Vital Sign -20124 - .pdf.................

Physical assisment

1. ST. LIDETA HEALTH SCIENCE AND BUSINESS COLLEGE
DEPARTMENT OF BSc PHARMACY


BSc PHARMACY – DEGREE STUDENTS
YEAR –III/ SEM. – I
PHYSICAL ASSESSMENT / VITAL SIGNS
COURSE OUTLINE - 2016 EC./ 2024 GC.

2. PHYSICAL ASSESSMENT
Course Schedule:

4. VITAL SIGNS:

UNIT CONTENT:
Introduction,
Body Temperature,
Pulse Rate or Rate of Heart beat,
Blood Pressure,
Respiratory Rate or Rate of Breathing,
Oxygen Saturation Level in Blood,

5. VITAL SIGNS LECTURE :…. Cont’d
Learning Outcomes:
After completion of this session, the student will be able to:

1.Describe the five common Types of Vital Signs,
2.State normal values for adult Vital Signs,
3.Describe the steps for obtaining - Temperature, Blood Pressure, Heart
Rate, and Respiratory Rate and Oxygen Saturation Level in Blood,
4.List out the importance of Vital Signs in assessing the health status of the
individual,
5.Discuss the factors that affect the Vital sing and accurate measurement
using various methods,
6.Identify sites used to assess - Pulse rate, Temperature, Blood pressure and
state the reasons,
7.Explain how to measure the - Pulse rate, Blood pressure, Respiratory rate,
Body temperature and Oxygen Saturation Level in Blood,

6. VITAL SIGNS:

INTRODUCTION TO VITAL SIGNS:
Vital signs are objective measurement of the essential physiological
functions of human being,
The name "Vital" is given as its measurement and assessment is the
critical first step for any clinical evaluation,
The first set of clinical examinations is an evaluation of the vital signs of the
patient,
Vital Signs are - measurements of the body's most basic functions and are
extremely useful tool to monitor homeostasis and measure physiological
normal functions within the body,
The human body constantly struggles to maintain….;
A stable state of being or homeostasis - which is central to life,
However - when someone is ill - the body’s strength is challenged and vital
signs will go out of their normal range to restore the body’s stability
(homeostasis),
Vital signs - can provide objective (factual) proof a change has occurred,
Which can reveal the body’s - stability or instability when interpreted
by a healthcare professional,

7. INTRODUCTION TO VITAL SIGNS:… Cont’d
The measurement of - Vital signs provides data driven documentation of an
individual’s decline or improvement, and in this way;
Can assist healthcare professionals to make informed clinical
decisions and an accurate diagnosis,
Vital signs - is an indicators or signs checked to monitor the function of
the body, it includes;
Temperature,
Pulse /Pulse Rate,
Respiration /Respiratory Rate and
Blood Pressure,
Oxygen Saturation Level in the Blood,
Recently some agency designed - Pain as a fifth Vital Sign to be
assessed,

8. INTRODUCTION TO VITAL SIGNS :… Cont’d
Vital Signs are - the first measurements taken by health care professionals
when initiating care in all healthcare settings like;…:
Primary care,
Emergency care,
Urgent care,
Specialty care,
Surgical and Medical care and Acute care,
Vital signs are – such an important tool in acute care settings to assess the
body’s stability,
It is sometimes measured on an ongoing basis using wearable
(appropriate) monitoring devices,
For this reason - Vital Signs can/are…;
Help determine - major changes in basic body functions,
Highly responsive to - abnormalities and changes within the body,
Based on factual data - which can be compared to prior vital sign
readings or shared with a health care professional,
The sensitivity of vital signs to even subtle changes in a person’s health
condition is highly effective,

9. INTRODUCTION TO VITAL SIGNS:… Cont’d
Vital signs also known as vitals are - a group of the four to six most
crucial medical signs that indicate the status of the body's Vital (life-
sustaining) functions,
These measurements are taken to help;
Assess the general physical health of a person,
Give clues to possible diseases, and
Show progress toward recover,
The normal ranges for a person's vital signs vary with;
Age,
Weight,
Sex, and Over all health,
There are four - primary vital signs: Body Temperature, Blood Pressure,
Pulse Rate( Heart Rate) and Breathing Rate ( Respiration Rate), often
notated as;
BT, BP, HR, and RR – respectively,
However, depending on the clinical setting, the vital signs may include;
 Other measurements called- the "fifth vital sign" or "sixth vital sign,"

