Chapter 24 Vital Signs. Temperature Pulse Respiration Blood Pressure Pain.

Chapter 24Chapter 24

Vital SignsVital Signs

Vital SignsVital Signs

TemperatureTemperature PulsePulse RespirationRespiration Blood PressureBlood Pressure PainPain

TemperatureTemperature

Heat ProductionHeat Production Heat LossHeat Loss

TemperatureTemperature

Core TemperatureCore Temperature Surface TemperatureSurface Temperature

Variations in Body Variations in Body TemperatureTemperature

Factors Affecting Body TemperatureFactors Affecting Body Temperature Circadian RhythmsCircadian Rhythms Age and SexAge and Sex Environmental TemperatureEnvironmental Temperature

Hypothermia – low body temperatureHypothermia – low body temperatureHyperthermia – high body Hyperthermia – high body

temperaturetemperature

Normal Body Normal Body TemperatureTemperature

Varies 0.3 to 0.6 degrees C (0.5-Varies 0.3 to 0.6 degrees C (0.5-1.0 degrees F).1.0 degrees F).

Afebrile – a person with a normal Afebrile – a person with a normal body temperaturebody temperature

Increased Body Increased Body TemperatureTemperature

Pyrexia (fever) –Febrile – a person with an Pyrexia (fever) –Febrile – a person with an increased body temperature.increased body temperature.

Hyperpyrexia – a high fever, usually above 41 Hyperpyrexia – a high fever, usually above 41 degrees C (105.8 degrees F).degrees C (105.8 degrees F).

Hyperthermia- differs from pyrexia – hypothalamic Hyperthermia- differs from pyrexia – hypothalamic set point is not changed, but in extreme heat set point is not changed, but in extreme heat exposure or excessive heat production, the exposure or excessive heat production, the mechanisms that control body temp are ineffective.mechanisms that control body temp are ineffective.

Neurogenic fever – result of damage to the Neurogenic fever – result of damage to the hypothalamus from intracranial trauma, intracranial hypothalamus from intracranial trauma, intracranial bleeding, or increased intracranial pressure.bleeding, or increased intracranial pressure.

Physical Effects of Increased Physical Effects of Increased Body TemperatureBody Temperature

Loss of appetite, headache, Loss of appetite, headache, hot, dry skin, flushed face, hot, dry skin, flushed face, thirst, and general malaise.thirst, and general malaise.

Young children may Young children may experience delirium or seizuresexperience delirium or seizures

Assess for potentially Assess for potentially dangerous manifestations of a dangerous manifestations of a fever, such as dehydration, fever, such as dehydration, decreased urinary output, and decreased urinary output, and rapid heart rate.rapid heart rate.

Methods of reducingMethods of reducing

Decreased Body Decreased Body TemperatureTemperature

Hypothermia – body temp below the Hypothermia – body temp below the lower limit of normal.lower limit of normal.

Death may occur when temp falls Death may occur when temp falls below 34 degrees C (93.2 degrees F).below 34 degrees C (93.2 degrees F).

Assessing TemperatureAssessing Temperature EquipmentEquipment

Electronic and Digital ThermometersElectronic and Digital Thermometers Tympanic Membrane ThermometerTympanic Membrane Thermometer Glass thermometerGlass thermometer Disposable Single-Use ThermometersDisposable Single-Use Thermometers Temporal Artery ThermometerTemporal Artery Thermometer Automated Monitoring DevicesAutomated Monitoring Devices

TemperatureTemperature

RoutesRoutes Oral most commonOral most common RectalRectal AxillaryAxillary TympanicTympanic

Always record site when recording Always record site when recording temperature.temperature.

PulsePulse

Throbbing sensation that can be Throbbing sensation that can be palpated over a peripheral artery or palpated over a peripheral artery or auscultated (listened to ) over the auscultated (listened to ) over the apex of the heart.apex of the heart.

Results as a wave of blood is pumped Results as a wave of blood is pumped into the arterial circulation by the into the arterial circulation by the contraction of the left ventricle.contraction of the left ventricle.

