Vital Signs and Related Medical Practices

Patient Homeostasis

  • Definition: The body's “steady state” maintained by adaptive responses that promote healthy survival.
  • Monitoring: Achieved through physiologic feedback loops.
    • Feedback Loops: Two types, predominantly negative loops.

Measuring Vital Signs

  • Vital signs are critical for physical assessment and include key indicators:
    • Body Temperature
    • Pulse
    • Respiration
    • Blood Pressure (BP)

Body Temperature

  • Definition: Physiologic balance between heat produced in body tissue and heat loss to the environment.
  • Regulation: Controlled by the hypothalamus in the basal region of the brain.
  • Normal fluctuations: Changes in physiology occur with temperature variations of 2 to 3 degrees.
  • Measurement units: Degrees Fahrenheit (℉) or degrees Celsius (°C).
Normal Body Temperature Ranges
  • Adult (14 years and over): 97.6℉ to 100.0℉ (36.5 to 37.8°C)
  • Child (5 to 13 years): 97.8℉ to 98.6℉ (36.7 to 37°C)
  • Infant (3 months to 3 years): 99.0℉ to 99.7℉ (37.2 to 37.7°C)
Abnormal Temperature Conditions
  • Fever (Hyperthermia): Body temperature exceeds normal ranges. Indicates a disturbance in the heat-regulating centers, often due to illness. Increased body temperature raises oxygen demands.
  • Hypothermia: Body temperature falls below normal limits, can be medically induced to reduce oxygen needs. Dangerously low temperatures include above 105.8℉ to 111.2℉ (41 to 44°C) or below 93.2℉ (34°C).
Measurement of Body Temperature
  • Measurement Sites:
    • Oral (98.6 ℉ or 37°C)
    • Tympanic or Aural (97.6 ℉ or 36.4°C)
    • Rectal (99.6 ℉ or 37.5°C, most reliable)
    • Axillary (97.6℉ to 98℉ or 36.4 to 36.7°C)

Pulse

  • Definition: The throbbing of arteries as blood is pumped by heartbeats, felt through the skin.
  • Measurement: Expressed as beats per minute (bpm).
Pulse Measurement Locations
  • Apical: apex of the heart (auscultated)
  • Radial: wrist
  • Carotid: neck
  • Femoral: groin
  • Popliteal: posterior knee
  • Temporal: near ear
  • Dorsalis Pedis: top of foot
  • Posterior Tibial: inner ankle
  • Brachial: elbow groove
Pulse Rate Norms
  • Average Pulse Rates:
    • Adult: 60 to 100 bpm
    • Child: 70 to 100 bpm
    • Infant: 120 bpm
  • Conditions:
    • Tachycardia: Over 100 bpm (abnormal)
    • Bradycardia: Under 60 bpm (abnormal)

Respiration

  • Function: Exchange of oxygen and carbon dioxide between the blood and the environment, indicated in breaths per minute (bpm).
Average Baseline Respiration Rates
  • Adult: 12 to 20 bpm
  • Child (1 to 10 years): 20 to 30 bpm
  • Infant (under 1 year): 30 to 60 bpm
  • Assessment: Should be quiet, effortless, and uniform.

Blood Pressure (BP)

  • Definition: Measurement of the force exerted on arterial walls during heart contractions (systolic) and relaxation (diastolic).
  • Recorded in mm Hg.
Blood Pressure Values
  • Systolic: First number (highest pressure during contraction)
  • Diastolic: Second number (lowest pressure during relaxation)
Normal BP Ranges
  • Adult:
    • Systolic: 110 to 120 mm Hg
    • Diastolic: 60 to 80 mm Hg
  • Adolescent:
    • Systolic: 85 to 130 mm Hg
    • Diastolic: 45 to 85 mm Hg
  • Child:
    • Systolic: 90 to 120 mm Hg
    • Diastolic: 50 to 70 mm Hg
Abnormal Blood Pressure Conditions
  • Hypertensive: Consistently over 140 mm Hg systolic or over 90 mm Hg diastolic.
  • Hypotensive: Systolic below 90 mm Hg.

Oxygen Administration

  • Importance: Essential for life; interruption is a medical emergency.
  • Goals: Maintain adequate tissue oxygenation; minimize cardiopulmonary work.
  • Conditions: Hypoxia is inadequate oxygen at the cellular level.
  • Monitoring: Pulse oximetry indicates SaO2 levels, normal values 95-100%; values below 85% signify inadequate oxygenation.
Oxygen Delivery Systems
  • Various Methods:
    • Nasal Cannula
    • Nasal Catheter
    • Face Mask
    • Transtracheal
    • Mechanical Ventilators
    • Oxygen Tent
    • Home Oxygen Delivery Systems
Safety Considerations
  • Oxygen must be prescribed and can cause severe toxicity.
  • Equipment must be replaced to prevent infection transmission.

Chest Tubes and Lines

  • Endotracheal Tube (ET Tube): Used for respiratory management.
  • Chest Tube: Drains the intrapleural space; crucial for fluid/air removal.
  • Central Venous Lines (CV): Used for drug/nutrition delivery, fluid management, cardiac pressure monitoring, and blood analysis. These catheters come in various types and are inserted for short or long-term use.
    • Types of lines include: single, double, multiple lumens, percutaneous, and PICC.
    • Goal: Position tip in a central vein.