10. INTRODUCTION TO VITAL SIGNS:… Cont’d
Measuring vital signs is usually the first step in almost every medical
evaluation,
Health care workers use the vital sings measurements to better understand
how a person’s body is functioning and to detect possible health concerns,
By monitoring a person’s vital signs consistently, such as; at every health
checkup, a health workers can establish a baseline data for the client,
Vital signs can then act as early warning flags,
For example - a change in a person’s baseline measurements might point
to an underlying illness or heart issue that has not yet been diagnosed,
FACTORS AFFECTING VITAL SIGNS:
Vital signs can fluctuate or change when a person is:……
Sick,
Anxiety,
Stress,
 Experiencing Pain,
Taking certain Medications,
A person’s age or a change in lifestyle can also affect one or more vital
signs,

11. INTRODUCTION TO VITAL SIGNS:… Cont’d
TIME AND CONDITIONS TO ASSESS VITAL SIGNS:
On admission,
Change in client’s health status,
Client reports symptoms such as;
Chest Pain,
Feeling Hot, or
Faint,
Pre and Post surgery,
During any invasive procedure,
Pre and post medication administration that could affect CV system,
Pre and post nursing intervention - that could affect vital signs Body,

12. Different Body Temperature Measurement Tools (Thermometers) for
Different Sites:

13. BODY TEMPERATURE MEASUREMENT:

Temperature measurement - describes the process of measuring a body
temperature for immediate or later evaluation,
Data sets consisting of repeated standardized measurements can
be used to assess temperature trends,
Body temperature measurement is - a measure of the body's ability to
generate and get rid of heat,
There are 4 ways to take (to measure) a body temperature:
Under the armpit - Axillary method,
In the mouth - Oral method,
In the ear - Tympanic method and
In the rectum - Rectal method,
Body temperature is a vital sign and it is important to measure it -
accurately,
Body temperature is a measure of how well your body can make and get
rid of heat,
The body is very good at keeping its temperature within a safe range,
Even when temperatures outside the body change a lot,

14. BODY TEMPERATURE:…. Cont’d

When one is too hot - the blood vessels in the skin widen - to carry the
excess heat to the skin's surface…,
Then one may start to sweat,
As the sweat evaporates - it helps cool your body,
When you are too cold, your blood vessels narrow,
This reduces blood flow to the skin to save body heat,
Then one may start to shiver,
When the muscles tremble this way - it helps to make more heat,
Body temperature - can be measured in many places on the body….,
The most common ones are the…;
Mouth - (sublingual/underneath the tongue ),
Ear, Armpit, Rectum and Skin (most common - forehead),
Thermometers show - body temperature in either;
Degrees Celsius (°C) or Degrees Fahrenheit (°F),
The standard in Canada and most other countries is - Degrees Celsius (°C),
In the United States, temperatures are often measured in - Degrees
Fahrenheit (°F),

15. BODY TEMPERATURE:…. Cont’d

Description of body temperature:
Body temperature is the expected temperature of the human body,
You may notice the body temperature change when:….
During exercise or
When feeling ill,
The average body temperature is 98.6 degrees Fahrenheit (37 degrees
Celsius),
But the normal temperature for a healthy person can range between
97.8
O
F to 99.1
O
F (36.55
O
C to 37.27
O
C ) or Slightly higher,
A temperature higher than 100.4
O
F (38
O
C ) is classified as a fever ,
A drop in body temperature below 95
O
F (35
O
C) is hypothermia,

16. BODY TEMPERATURE:…. Cont’d

Body temperature may be - abnormal due to fever (high temperature) or
hypothermia (low temperature),
According to the American Academy of Family Physicians…..,
Fever (high temperature) - is indicated when body temperature rises
about one degree or more over the normal temperature of 98.6 degrees
Fahrenheit;

