Clinical skills Vital Signs 2009_1

8/7/2019 Clinical skills Vital Signs 2009_1

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Vi t a l Signs

Dr Nabi l Sula im an


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Object ives Performs the assessment of:

Pulse

TemperatureBP

Respiration

Understand normal ranges of thesemeasurements

Discuss pathological and nonpathological factors that influence thesemeasurements


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Presentation

Video Practical

Format


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Th is lec t u re w i l l c over:

Vital SignsPulse

Blood PressureRespiration

Temperature, and Oxygen Saturation


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Vi t a l SignsWhy vital?

Provide critical information about the

patients state of health especially when ill

or recovering after procedure.

Can identify acute medical problem

Quantify the magnitude of illness andhow well the body is coping

Marker of chronic disease states


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Ideal ly

Warm roomPatients with gown and briefs

Curtain for privacyUsually sitting position


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Tempera tureThermometer Electronic/ digital Mercury sterilized using 70% alcohol for 10 minutes or

plastic cover and clean with alcohol swab before reuseMeasured in: Mouth (Oral) under tongue Ear using disposable ear piece Axilla Rectal Skin

Normal oral temp is 37C Higher in rectum 37.5C Lower in axilla (0.5 C) Diurnal (day and night) variation

Variation across menstrual cycle in women


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Respi rat ionCheck:

Rate average 14 (12-20) per minute Symmetry

Depth

RegularityTypes: more thoracic in women and moreabdominal in men

How: count the respiration while taking thepulse


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PulsePalpate the radial pulse, proximal to the wristjoint and medial to the radius on the thumbside. What are you palpating arterial or

venous pulses and why?

Now describe the pulse you are feeling:

Rate: count for 30 sec X 2 or 15 sec X4 Rhythm: regular or irregular Volume: small or large


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PulseOther pulses you may palpate: Carotid artery Brachial artery

Popliteal artery Posterior tibial artery Dorsalis pedis artery


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Pulse

Now examine the radial pulse in three

subjects:

At rest, check both right and left pulsesimultaneously

During inspiration and expiration andcompare

Exercise

while examining the pulse check

respiratory rate


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Blood Pressure (BP)Screening patients for hypertension

Monitoring antenatal care

Monitoring cardiac output:

Surgery C.V. collapse such as hemorrhage

Stroke Heart attack


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BP- WhatSphygmomanometer measures arterial

BP indirectly by detecting pulsations in

the brachial artery heard as sounds inthe stethoscope or can be imparted tothe air in the bag and cause oscilliations

in the manometer

Systolic BP (highest)

Diastolic BP (lowest)


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BP- How ?Check size of the cuffInflate cuff to occlude the blood flowGradually deflated and the first sound(Koratkoff sounds) is systolic BP (~120 mmHg), oscilliations starts in the manometerKeep deflating, when the sound disappear it

is the diastolic BP (~80 mm Hg)Use palpation method (radial) andauscultation (brachial) using stethoscope

Normal 120/80 (range 100/60 to 140/90).


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Ox ygen Sat urat ion?

Non-invasive measurement of gas

exchange and RBC blood carryingcapacity

Provides important information on

cardiopulmonary dysfunction.

Considered by many to be the fifth vital

sign


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Video Dem onst ra t ion

then

Prac t ic a l in Cl inic a lSk i l l s Lab upst a i rs

Clinical skills Vital Signs 2009_1

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