Vital Signs

Homeostasis

• Definition:
    - Process by which the body maintains a stable internal environment.

The Hypothalamus

• Location:
    - Situated in the brain, just above the brain stem.

• Function:
    - Regulates key physiological processes to maintain homeostasis, including:
      - Body temperature
      - Hunger
      - Thirst
      - Blood pressure (BP)
      - Heart rate (HR)

Temperature Regulation

• Normal Internal Core Temperature:
    - 98.6°F

• Response to Elevated Body Temperature:
    - Body cools itself by sweating.

• Response to Decreased Body Temperature:
    - Body warms itself by shivering.

• Mechanism:
    - Signals are sent from the hypothalamus to regulate body temperature, maintaining homeostasis at approximately 98.6°F.

Feedback Mechanisms

• Negative Feedback Mechanisms:
    - Function to reduce the output or activity of a system to return to its set point.
    - Example: cooling off through sweating initiated by temperature change.

• Positive Feedback Mechanisms:
    - Definition:
      - Intensifies changes occurring away from a normal state until the stimulus is removed.
    - Example: Childbirth
      - Estrogen sensitizes the uterus to oxytocin.
      - Oxytocin, released from the fetus and pituitary gland, stimulates contractions.
      - Prostaglandins are released, further stimulating contractions.
    - Other examples:
      - Hunger
      - Food digestion
      - Blood clotting
    - Key Characteristics:
      - Causes greater changes in the body, resulting in a stronger response.

Methods for Body Cooling

• Sweating:
    - Evaporative cooling mechanism.

• Dermal Blood Vessel Dilation:
    - Increases blood flow to the skin surface, facilitating heat loss.

Methods for Body Warming

• Internal Heat Production (Thermogenesis):
    - Result of metabolism and muscle contraction.
      - Includes processes stimulated by the endocrine system that activate the hypothalamus.

• Shivering:
    - Involuntary contractions of skeletal muscles generate heat.
    - Causes dermal blood vessels to constrict, reducing heat loss.

Mechanisms of Heat Loss

Laws of Thermodynamics:

• General Principle:
    - A body warmer than its surroundings will lose heat until thermal equilibrium is reached.

Modes of Heat Transfer:

• Conduction:
    - Definition: Transfer of heat through direct contact between objects.
    - Example: Melting an ice cube in the hand due to heat transfer from the hand.

• Convection:
    - Definition: Transport of energy by the motion of heated matter.
    - Example: Heated air rising from a space heater, creating a convection current.

• Radiation:
    - Definition: Loss of heat to the environment due to a temperature gradient.
    - Continuous process where the body radiates heat.
    - Wearing heavy clothing can trap heat, which is undesirable in hot environments.

• Evaporation:
    - Process of converting liquid water into vapor (e.g., sweating).

ature and Its Implications

• Normal Body Temperature: Standard body temperature is generally accepted as 98.6ºF, though it can vary from person to person.

• Fever as an Indicator of Infection:
    - A body temperature above 99ºF could indicate an infection.

• Hyperthermia:
    - Definition: Hyperthermia is defined as an excessive increase in body temperature.
    - Critical Range: Body temperature may exceed 105ºF in cases of hyperthermia.
    - Life Threat: Hyperthermia can pose a life-threatening situation if not promptly treated.

• Hypothermia:
    - Definition: Hypothermia occurs when the core body temperature falls below 95ºF.
    - Life Threat: Similar to hyperthermia, hypothermia is also a potentially life-threatening condition if untreated.

Measurement Methods for Body Temperature

• Thermometers:
    - It's crucial that thermometers designed for rectal use are marked in red; these should not be utilized for any other measurement routes.

Routes of Temperature Measurement:

• Least Accurate Routes:
    - Axillary (Arm Pits): Generally considered the least accurate method for measuring body temperature.
    - Forehead Thermometers: Made from thin pieces of plastic, these are also less reliable.
    - Aural (Ear): Temperature readings from the ear may vary in accuracy.