Hypothermia (low temperature) - is defined as a drop in body
temperature below 95 degrees Fahrenheit,


CAUTION /RISK AVOIDANCE: - About glass thermometers containing
mercury;
According to the Environmental Protection Agency,
Mercury is a toxic substance,
Poses a threat to the health of humans as well as to the environment,

Because of the risk of breaking glass thermometers containing mercury
should be removed from;
Reuse and disposed of properly in accordance with local, state, and
federal laws,

17. BODY TEMPERATURE:…. Cont’d

MEASUREMENT OF BODY TEMPERATURE:

The normal body temperature of a person varies depending on;
Gender,
Recent activity,
Food and fluid consumption,
Time of the day, and,
In women - the stage of the menstrual cycle,
Normal body temperature can range from;
97.8 degrees F (or Fahrenheit, equivalent to 36.5 degrees C, or
Celsius) - to 99 degrees F (37.2 degrees C) - for a healthy adult,
A person's body temperature can be taken in any of the following
ways: -
Orally,
Rectally,
Axillary,
By Ear,
By Skin,

18. MEASUREMENT BODY TEMPERATURE:

Different Types of Body Temperature Measurement:
1.Orally, 1- 2-
2.Rectally,
3.Axillary,
4.By Ear,
5.By Skin,

3- 4- 5-





5 -

19. BODY TEMPERATURE:…. Cont’d

Different Types of Body Temperature Measurement :
1- Orally:
Oral temperature can be taken by - mouth using either the classic glass
thermometer, or the more modern digital thermometers that use an
electronic probe to measure body temperature,
2- Rectally:
Rectal temperature taken rectally (using a glass or digital thermometer) tend
to be 0.5 to 0.7 degrees F higher than when taken by mouth,
3- Axillary:
Axillary temperature can be taken- under the armpit (Axillary) using
a glass or digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4
degrees F lower than those temperatures taken by mouth,
4- By Ear:
A special thermometer can quickly measure the temperature of the ear
drum, which reflects the body's core temperature (the temperature of the
internal organs),
5- By Skin:
A special thermometer can quickly measure the temperature of the skin on
the forehead,

20. BODY TEMPERATURE:…. Cont’d

Different Types of common Thermometers: Oral Thermometers:
Axillar Thermometer:







Rectal Thermometers: Skin Surface Thermometer:


21. BODY TEMPERATURE:…. Cont’d

Technique to check body temperature:
Body temperature can measure by using a
thermometer; If using a temporal thermometer,
Place it just in front of the forehead,
When using a traditional thermometer,
Insert the tip of the thermometer into the;
Mouth or Rectum or Place it under the Armpit,
Thermometer should be reset by shaking the mercury level down below 35°C
(95°F) each time before using,
The tips of oral thermometer and rectal thermometer are different in shape
(Slender Vs. Round) and must not be cross-used,
After a few seconds - remove the thermometer and read the temperature,
Follow the instructions - that came with the thermometer to get an
accurate reading,
Wash and sanitize your thermometer after each use,
A healthcare provider can also measure the body temperature using;
A special thermometer - inserted into the ear canal,

22. BODY TEMPERATURE:…. Cont’d

Different Types of Thermometers: - Oral Thermometers (Sublingual):
Axillar Thermometer:







 - The tympanic temperature:
Rectal Thermometers: - Skin Surface Thermometer:

23. BODY TEMPERATURE:…. Cont’d

FACTORS AFFECTS BODY TEMPERATURE:

Factors that can affect the body temperature include:
Being in a hot or cold environment,
Exercise,
Eating hot or cold foods and beverages,
Strong emotions,
Medical conditions that can cause the body temperature to change
include:
Stress,
Infection,
Hypothyroidism,/Hyperthyroidism,
Dehydration,
Sunburn,
Rheumatoid arthritis,
Hormonal changes,

As the age is getting advanced, the body isn’t able to regulate the body
temperature as well as it should,

That’s why one may not have more frequent temperature changes,
if he/she is 65 year or older,