Pulse PhysiologyPulse Physiology

Pulse regulated by the ANS through the Pulse regulated by the ANS through the cardiac SA node (pacemaker).cardiac SA node (pacemaker).

Parasympathetic stimulation via the vagus Parasympathetic stimulation via the vagus nerve decreases the HR, and sympathetic nerve decreases the HR, and sympathetic stimulation increased the HR and force of stimulation increased the HR and force of contraction.contraction.

Pulse rate is the number of pulsations felt over Pulse rate is the number of pulsations felt over a peripheral artery or heard over the apex of a peripheral artery or heard over the apex of the heart in 1 minute.the heart in 1 minute.

Variations in Pulse RateVariations in Pulse Rate

Pulse RatePulse Rate Normal range 60 – 100Normal range 60 – 100 Increased to 100 – 180 TachycardiaIncreased to 100 – 180 Tachycardia Decreased below 60 BradycardiaDecreased below 60 Bradycardia

Variations in Pulse Variations in Pulse Amplitude and QualityAmplitude and Quality

Pulse Amplitude and QualityPulse Amplitude and Quality Quality of pulse in terms of its fullness and reflects Quality of pulse in terms of its fullness and reflects

the strength of left ventricular contraction.the strength of left ventricular contraction. Assessed by the feel of the blood flow through the Assessed by the feel of the blood flow through the

vessel.vessel. Amplitude is normally strong in areas where an Amplitude is normally strong in areas where an

artery can be palpated.artery can be palpated. Absent (0), Thready (1+), Weak (2+), Normal (3+), Absent (0), Thready (1+), Weak (2+), Normal (3+),

Bounding (4+)Bounding (4+)

Variations in Pulse Variations in Pulse RhythmRhythm

Pulse RhythmPulse Rhythm The pattern of the pulsations and the pauses The pattern of the pulsations and the pauses

between them.between them. Normally regularNormally regular Irregular pattern of heartbeats - dysrhythmiaIrregular pattern of heartbeats - dysrhythmia

Assessing the PulseAssessing the Pulse

Palpating peripheral arteries or by Palpating peripheral arteries or by auscultating the apical pulse with a auscultating the apical pulse with a stethoscope.stethoscope.

EquipmentEquipment StethoscopeStethoscope

Sites and MethodsSites and Methods of of Assessing the PulseAssessing the Pulse

Peripheral Arterial Pulses – place the middle three Peripheral Arterial Pulses – place the middle three fingers over the artery and lightly compress the artery fingers over the artery and lightly compress the artery so pulsations can by felt and counted.so pulsations can by felt and counted. TemporalTemporal Carotid – during emergency situationsCarotid – during emergency situations Brachial – used for infants who have had a cardiac arrestBrachial – used for infants who have had a cardiac arrest Radial – most commonly used in children and adultsRadial – most commonly used in children and adults FemoralFemoral PoplitealPopliteal Posterior tibialPosterior tibial Dorsalis pedisDorsalis pedis

PulsePulse

Apical PulseApical Pulse Apical-Radial PulseApical-Radial Pulse

RespirationsRespirations

Pulmonary ventilation (or breathing) is movement of air Pulmonary ventilation (or breathing) is movement of air in and out of the lungs; inspiration (or inhalation) is the in and out of the lungs; inspiration (or inhalation) is the act of breathing in, and expiration ( or exhalation) is the act of breathing in, and expiration ( or exhalation) is the act of breathing out.act of breathing out.

External respiration is the exchange of oxygen and External respiration is the exchange of oxygen and carbon dioxide between the alveoli of the lungs and the carbon dioxide between the alveoli of the lungs and the circulating blood through diffusion.circulating blood through diffusion.

Internal respiration is the exchange of oxygen and Internal respiration is the exchange of oxygen and carbon dioxide between the circulating blood and tissue carbon dioxide between the circulating blood and tissue cells.cells.

Respiration PhysiologyRespiration Physiology

Rate and depth of breathing can change Rate and depth of breathing can change in response to body demands.in response to body demands.

