) tubes (ETT)

• used to manage a variety of respiratory complications

• intubation

  • translaryngeal approach via mouth or nose

  • tracheostomy

What are some indications/reasons an ETT would be placed?

• need for mechanical ventilation

• upper airway obstruction

• impending gastric reflux or aspiration

• provisions for tracheobronchial lavage

How can you tell if an ETT is placed properly in a radiograph?

distal tip is 1-2 inches superior to tracheal bifurcation/carina (BUT YOU DO NOT HAVE THE AUTHORITY TO SAY WHETHER OR NOT IT IS PLACED CORRECTLY)

Describe thoracotomy tubes

• commonly called chest tubes

• used to drain the intrapleural space and the mediastinum

• fluid or air accumulation in either space may be life threatening

What are some indications/reasons a thoracotomy tube would be placed?

• pneumothorax

  • collapsed lung

• hemothorax

  • blood in the pleural cavity

• pleural effusion

  • fluid in the pleural cavity

• empyema

  • pus in the pleural cavity caused by bacteria

• atelectasis

  • partial or full lung collapse

What are the three components of thoracotomy tubes and their functions?

1. collection chamber (collects fluid leaving lung)

2. water seal chamber (contains water and prevents room air entering tube)

3. suction control chamber (contains water and controls suction)