24. 2 - MEASUREMENT OF THE PULSE RATE:

25. MEASUREMENT OF THE PULSE RATE:

Different sites of Pulse rate Measurement:

Central monitoring (includes, Pulse rate):

Radial Pulse at Wrist,







Taking pulse Rate at carotid artery:

Brachial pulse at elbow:

26. MEASUREMENT OF THE PULSE RATE:
The Pulse Rate is - a measurement of the heart rate, or the number of times
the heart beats per minute,
As the heart pushes blood - through the arteries;
The arteries expand and contract with the flow of the blood,
Taking a pulse not only measures the heart rate, but also can indicate the
following:
Heart Rhythm,
Strength of the Pulse,
The normal pulse for healthy adults ranges from 60 to 100 beats per
minute,
The pulse rate may fluctuate and increase with;
Exercise, Illness, Injury, and Emotions,
Females ages 12 and older, in general, tend to have - faster heart rates
than do males,
Athletes, such as; Runners, who do a lot of cardiovascular conditioning,
may have;
Heart rates near 40 beats per minute and
Experience no problems,

27. MEASUREMENT OF THE PULSE RATE:….Cont’d

As the heart forces blood through the arteries;
One feel the beats by firmly pressing on the arteries,
Which are located close to the surface of the skin at
certain points of the body,
The pulse - can be found on/at…;
The side of the neck,
The wrist, or
The inside of the elbow,
For most people - it is easiest to take the pulse at the wrist,
If one use the lower neck be - sure not;
To press too hard, and
Never press of the pulses on both sides
of the lower neck at the same time;
To prevent blocking blood flow (Carothoid artery) to the brain,
When taking the pulse - using the first and second fingertips,
Press firmly but gently on the arteries until you feel a pulse,
Begin counting the pulse when the - clock's second hand is on the 12,

28. MEASUREMENT OF THE PULSE RATE:….Cont’d

Count the Pulse Rate - for 60 seconds – or…;
For 15 seconds and then multiply by four to calculate beats per
minute,
When counting - do not watch the clock continuously,
But concentrate on the beats of the pulse,
If one isn’t sure about the results, ask another person to count for;
Counter check,
If having difficulty finding the pulse site/or difficulty in counting the rate;
Consult other health worker for technical support,
DESCRIPTION OF PULSE RATE:
One measure pulse rate anywhere an artery comes close to the skin,
such as;
In the Wrist or Neck,
Temple area,
Groin, Behind the Knee, or top of your foot,
One can easily check the pulse on the inside of the wrist, below the thumb,
Gently place - 2 fingers of the other hand on this artery,

29. MEASUREMENT OF THE PULSE RATE:….Cont’d
Description of Pulse: ….. Cont’d
Pulse is the number of times the heart beats per minute,
A normal Pulse rate for a healthy adult at rest ranges from 60 to 100
beats per minute (bpm/beats/minute),
Pulse rates vary from person to person, women tend to have faster pulse
rates than men,
Pulse is lower when one is at rest and higher when exercise,
This happens because the body needs more oxygen-rich blood when one
does exercise,
Keep in mind the following….:
One should take into consideration, if the pulse rate is routinely less
than 60 beats per minute or more than 100 beats per minute,
Each beat should be equally spaced out,
Beats shouldn’t be excessively strong,
If so - this could indicate that the heart is working hard,
The heart shouldn’t skip a beat

30. TECHNIQUE TO MEASURE THE PULSE RATE:

One can measure the pulse by firmly, but gently, pressing - the first and
second fingertips against certain points on the body….
Most commonly at the wrist or neck,
Use the watch and count the number of heart beats in 60 seconds,
The result is Pulse rate or Heart rate,

For most people, it’s easiest to measure the heart rate at the wrist,
Here are the common steps to take….:
1.Using the first and second fingertips - press gently on the arteries that
run beneath the skin of the wrist (just below the hand) until one feel a
pulse,
2.Have a clock nearby and begin counting the Pulse when the clock’s
second hand is on the 12,
3.Count the Pulse for 15 seconds, and then multiply that number by 4 to
calculate the number of beats per minute,
4.It may be worthwhile to repeat the count to see whether one get the
same number,
5.If one is not sure about the results or keep getting different results, ask
someone to count or watch the clock,