• Most Accurate Routes:
    - Rectal Temperature: The most accurate way to measure body temperature.
    - Oral Temperature: Measured via non-disposable glass or electronic thermometers.
    - Temporal Artery Thermometers: These devices scan the forehead for infrared heat reading and provide reasonable accuracy.
    - Disposable Oral Thermometers: Thin, flat pieces of plastic that can accurately measure oral temperature.

Guidelines for Checking Oral and Rectal Temperatures

• Before Checking Oral Temperature:
    - Ask the patient: “Have you had anything to eat or drink, or did you smoke or chew gum in the past 15 minutes?”
    - If the patient responds “Yes,” it is necessary to wait 20 minutes before taking the oral temperature to ensure accuracy.

• Checking Rectal Temperature:
    - Preparations:
      - Always wear gloves.
      - Use the designated rectal thermometer.
    - Procedure:
      - Position the patient correctly.
      - Hold the thermometer in place with one hand.
      - Use the other hand to stabilize the patient to prevent movement.
    - Post-Measurement:
      - Record the temperature findings.
      - Report any unusual findings to your supervisor for further action.

BBREVIATIONS

• VS: Vital Signs

• BP: Blood Pressure

• TPR: Temperature, Pulse, Respiration

• (R): Rectal Temperature

• (Ax): Axillary Temperature

• (O): Oral Temperature

• (TAT) or (TEMP): Temporal Artery Temperature

• (T): Tympanic Temperature

• bpm: Beats per minute

• P: Pulse

• HR: Heart Rate

• RR: Respiratory Rate

• Hx: History

• Dx: Diagnosis

SIGNS VS SYMPTOMS

• Symptoms: Subjective experiences only felt by the patient, not directly observable or measurable by healthcare professionals. Examples include:
    - Pain
    - Nausea
    - Dizziness

• Signs: Objective facts that can be observed, measured, or tested. Examples include:
    - Blood pressure
    - Temperature
    - CT scan results
    - Skin appearance

HISTORY & PHYSICAL EXAMINATION (H&P)

• Essential components when entering a patient's room:
    - Date: Record date of examination.
    - Demographics: Patient’s demographic information (age, gender, etc.)
    - Source of Referral: How the patient was referred to the care facility.
    - Chief Complaint(s): Primary issues expressed by the patient.
    - History of Present Illness: Details regarding the current health issue.
    - Past History: Medical history prior to current illness.

BASELINE ASSESSMENT

• Post-information collection, a baseline of the patient's health is established. Components include:
    - Current Health Status: Patient's ongoing health conditions.
    - Family History of Illness: Relevant medical history of family members.
    - Psychosocial History: Patient's social and psychological factors.
    - Review of All Systems: Systematic evaluation of body systems to identify potential issues.

REVIEW OF SYSTEMS (ROS)

• Purpose: Update medical records regarding a patient's general medical health.
    - For new patients, established patients with new problems, or those not seen for an extended period.
    - Procedures:
      - If no difficulties exist, check "No Problems."
      - Circle symptoms that apply or explain others not listed.
      - Encourage questions from patients.

• General Health: No problems indicate general well-being and lack of significant symptoms (e.g., lack of energy, unexplained weight changes, fever, etc.).

• Ears, Nose, Mouth & Throat: Assessing difficulties in hearing, sinus issues, and throat pain.

• Cardiovascular (C-V): Irregular heartbeat, chest pains, and leg swelling.

• Respiratory (Resp.): Signs of shortness of breath, cough, and previous lung conditions.

• Gastrointestinal (GI): Issues like heartburn, abdominal pain, and changes in bowel habits.

• Genitourinary (GU): Problems related to urination and reproductive health.

• Musculoskeletal (MS): Joint and muscle pain, swelling, and deformities.

• Integumentary (Integ.): Skin-related issues like rashes or changes in lesions.

• Neurological: Symptoms like headaches or dizziness.

• Psychiatric: Mental health issues like insomnia or mood swings.

• Endocrinologic: Hormonal symptoms including heat/cold intolerance.

• Hematologic: Issues with bleeding or bruising easily.

• Allergic/Immunologic: Seasonal allergies or frequent infections.

GENERAL SURVEY

• Purpose: Observe patient holistically, using overall impressions to inform focus area if time is limited.

