Week 3 Lecture: Vital Signs

Vital Signs

• Temperature

• Pulse

• Respiration

• Blood Pressure

• Pain

• Oxygen Saturation

What is the fifth vital signs?

Pain

When should vital signs be taken?

When the patient is at rest

Temperature Range

36 to 38 degrees celsius(96.8 degrees to 100.4 degrees Fahrenheit)

Normal Pulse

60-100 beats per minute

Normal Respirations

12-20 breaths per minute

Normal BP

• Average: <120/80 mm Hg

• Pulse pressure: 30-50 mm Hg

Which body region regulates the temperature?

Hypothalamus

Primary source of body’s heat

Metabolism

Basal Metabolic Rate

Occurs at rest

Normal heat loss through:

• Radiation

• Conduction

• Convection

• Evaporation

Hyperthermia

Above normal temperature

Hyporthermia

Lower than normal temperature

Pyrexia/Febrile

Fever

Afebrile

Without fever

Fever

Bacteria and viruses trigger immune response

system

– Hypothalamus reacts

– Raises “set point”

How harmful is it?

Most not harmful if below 104° F

Sites for Assessment of Temperature

• Oral

• Axillary

• Tympanic

• Rectal

• Forehead

Pulse

Palpable bounding of blood flow in the

peripheral artery.

Cardiac Output

Volume of blood pumped by the heart each

minute

Cardiac Output Formula

Heart rate x stroke volume = CO

Pulse Rate

Number of beats felt/heard in 1 minute

Heart and stroke volume has what type of relationship?

Inverse(If one goes up, other goes down)

Pulse Rate

Number of beats felt/heard in 1 minute

Sites for Pulse

Temporal

Carotid

Apical

Brachial

Radial

Femoral

Popliteal

Posterior Tibial

Dorsalis Pedis

Trachycardia

Over 60 beats per minute

Brachycardia

Less than 60 beats/minute

Apical pulse

4th or 5th intercostal space, left mid clavicular line

Popliteal pulse

Place stethoscope there for lower extremity BP

Posterior and Tibial Dorsalis Pedis

Most common used for lower extremity pulse

Which sight is the most common site for palpation?

Radial

Which pulse is auscultated with a

stethoscope?

Apical Pulse

When would you use apical pulse other than brachial?

1) Patient has irregular rhythm

2) About to give cardiac medications

3) Patient has history of cardiac disease

Do you use bell or diaphragm for apical pulse?

Diaphragm

Rhythm(regular/irregular)

Dysrhythmia/Arrhythmia

Force/Strength

▪ 0 = absent

▪ 1+ = weak

▪ 2+ = normal

▪ 3+ = strong

▪ 4+ = bounding

Respiration

Controlled by brain stem – medulla oblongata

Respiration is what kind of process?

Passive process

What is the respiration regulated by?

Levels of Carbon Dioxide, Oxygen, and Hydrogen ion concentration (pH) in arterial blood

Should you tell the patient that you’re taking an assessment of respiration?

NO

Respiration Rate

• Bradypnea(low)

• Tachypnea(high)

• Apnea(dyspnea)<—Without/difficult

Rhythm

– regular/irregular pattern

– labored/unlabored

Depth

shallow, normal, deep

Oxygen Saturation

• Measures oxygen concentration in the blood

  • Percent of hemoglobin bound to oxygen in arteries (SaO2)

  • Probe placed on finger or earlobe

Normal Range of Oxygen Saturation

95-100%

Can get false results for oxygen saturation

• Anemia

• Nail polish(or artificial)

• Impeding blood flow(brisk cap refill)

Blood Pressure

Amount of force by blood against the walls of the artery

Systole

Period of heart muscle contraction

Diastole

Period of heart muscle relaxation

Systolic Pressure

Represents the pressure in the arteries during systole

Diastolic Pressure

Represents the pressure in the arteries during diastole

Pulse Pressure

Difference between systolic and diastolic pressure

Noninvasive

Uses a stethoscope and sphygomanometer

Cuff is wrapped around where?

-1 in above antecubital space/elbow

Things to keep in mind with BP?