31. FACTORS AFFECT THE PULSE RATE:

Factors that can affect the pulse include…;
Exercise,
Stress,
Strong emotions,
Caffeine,
Health and Health related conditions that can affect the pulse may
include, but aren’t limited to, the following:
Infection.
Dehydration.
Stress,
Anxiety,
Thyroid conditions (Hypothyroidism/Hyperthyroidism),
Anemia,
Shock,
Arrhythmia,
Some medications, especially beta-blockers and digoxin, can slow the
Pulse Rate,

32. COMMON PULSE POINTS/ PULSE SITES:
Pulse Points in the Human Body:
As the pulse represents the human cardiovascular system, it can not be
measured at any point in the human body,
There are some specific points where the pulse can be felt and measured,
Those points are called Pulse points of the human body,
There are seven Pulse points on the human body, where the pulse can be
felt,
The pulse points of the human body are : ….
Radial artery – Wrist,
Carotid artery – Neck,
Brachial artery - Medial border of the Humerus,
Femoral artery - At the Groin,
Popliteal artery - Behind the Knee,
Dorsalis Pedis and Posterior Tibial arteries – Foot,
Abdominal Aorta - Abdomen,
By different touching processes, the pulse can be felt and measured at these
points mentioned above,

33. COMMON PULSE POINTS/ PULSE SITES:
Nine common Pulse Points
(start from head-to-toe…this
makes it easier when you
have to Perform this skill):
1.Temporal
2.Carotid
3.Apical
4.Brachial
5.Radial
6.Femoral
7.Popliteal
8.Posterior Tibial
9.Dorsalis Pedis

34. THE SEVEN /7 MOST COMMON - PULSE LOCATIONS:

There are a total of most common seven pulse points in the human body,
These pulse points are;
The neck - Carotid artery,
The wrist - Radial artery,
Behind the knee - Popliteal artery,
The groin - Fmoral artery,
Inside the elbow - Brachial artery,
The foot - Dorsalis pedis and
Posterior Tibial artery,
The abdomen - Abdominal aorta,
Most common - Seven Types of Pulse:
Temporal - It is felt in the head,
Carotid - It is felt in the neck,
Branchial - It is felt in the elbow,
Femoral - It is felt at the groin,
Radial - It is felt on the wrist,
Popliteal - It is felt on the knee,
Dorsalis pedis - It is felt on the foot,

35. MEASUREMENT OF THE PULSE RATE:….Cont’d

 REASONS FOR USING SPECIFIC PULE SITE:

36. 3 - MEASUREMENT OF RESPIRATION RATE:

37. MEASUREMENT OF RESPIRATION RATE:
The Respiration Rate is - the number of breaths a person takes per
minute,
The rate is - usually measured;
When a person is at rest and
Simply involves counting the number of breaths - for one minute,
By Counting how many times the chest rises,
Respiration rates - may increase with;
Fever,
Illness, and Other medical conditions,
When checking respiration - it is important to also note;
Whether a person has any difficulty in breathing,
Normal respiration rates for an adult person at rest range from;
12 to 16 breaths per minute,
The Latest authors of state that children have a higher respiratory rate than
adults,
Once a child reaches the age of - 2, the respiration rate reduces from 44
breaths per minute to 26.

38. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
The normal respiratory rate for healthy adults is between 12 – 20 breaths per
minute,
At this breathing rate, the carbon dioxide exits the lungs at the same
rate that the body produces it,
Breathing rates of below 12 or above 20 can mean a disruption in the
breathing processes,
Many factors, including; age and activity levels, affect a person’s respiratory
rate,
Adults usually take between 12 – 20 breaths per minute, but children tend
to breath faster,
The respiratory rate is the number of breaths someone takes every minute;
It is one of the main vital signs, along with;
Blood Pressure,
Pulse, and Temperature ,
Some health issues - such as;
Anxiety,
Fever, or
Heart problems - can cause breathing rates to speed up,