• Observational Focus:
    - Posture: Body positioning and alignment.
    - Body Proportion and Size: Assessing general physical build and proportion.
    - Skin Color: Noting any abnormalities or changes in skin tone.
    - Odors: Detect any unusual body or breath smells.
    - Character of Speech: Clarity and coherence of patient communication.
    - Vital Signs: Recording basic physiological measurements (temperature, pulse, etc.).
    - Level of Consciousness: Assessing alertness and responsiveness of the patient.

PSYCHOSOCIAL OBSERVATIONS

• Part of the general survey, including:
    - Emotional Status: The patient’s emotional well-being.
    - Mental Status: Cognitive awareness and orientation.
    - Appearance: Physical representation regarding hygiene and grooming.

PHYSICAL ASSESSMENT SKILLS

• Techniques for Assessment are:
    - Inspection: Visual examination of the patient.
    - Auscultation: Listening to internal body sounds.
    - Palpation: Feeling body parts for abnormalities.
    - Percussion: Tapping on body surfaces for diagnosis.

SYSTEM ASSESSMENT

• Systems evaluated during assessment include:
    - Musculoskeletal
    - Integumentary
    - Circulatory/Respiratory
    - Digestive
    - Urinary
    - Eyes/Ears
    - Nervous
    - Endocrine
    - Reproductive

PAIN EVALUATION

• Originates from subjective information provided by the patient.

• Utilization of pain rating scale from 0 to 10, where:
    - 0: No pain
    - 10: Worst pain imaginable

• Other scales used include Wong-Baker FACES Pain Rating Scale and Oucher Scale.

• Comparing pain levels before and after administering medication is crucial.

• Nonverbal cues should also be documented as they can indicate pain levels.

ACTIVITIES OF DAILY LIVING (ADL) EVALUATION

• Defines actions regularly performed to meet individual physical needs, including:
    - Examples: Bathing, eating, shopping, dressing.

• Inability to perform ADLs indicates need for assistance.

HOMEOSTASIS

• Defined as a state of balance within the human body.

• Regulated by cardinal vital signs:
    - Temperature
    - Pulse
    - Respiration
    - Blood Pressure

TEMPERATURE

• Measurement of body heat, regulated by the balance of heat produced and lost:
    - HEAT PRODUCED:
      - Muscle activity
      - Glandular activity
      - Oxidation of food
    - HEAT LOST:
      - Perspiration
      - Respiration
      - Excretion

• Regulation: Managed by the hypothalamus, which maintains body temperature through input from thermoreceptors.

TEMPERATURE MEASUREMENTS

• Can be taken from various locations, including:
    - Temporal: Across the forehead
    - Tympanic: Taken in the ear
    - Oral: In the mouth
    - Rectal: In the rectum
    - Axillary: Under the armpit

NORMAL TEMPERATURE

• Normal Body Temperature Range: 97.0 °F - 99.0 °F

• Definitions:
    - Febrile: Elevated temperature
    - Pyrexia: Above-normal temperature (fever)
    - Hyperthermia: Uncontrolled high temperature
    - Hypothermia: Below-normal temperature

• Average vs. Normal: Average temperature differs from normal range.
    - Average Temperature in Various Locations:
      - Oral: 98.6 °F (Normal Range: 97.6 °F - 99.6 °F)
      - Rectal: 99.6 °F (Normal Range: 98.6 °F - 100.6 °F)
      - Axillary: 97.6 °F (Normal Range: 96.6 °F - 98.6 °F)
      - Aural/Tympanic: Similar to Rectal
      - Temporal: Similar to Rectal

IMPORTANCE OF FEVER

• Fever plays a crucial role in the body's defense against infections; it raises the body temperature above what bacteria and viruses require for optimal reproduction.

• Additionally, fever activates the immune system to produce more white blood cells and antibodies.

PULSE

• Definition: An indication of the effectiveness of blood circulation within the body.

• Described as the pressure of blood pushing against the artery walls during heart contractions and relaxation.