Increase in carbon dioxide is the most Increase in carbon dioxide is the most powerful respiratory stimulant, causing powerful respiratory stimulant, causing an increase in respiratory depth and rate.an increase in respiratory depth and rate.

The cerebral cortex of the brain allows The cerebral cortex of the brain allows voluntary control of breathing.voluntary control of breathing.

Variations in Respiratory Variations in Respiratory Rate and DepthRate and Depth

Normally smooth, effortless, and without Normally smooth, effortless, and without conscious effort.conscious effort.

Factors Affecting RespirationFactors Affecting Respiration Respiratory Rate (12 to 20 times each minute)Respiratory Rate (12 to 20 times each minute)

Normal – eupnea (1 resp to 4 heartbeats)Normal – eupnea (1 resp to 4 heartbeats) Increased – tachypnea – occurs inresponse Increased – tachypnea – occurs inresponse

to the increased metabolic rate during fever to the increased metabolic rate during fever (pyrexia).(pyrexia).

Decreased – bradypnea – occurs in some Decreased – bradypnea – occurs in some pathologic conditions.pathologic conditions.

Respiratory Depth and Respiratory Depth and RhythmRhythm

Normally from shallow to deep.Normally from shallow to deep. Apnea – no breathingApnea – no breathing

If lasts longer than 4 to 6 minutes, brain If lasts longer than 4 to 6 minutes, brain damage and death might occur.damage and death might occur.

Dyspnea – difficult or labored breathingDyspnea – difficult or labored breathing

Assessing RespirationsAssessing Respirations

Rate, Depth, and Rhythm by inspection Rate, Depth, and Rhythm by inspection (observing and listening) or by listening with (observing and listening) or by listening with the stethoscope.the stethoscope.

Monitoring arterial blood gas results and using Monitoring arterial blood gas results and using a pulse oximeter to determine oxygenation of a pulse oximeter to determine oxygenation of blood.blood.

Depth – assessed by observing the degree of Depth – assessed by observing the degree of excursion or movement in the chest wall.excursion or movement in the chest wall.

RhythmRhythm

Alterations in Alterations in RespirationsRespirations

BradypneaBradypnea - <10 rate reg but abn slow. - <10 rate reg but abn slow. Tachypnea Tachypnea - > 24 rate reg but abn rapid.- > 24 rate reg but abn rapid. HyperpneaHyperpnea – resp labored, increase in – resp labored, increase in

depth, increase in rate > 20 (occurs depth, increase in rate > 20 (occurs normal in exercise).normal in exercise).

Apnea Apnea – respirations cease for several – respirations cease for several second. Persistent cessation results in second. Persistent cessation results in respiratory arrest.respiratory arrest.

Alterations in Alterations in RespirationsRespirations

Hyperventilation Hyperventilation – increased rate and depth – increased rate and depth HypoventilationHypoventilation – decreased rate and depth; – decreased rate and depth;

irregularirregular Cheyne-Stokes RespirationsCheyne-Stokes Respirations – Alternating – Alternating

periods of deep, rapid breathing followed by periods of deep, rapid breathing followed by periods of apnea.periods of apnea.

Kussmauls’s RespirationsKussmauls’s Respirations – abnormally – abnormally deep; regular and increase in rate.deep; regular and increase in rate.

Biolt’s RespirationsBiolt’s Respirations – varying depth and rate – varying depth and rate of breathing, followed by periods of apnea. of breathing, followed by periods of apnea.

Oxygen SaturationOxygen Saturation

Measures diffusion and perfusion.Measures diffusion and perfusion. 95% - 100% - % of hemoglobin that is 95% - 100% - % of hemoglobin that is

bound with oxygen in the arteries is the bound with oxygen in the arteries is the % of saturation of hemoglobin (SaO2).% of saturation of hemoglobin (SaO2).