Extremeities with IV’s, side of a mastectomy, dialysis shunt

What position should the patient be at?

Sitting/lying, forearm at heart level

How high do you inflate the cuff?

30 mmHg above your estimated or expected systolic pressure

How fast do you release the air/lower the gauge?

2 mmHg per second/1 line per second

Risk Factors for Hypertension

• Family History

• Obesity

• Smoking

• Heavy alcohol consumption

• High sodium intake

• Sedentary lifestyle

• Stress

• Diabetes

• Elderly

• African-American

• High cholesterol

Normal Blood Pressure Range

• Systolic: 90-119 mmHg

• Diastolic: 60-79 mmHg

Orthostatic Hypotension

c/o “lightheadedness”, “dizziness,” or fainting spells

Orthostatic Hypotension Risk Factors

– volume depletion

– dehydration

– anemia

– prolonged bedrest

– anti-hypertensive medications

Orthostatic BP must be taken

1. Supine

2. Sitting

3. Standing

Orthostatic Hypertension Numbers

– Sys ↓ >20 mm Hg

– Dias ↓ >10 mm Hg

– HR ↑ 10%

How long to wait in changes of positions when checking for orthostatic hypotension vitals?

1-3 minutes

Pain is what type of data?

Subjective / not objectively measured

Definition of pain

Pain is whatever the experiencing person says it is, existing whenever they say it does

Types of Pain

Acute/Chronic

Pathologic Condition

• Nociceptive pain

• Neuropathic pain

Types of Nociceptive Pain

– Cutaneous

– Somatic

– Visceral

Nocicpetive Pain

From an injury

Neuropathic Pain

Patient is feeling pain through nervous system without any sort of injury

Cutaneous Pain

Papercut, skin injury

Somatic Pain

Deeper tissue injury(muscle, bone)

Visceral Pain

Organs level issue

Idiopathic

Unknown cause

Expression of Pain

Nonverbal behaviors associated with chronic pain

(validate data)

• Bracing

• Rubbing

• Sighing

• Change in appetite

Assessment Questions(PQRST)

• Precipitating cause: What were you doing?

• Quality: Description of pain(in their words, not yours)

• Region/Radiation: Where is the pain? Does it spread?

• Severity: 0-10 scale

• Timing: Start? Constant/Intermittent?

Non-Pharmacological Pain Relief

• Relaxation, Guided Imagery

• Pleasurable stimuli release endorphins

• Biofeedback

• Distraction

• Cutaneous Stimulation

Pharmacological Pain Relief

• Analgesics (Three types)

  • NSAIDs and Non-Opioids

  • Opioids

  • Adjuvants

Things to Note about Pain Medication

• Know the route that you are administering

  • When is it effective

  • Full effect

• Common side effect of opiates

  • Respiratory Depression

  • Drowsiness

  • Constipation

NSAIDs & Non-Opioids

• Mild to Moderate pain

• Inhibit the synthesis of prostaglandins and cellular response to inflammation

• No CNS depression

• Safe for short periods of time

  • Can cause GI Bleed (NSAIDs – careful with ulcers)

  • Liver Toxicity (acetaminophen – 4 grams/day)

Common NSAID’s and Non-Opioids

• Ibuprofen

• Naproxen

• Diclofenac

• Aspirin

• Acetaminophen

Opioids

• Moderate to severe pain

• Act on centers of brain and spinal cord

  • Bind with opiate receptors to modify perception of pain

• May cause respiratory depression

• Sedation always occurs

• Opioid antagonist (naloxone)

List of Opioids

• Oxycodone

• Codeine

• Hydrocodone

• Fentanyl

• Morphine

Adjuvant Drugs

Assist primary drugs in relieving neuropathic pain

• Antidepressants

• Anticonvulsants

• Corticosteroids

Examples of Adjuvant Drugs

• Amitriptyline

• Gabapentin

• Dexamethasone

• Prednisone

How does The Joint Commission recommend identifying each client?

• Name

• Date of Birth

• ID Number

• Phone Number

• Photo ID

• Bar-Code