PULSE CHARACTERISTICS

• Rate: Number of beats per minute (BPM).
    - Normal Pulse Rates by Age:
      - Before Birth: 140-150 BPM
      - At Birth: 90-160 BPM
      - First Year of Life: 115-130 BPM
      - Childhood Years: 80-115 BPM
      - Adult: 60-80 BPM
    - Conditions:
      - Tachycardia: Pulse rate over 100 BPM in adults
      - Bradycardia: Pulse rate under 60 BPM in adults

RHYTHM OF PULSE

• Refers to the regularity of heartbeats:
    - Arrhythmia: An irregular pulse rate often caused by uneven intervals between beats.

PULSE VOLUME

• The strength or pressure felt during each heartbeat:
    - Volume Characteristics:
      - PULSE VOLUME SCALE:
         - 0: Absent, not palpable
         - 1: Diminished, thready, weak
         - 2: Expected, easy to palpate
         - 3: Full, increased
         - 4: Bounding, strong

PULSE SITES

• Locations on the body where arteries are sufficiently accessed to feel a pulse:
    - Common Sites:
      - Carotid
      - Apical
      - Brachial
      - Radial
      - Femoral
      - Dorsalis Pedis
      - Posterior Tibial
      - Temporal

• An apical pulse should be taken for at least 60 seconds.

COUNTING A PULSE

• To convert seconds to beats per minute:
    - 1 Minute = Count total number of beats.
    - 30 Seconds = Multiply by 2 to obtain beats per minute.
    - 10 Seconds = Multiply by 6 to obtain beats per minute.

RESPIRATION

• Defined as the process of taking oxygen into the body and expelling carbon dioxide.

• One inspiration (breath in) and one expiration (breath out) counts as one respiration.

COUNTING RESPIRATIONS

• Should be done discreetly, without the patient being aware of the count to avoid alteration in breathing patterns. Recommended to be taken after counting pulse.

RESPIRATION CHARACTERISTICS

• Rate: Number of respirations per minute.

• Rhythm: Regularity or irregularity of breathing cycles.

• Quality: The amount of air exchanged and the effort required to breathe.

NORMAL RESPIRATION RATES

• Normal Rates for Adults: 12 - 20 breaths/minute

• Infants: 30 - 50 breaths/minute

• Children: 16 - 25 breaths/minute

RESPIRATION TERMINOLOGY

• dyspnea: Shortness of breath

• tachypnea: Abnormally fast breathing

• apnea: Absence of breathing

• Cheyne-Stokes: A pattern of breathing characterized by labored breathing followed by periods of apnea

• Rales: Bubbling or rattling sounds in the lungs,

TEMPERATURE, PULSE, AND RESPIRATION (TPR) DOCUMENTATION

• When documenting vital signs, write results in order (Temperature, Pulse, Respiration):
    - Example: 100.6 °F (oral), 78 BPM, 16 breaths/min

BLOOD PRESSURE

• Defined as the force of blood against the walls of blood vessels, divided into two measurements:
    - Systolic: The greatest pressure when the heart is contracting.
    - Diastolic: The least pressure when the heart is at rest.

BLOOD PRESSURE NORMS

• Definitions and conditions:
    - Hypotension: Low blood pressure
    - Hypertension: High blood pressure

• Blood Pressure Categories:
    - Systolic (mmHg):
      - Normal: Less than 120
      - Elevated: 120-129
      - Hypertension Stage 1: 130-139
      - Hypertension Stage 2: 140 or higher
    - Diastolic (mmHg):
      - Normal: Less than 80
      - Hypertension Stage 1: 80-89
      - Hypertension Stage 2: 90 or higher
      - Hypertensive Crisis: Higher than 120

BLOOD PRESSURE EQUIPMENT

• Sphygmomanometer: Measures blood pressure; components include:
    - Cuff: Inflates around the arm to create pressure.
    - Gauge: Displays the pressure measurement.
    - Bulb: Used to inflate the cuff.
    - Dial: Is turned clockwise to allow inflation and counter-clockwise for deflation, air pressure valv

• Stethoscope: Used for auscultation to listen to internal sounds; consists of ear tips, bell, and diaphragm.