Pulse oximeter – indirect measurementPulse oximeter – indirect measurement Interferance with Light TransmissionInterferance with Light Transmission

Reduction of Arterial Reduction of Arterial PulsationsPulsations

PVDPVD HypothermiaHypothermia Pharmocological vasoconstrictorsPharmocological vasoconstrictors Decreased Cardiac Output and Decreased Cardiac Output and

HypotensionHypotension Peripheral EdemaPeripheral Edema Tight ProbeTight Probe

Blood PressureBlood Pressure

The force of the blood against arterial walls.The force of the blood against arterial walls. Maximum blood pressure is exerted on the Maximum blood pressure is exerted on the

walls of arteries when the left ventricle of the walls of arteries when the left ventricle of the heart pushes blood through the aortic valve heart pushes blood through the aortic valve into the aorta at the beginning of systole.into the aorta at the beginning of systole.

Pressure rises as the ventricle contracts and Pressure rises as the ventricle contracts and falls as the heart relaxes.falls as the heart relaxes.

This continuous contraction and relaxation of This continuous contraction and relaxation of the left ventricle creates a pressure wave that the left ventricle creates a pressure wave that is transmitted through the arterial system.is transmitted through the arterial system.

Blood PressureBlood Pressure

Systolic pressureSystolic pressure (numerator) – the highest (numerator) – the highest pressurepressure

Diastolic pressureDiastolic pressure (denominator) – the lowest (denominator) – the lowest pressure pressure

Pulse pressurePulse pressure – the difference between – the difference between Systolic and Diastolic pressure.Systolic and Diastolic pressure.

Measured in millimeters of mercury (mm Hg) Measured in millimeters of mercury (mm Hg) and recorded as a fraction. (Example 120/80 – and recorded as a fraction. (Example 120/80 – systolic 120, diastolic 80, pulse pressure 40)systolic 120, diastolic 80, pulse pressure 40)

ComplianceCompliance

Arteries have a considerable quantity of elastic Arteries have a considerable quantity of elastic tissue that allows them to stretch and distend.tissue that allows them to stretch and distend.

Constant state of pressure in arteries which Constant state of pressure in arteries which offers the resistance. offers the resistance.

Elasticity of walls + resistance of the arterioles Elasticity of walls + resistance of the arterioles = maintain normal blood pressure.= maintain normal blood pressure.

With age, walls of arterioles less elastic, With age, walls of arterioles less elastic, decreased ability to stretch and dilate. decreased ability to stretch and dilate. Ultimately limits adequate blood flow and Ultimately limits adequate blood flow and contributes to rising pressure.contributes to rising pressure.

Neural and Humoral Neural and Humoral MechanismsMechanisms

ANS mediates control mechanisms that function to ANS mediates control mechanisms that function to maintain short-term regulation of BPmaintain short-term regulation of BP

Hormones and humoral mechanisms regulate BPHormones and humoral mechanisms regulate BP Renin-angiotensin-aldosterone system controls Renin-angiotensin-aldosterone system controls

vasoconstriction to increase peripheral vascular vasoconstriction to increase peripheral vascular resistance and also increases sodium and water resistance and also increases sodium and water retention bythe kidneys to increase circulatory fluid retention bythe kidneys to increase circulatory fluid volume – increased BPvolume – increased BP

ADH 0 Antidiuretic hormone – vasopressin- is release ADH 0 Antidiuretic hormone – vasopressin- is release from the posterior pituitary when stimulated by from the posterior pituitary when stimulated by decreased blood volume and blood pressure, or by an decreased blood volume and blood pressure, or by an increased osmolarity of the blood – water is retained to increased osmolarity of the blood – water is retained to increase circulatory fluid volume - increase BPincrease circulatory fluid volume - increase BP

Cardiac OutputCardiac Output

Stroke Volume – quantity of blood forced Stroke Volume – quantity of blood forced out of the left ventricle with each contractionout of the left ventricle with each contraction

Cardiac Output is the amount of blood Cardiac Output is the amount of blood pumped per minute, and averages from pumped per minute, and averages from 3.5L to 8.0 L/min in a healthy adult.3.5L to 8.0 L/min in a healthy adult.