MEASURING BLOOD PRESSURE

• Systolic BP: Determined at the first sound of heartbeat detected after occluding the artery.

• Diastolic BP: Checked once the sound ceases while the artery is still released.

FACTORS AFFECTING BLOOD PRESSURE

• Potential Influencing Factors:
    - Increase: Stress, stimulant medications, exercise.
    - Decrease: Hemorrhage, depressant medications, shock.

BASIC MEDICAL TERMINOLOGY: VITAL SIGNS (Pre-med) – Part 5

Overview of Vital Signs

• Vital signs include temperature, pulse, respiration, and blood pressure (TPR & BP).

• Vital signs provide essential information about the body's fundamental functions.

• They are critical for monitoring and diagnosing medical conditions.

TEMPERATURE

Normal Body Temperature

• Normal body temperature ranges from 97ºF to 99ºF.

• Individual variations in body temperature can occur based on:
    - Individual Differences
    - Time of Day
    - Activity Level
    - Body Sites
    - Age Groups

Classification of Body Temperature

• Febrile: indicates elevated body temperature.

• Afebrile: indicates normal body temperature.

• A body temperature above 99ºF may suggest an infection.

Extreme Temperature Conditions

• Hyperthermia: Excessive increase in body temperature, potentially exceeding 105ºF; can be life-threatening without treatment.

• Hypothermia: Core body temperature below 95ºF; also life-threatening if untreated.

Thermometer Use and Accuracy

• Least Accurate Routes:
    - Axillary (armpits)
    - Groin

• Most Accurate Routes:
    - Rectal (R)
    - Oral (non-disposable glass or electronic)
    - Aural (ear)
    - Temporal artery thermometers (scanning forehead)

• Precautions:
    - Use a rectal thermometer only if designated and marked in red.

Oral Temperature Check Protocol

• Before checking, confirm if patient has eaten, drunk, smoked, or chewed gum in the past 15 minutes.

• If the response is "Yes", wait 20 minutes before checking.

Rectal Temperature Procedures

• Wear gloves.

• Use a specified rectal thermometer.

• Position the thermometer and hold it in place; ensure the patient does not move.

• Record findings and report any abnormalities.

PULSE

Heartbeat Mechanics

• The heart produces two sounds: “lub” and “dub”, with each pair constituting one heartbeat when heart valves open and close to allow blood flow.

Pulse Measurement

• Palpation: felt with fingertips at various pulse sites.

• Auscultation: using a stethoscope at the heart's apex.

• Techniques include:
    - Good: Use index and middle fingers upright at the pulse site.
    - Poor: Avoid using flat fingers against the wrist.

Blood Pressure Phases Connection

• Pulse reflects blood pressure exerted against artery walls during the heart's contraction (systolic) and relaxation (diastolic).

• Each heartbeat consists of:
    - Systolic Blood Pressure (SBP): pressure during heart contraction.
    - Diastolic Blood Pressure (DBP): pressure during heart relaxation.

Pulse Recording and Assessment

• Record as beats per minute (BPM).

• Assess rhythm and volume concurrently:
    - Rhythm: should be steady.
    - Volume: should be strong, not weak.

Normal Pulse Rate Ranges by Age

• Adults: 60-100 BPM

• Children (over 7 years): 70-100 BPM

• Children (ages 1-7): 80-110 BPM

• Infants: 100-160 BPM

Bradycardia and Tachycardia

• Bradycardia: pulse rate below 60 BPM.

• Tachycardia: pulse rate above 100 BPM (except in children).

Pulse Locations

• Apical: apex of the heart (most accurate).

• Radial: thumb side of the wrist (most common).

• Brachial: inner aspect of forearm.

• Carotid: side of the neck.

• Ulnar: pinky side of the wrist.

• Pedal: on top of the foot.

• Popliteal: behind the knee.

• Femoral: inner upper thigh.

Counting Procedure

• Count for 1 full minute for accurate BPM.

• Alternatives:
    - Count for 30 seconds and multiply by 2.
    - Count for 15 seconds and multiply by 4.

APICAL PULSE

Procedures for Checking

• Place the stethoscope's diaphragm at the heart's apex.