CO = SV X HRCO = SV X HR Increases during exercise, decreases Increases during exercise, decreases

during sleep.during sleep. Varies depending on body size and Varies depending on body size and

metabolic needs.metabolic needs. Increased CO – arteries distend more, Increased CO – arteries distend more,

increased BP.increased BP. Decreased CO – BP fallsDecreased CO – BP falls

Variations in Blood Variations in Blood PressurePressure

Factors Affection BPFactors Affection BP AgeAge Circadian rhythmCircadian rhythm SexSex Food IntakeFood Intake ExerciseExercise WeightWeight Emotional stateEmotional state Body positionBody position RaceRace Drugs/MedicationsDrugs/Medications

Increased Blood PressureIncreased Blood Pressure

Hypertension – BP is above normal for a sustained Hypertension – BP is above normal for a sustained periodperiod

Most common health problems in adults and the Most common health problems in adults and the leading cause of cardiovascular disorders.leading cause of cardiovascular disorders.

Primary or essential HTN – without know cause.Primary or essential HTN – without know cause. Secondary HTN – with know pathology.Secondary HTN – with know pathology. Major risk factor for heart disease, and most imp risk Major risk factor for heart disease, and most imp risk

factor for stroke.factor for stroke. ““Silent Killer”Silent Killer”

Few symptoms beyond the HTN; 22 million don’t knowFew symptoms beyond the HTN; 22 million don’t know

Risk Factors for HTNRisk Factors for HTN

Family historyFamily history Sedentary lifestyleSedentary lifestyle ObesityObesity Continual stressContinual stress

HIGH RISK FACTORSHIGH RISK FACTORS

Cigarette smokingCigarette smoking Alcohol consumptionAlcohol consumption High salt intakeHigh salt intake High-fat, high-calorie dietHigh-fat, high-calorie diet Twice as common in African Americans Twice as common in African Americans

as in Americans of European descent.as in Americans of European descent.

Treatment of HTNTreatment of HTN MedicationsMedications

Antihypertensive medicationAntihypertensive medication Diuretics – to decrease fluid volume.Diuretics – to decrease fluid volume. Beta-adrenergic blockers – to block Beta-adrenergic blockers – to block

sympathetic stimulation and decrease sympathetic stimulation and decrease cardiac output.cardiac output.

Vasodilators and calcium channel Vasodilators and calcium channel blockers – to relax smooth muscles of blockers – to relax smooth muscles of arterioles and decrease peripheral arterioles and decrease peripheral vascular resistance.vascular resistance.

ACE inhibitors – to prevent ACE inhibitors – to prevent vasoconstriction by angiotensin II and vasoconstriction by angiotensin II and decrease circulatory fluid volume by decrease circulatory fluid volume by reducing aldosterone production.reducing aldosterone production.

Lifestyle ChangesLifestyle Changes

Low-calorie, low-fat dietLow-calorie, low-fat diet Losing excess weight and Losing excess weight and

maintaining weight lossmaintaining weight loss Limiting alcohol intakeLimiting alcohol intake Eliminating smokingEliminating smoking Reducing salt intakeReducing salt intake Regular physical activityRegular physical activity

Decreased Blood Decreased Blood PressurePressure

HypotensionHypotension – below-normal BP – below-normal BP Orthostatic hypotension (Postural Orthostatic hypotension (Postural

Hypotension)Hypotension) – low BP – low BP

Assessing Blood PressureAssessing Blood Pressure

EquipmentEquipment SphygmonmanometerSphygmonmanometer Noninvasive BP monitorsNoninvasive BP monitors Doppler UltrasoundDoppler Ultrasound Direct Electronic MeasurementDirect Electronic Measurement

Assessment Sites and Assessment Sites and MethodsMethods

Korotkoff SoundsKorotkoff Sounds Assessing a Brachial Artery BPAssessing a Brachial Artery BP Assessing a Popliteal Artery BPAssessing a Popliteal Artery BP Palpating the BPPalpating the BP

Blood Pressure Assessment Blood Pressure Assessment Errors and Contributing Errors and Contributing CausesCauses

See Table 24-11 on page 554.See Table 24-11 on page 554.