• Count beats for 1 full minute.

• Avoid clothing interference while auscultating.

Ulnar and Pedal Pulses

• Ulnar Pulse: indicates circulation to the hand, may be faint.

• Pedal Pulse: checks circulation status in the foot.

POPLITEAL AND FEMORAL PULSES

• Popliteal Pulse: used for blood pressure measurement on the thigh; confirms circulation to the lower leg.

• Femoral Pulse: palpated in the groin to assess blood flow to the legs.

RESPIRATION

Definition of Respiration

• Defined as the exchange of O2 and CO2 during breathing (1 respiration = Inspiration + Expiration).

Normal Respiration Rates by Age

• Adults: 12-20 respirations per minute (RPM).

• Children: 16-30 RPM.

• Infants: 30-50 RPM.

Nature of Breathing

• Respiration can be voluntary or involuntary.

• To accurately check rates, avoid making the patient aware you are counting breaths, possibly continue checking pulse.

Characteristics to Observe During Respiration Assessment

• Rates: within normal limits for age.

• Character: depth and quality (should not be shallow or labored).

• Rhythm: a consistent air flow in and out.

Abnormal Breathing Conditions

• Dyspnea: difficulty or labored breathing.

• Apnea: absence of breathing.

• Tachypnea: rapid, shallow breaths (>25 RPM).

• Bradypnea: slow rate (<10 RPM).

• Orthopnea: dyspnea except in upright or standing position.

• Cheyne-Stokes: alternating dyspnea and apnea.

• Rales: crackling sounds due to fluid in airways.

• Wheezing: high-pitched whistling during expiration from constricted airways.

• Cyanosis: bluish skin, lips, and nails indicating low O2 and increased CO2.

BLOOD PRESSURE

Definition of Blood Pressure

• Blood pressure measures the force against arterial walls from blood pumped by the heart, expressed in mmHg (millimeters of mercury).

Blood Pressure Phases

• Systolic Blood Pressure (SBP): top number during contraction phase.

• Diastolic Blood Pressure (DBP): bottom number during relaxation phase.

Understanding Blood Pressure Readings

• A reading of 126/88 consists of SBP = 126 and DBP = 88.

Classification of Blood Pressure Levels

Common Causes of Blood Pressure Conditions

• Hypertension (high blood pressure): caused by anxiety, stress, aging, thyroid issues, high salt intake, obesity, arterial disease, genetics.

• Hypotension (low blood pressure): caused by blood loss, depression, dehydration, shock, heart failure.

Equipment Needed for Blood Pressure Measurement

• Sphygmomanometer (blood pressure cuff).

• Stethoscope.

Technique for Taking Blood Pressure

• Locate the brachial artery on an unaffected arm.

• Position cuff above the elbow, with the artery arrow aligned.

• Fit 2 fingers under the cuff; ensure it is snug but not too tight.

• Close the valve on the bulb, place the stethoscope over the brachial pulse, and inflate the cuff.

• When the first heartbeat is heard, it indicates the SBP; the last heartbeat indicates the DBP.

Retaking Blood Pressure

• If needed, wait 15 minutes before retaking BP on the same arm or use the other arm.

• Blood pressure should not be taken over clothing.

Recommended Techniques and Precautions

• Always wash hands before and after procedures.

• Disinfect equipment between patients.

Conclusion

• In-depth knowledge and accurate measurement of vital signs are critical for effective patient assessment and care.

A pulse oximeter measures two things:

• Blood Oxygen Saturation (SpO2): The measurement that indicates what percentage of blood is saturated. ...

• Pulse Rate: Pulse rate is nothing but the heart rate that indicates the number of times a heart beats per minute.

• What is normal SpO2 by age?

  

  Oxygen saturation levels (SpO2) between 95 to 100 percent are considered normal for both adults and children (below 95% is considered abnormal). People over 70 years of age may have oxygen levels closer to 95%. Normal oxygen saturation levels (SpO2) are between 95 to 100 percent for both adults and children.

Thermo Laws

• Energy can be transformed, not created nor destroyed

• Energy disperses/entropy increases

• Absolute zero is unreachable