39. MEASUREMENT OF RESPIRATION RATE : …. Cont’d
METHODS OF RESPIRATORY RATE MEASURING:

The Respiratory Rate is also known as the Breathing Rate;
This is the number of breaths one take per minute..
One can measure the Breathing Rate by counting the number of breaths
the client take over the course of one minute while he/she is at rest,
To get an accurate measurement, follow the following conditions;:
Client should - Sit down and try to relax,
It's best to take the respiratory rate while sitting up in a chair or in bed,
Measure the breathing rate by counting the number of times the clients’
chest or abdomen rises over the course of one minute,
Finally - record the number, one counts of breathing per minute,
Technic to check respiratory rate:
One can check the respiratory rate by:
Finding a quiet location to sit down and relax,
Use the hand watch and count how many breaths one take in 60
seconds,

40. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
Technic to check respiratory rate:…. Cont’d
It can be difficult to count one own breaths, especially if the client is
nervous or anxious,
One can ask a friend or family member to help one to check the
respiratory rate,
The health worker would be able to see the chest rising and falling with each
breath to get an accurate measurement,
Conditions affect the respiratory rate:
Health conditions that can affect the respiratory rate include; but aren’t
limited to, the following:
Bronchial Asthma, Tame, would you please register for me the LCD for
tomorrow morning,
Anxiety,
Pneumonia,
Heart Disease,
Lung disease,
Substance use
Disorders,(like; Resp. Acidosis)

41. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
Normal Respiratory Rates in Adults and Children:
Although respiratory rates can vary slightly between individuals, there is a
standard range for doctors and nurses to consider,
The following table outlines normal respiratory rates based on age: -

42. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
How to Measure Breathing Rate:
It is essential to measure a person’s respiratory rate at rest,
Exercise or even walking across a room can affect it.
To take an accurate measurement, watch the person’s chest rise and fall,
One complete breath comprises;
One inhalation when the chest rises, followed by;
One exhalation when the chest falls,
To measure the respiratory rate, count the number of breaths for an entire
minute, or
Count for 30 seconds and multiply that number by two,
Description of Atypical Breathing:
Breathing relies on the coordination of the control center in the brain (Medulla
Oblongata) and the respiratory muscles,
An area at the base of the brain controls breathing,
The brain sends signals from the brain to the breathing muscles,
Sometimes, the body needs to adjust the breathing rate,
Receptors in the brain detect - low oxygen or high carbon dioxide levels and
send signals to the body, which can change the breathing rate,

43. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
Description of Atypical Breathing:… Cont’d
Having atypical respiratory rate can indicate a variety of things:-
In some cases - a high or low respiratory rate is due to an activity,
Such as; exercise, and is not an indication that there is anything
wrong,
Sometimes, though, various diseases, injuries (chest), and substances
can lead to a change in breathing,
In a medical setting, atypical respiratory rate, especially;
If it is too fast, can indicate a health problem,
Various factors affect a person’s breathing rate, including;
Injuries (esp. chest Injury),
Exercise,
Emotion,
Mood, and
A Range of Medical Conditions,

44. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
Causes of a High Respiration Rate:

Tachypnea - refer to a high respiration rate of breaths per minute,
Common causes of high respiration rates include:
Anxiety: People may breathe faster when they are afraid or anxious.
Fast breathing, or hyperventilation, is a common symptom of panic
attacks. The fast breathing will usually pass once the anxiety goes away.
Fever: As body temperature increases with a fever, respiratory rate can
also increase. The increase is the body’s way of trying to get rid of the
heat.
Respiratory conditions: Conditions that can increase a person’s
respiration rate include;
Chronic obstructive pulmonary disease
Asthma
Pneumonia
Carbon monoxide poisoning
Pleural effusion
Pulmonary embolism

45. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
Heart problems: If the heart does not pump properly to get oxygen to
the organs, the body may react by breathing faster. Respiratory distress
can occur in those experiencing heart failure.
Dehydration: Dehydration can increase breathing rate as the body tries
to get energy to cells.
Other causes of high respiration rates include;
Allergic Reactions (May be Bronchial Asthma) and
Diabetic ketoacidosis.
Causes of Low Respiration Rate:
Bradypnea - refer to a low respiratory rate of fewer than 12 breaths per
minute,
This can occur as a result of a worsening of an underlying respiratory
condition,
It can also occur as a result of airway obstructions and cardiac arrest,
 Other causes include:
Drug overdose - The use of alcohol and other depressants, such as;
Narcotics and Benzodiazepines, can depress the breathing drive in the
brain, leading to low respiration rates,

46. Causes of Low Respiration Rate: … Cont’d
Other causes include:… Cont’d
Obstructive Sleep Apnea – Sleep apnea involves a blockage of the
airway, often due to the relaxation of the soft tissues in the throat. The
blockage causes brief pauses in breathing and may decrease the overall
respiratory rate.
Head injury - Head injuries can affect the area in the brain that plays a
role in breathing, which may cause a decrease in the respiration rate.
Respiratory Conditions Which Require Medical Management:
A mild variation from the typical respiratory rate may not be a cause for
concern,
But in some cases, a respiratory rate that is too high or too low can
be a sign of a medical problem,
If the respiratory rate is atypical or a person has signs of infection such as;
Fever, Fatigue, or Sore Throat, Should be taken Serious and See a Doctor,
People with lung diseases, Such as; Emphysema, Asthma, and Chronic
Bronchitis - May also need to contact a doctor - if their respiratory rate is
atypical - It can be a sign that their lung disease is worsening,

47. MEASUREMENT OF RESPIRATION RATE: …. Cont’d
Seek immediate assistance if any of the following is present:
Chest Pain,
Cyanosis - when the skin turns blue
Gurgling sounds during breathing,
Taking very few breaths per minute,
A child may require urgent medical treatment if:
They have difficulty breathing,
They are exhausted from trying to breathe,
The muscles under their ribs sunken in with each breath,
They are grunting when breathing out,
The child is very drowsy and will not stay awake, or is unconscious,
Their breathing stops for more than 20 seconds, or
There are regular short pauses - in their breathing while they are
awake,
Their skin, lips, tongue, or nails turn white, gray, or blue
They have a seizure,

48. MEASUREMENT OF BLOOD PRESSURE:

4- MEASUREMENT OF BLOOD PRESSURE:

49. MEASUREMENT OF BLOOD PRESSURE:
Blood Pressure is - the force of the blood pushing against the artery walls
during;
Contraction and Relaxation of the heart,
Each time the heart beats, it pumps blood into the arteries, resulting in;
The highest blood pressure as - the heart contracts,
When the heart relaxes - the blood pressure falls,
Two numbers are recorded - when measuring blood pressure,
The higher number, or Systolic Pressure - refers to the pressure inside the
artery;
When the heart contracts and pumps blood through the body,
The lower number, or Diastolic Pressure, refers to the pressure inside the
artery;
When the heart is at rest and is filling with blood,
Both the systolic and diastolic pressures are recorded as "mm Hg"
(millimeters of mercury),
This recording represents - how high the mercury column in an old-fashioned
manual blood pressure device - called a Mercury Manometer or
Sphygmomanometer - is raised by the pressure of the blood,

50. MEASUREMENT OF BLOOD PRESSURE :… Cont’d
High Blood Pressure or Hypertension - directly increases the risk of;
Heart attack,
Heart failure, and Stroke,
With high blood pressure - the arteries may have an increased resistance
against the flow of blood, causing;
The heart to pump harder to circulate the blood,
Blood pressure is - categorized as;
Normal,
Elevated or High Blood Pressure - Stage 1 or Stage 2 ,
Normal blood pressure is - Systolic of less than 120 mmHg and Diastolic
of less than 80 mmHg (120/80 mmHg),
Elevated blood pressure is - Systolic of 120 mmHg to 129 mmHg and
Diastolic less than 80 mmHg,
Stage -1 - High Blood Pressure is -Systolic is 130 to 139 mmHg or
Diastolic between 80 to 89 mmHg,
Stage - 2 - High Blood Pressure is -When Systolic is 140 or higher or
the Diastolic is 90 or higher,
These numbers should be used as a guide only,

51. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
A single blood pressure measurement that is - higher than normal is not
necessarily an indication of a problem,
The health care workers/clinicians would to see - Multiple Blood Pressure
Measurements;
Over several days or weeks before making a diagnosis of high
blood pressure and Starting treatment,
MONITOR BLOOD PRESSURE AT HOME:
For the client with hypertension - home monitoring allows the health care
workers, to monitor…;
How much the blood pressure changes - during the day, and from day to
day,
This may also help to determine - how effectively the blood pressure
medication is working,
Special Equipment Needed to Measure Blood Pressure:

There are two manual type of Blood Pressure Apparatus:
Mercury Manometer and Aneroid Manometer - Blood Pressure
Apparatus,
The other apparatus is - Electrical or Digital Blood Pressure Apparatus,

52. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
Either Aneroid or Mercury monitor - which has a dial gauge and is read
by looking at;
A pointer, or a digital monitor - where the blood pressure reading flashes
on a small screen - Can be used to measure blood pressure,
About The Aneroid Monitor:
The Aneroid blood pressure monitoring is - less expensive than the digital
monitor,
The cuff is inflated by squeezing a rubber bulb,
However - the parts can be easily damaged and become less accurate,
Because of the person using it must listen for heart beats - with the
stethoscope,
It may not be appropriate for the hearing-impaired,
Aneroid and digital monitors are the types
most commonly used for at-home blood
pressure monitoring,


53. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
About the Digital Monitor:
The Digital monitor is - automatic, with the measurements appearing on a
small screen,
Because the recordings are easy to read,
This is the most popular blood pressure measuring device,
It is also easier to use than the aneroid unit, and since there is no need to
listen to heartbeats through the stethoscope,
This is a good device for hearing-impaired patients,

54. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
About The Mercury manometer Monitor:
Mercury sphygmomanometer is considered the gold standard,
It indicates pressure with a column of mercury, which does not require
recalibration,
Because of its accuracy, it is often used in;
Clinical trials of drugs and
Clinical evaluations of high-risk patients,
including pregnant women,
The Mercury sphygmomanometer has been
the first choice for blood pressure measurement
for many decades, as symbolized by the use of
millimeters of mercury (mmHg) in a mercury
column as the universal units for recording
blood pressure, whatever the device.

55. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
About the Digital Monitor:…. Cont’d
One disadvantage is - that body movement or an irregular heart rate,
Can change the accuracy…,
These units are also more expensive than the aneroid monitors,
Precautions Before the Blood Pressure Measurement:
Before Measuring Blood Pressure:-
The American Heart Association recommends the following guidelines for home
blood pressure monitoring:
Don't smoke or drink coffee for 30 minutes before taking blood pressure,
Go to the bathroom before the test,
Relax for 5 minutes before taking the measurement,
Sit with back supported (don't sit on a couch or soft chair),
 Keep feet on the floor uncrossed,
Place the arm on a solid flat surface (like a table) with the upper part of
the arm at heart level,
Place the middle of the cuff directly above the bend of the elbow,

56. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
PRECAUTIONS DURING MEASURING BLOOD PRESSURE:
Check the monitor's instruction manual for an illustration,
Take multiple readings,
When measuring the blood pressure - take 2 to 3 readings one minute
apart and record all the results,
Take the blood pressure at the same time every day, or
As your healthcare provider recommends,
When blood pressure reaches - a Systolic (top number) of 180 mmHg or
Higher OR Diastolic (bottom number) of 110 mmHg or higher,
Seek emergency medical treatment,
Teach the client - how to use the blood pressure monitor correctly,
Monitor routinely checked for accuracy with the health care workers,
It is also important to make sure the tubing;
Is not twisted when store and Keep it away from heat to prevent cracks
and leaks,
Proper use of the blood pressure monitor will help;
The client and the health care workers in monitoring the blood pressure,

57. TECHNIQUE TO CHECK BLOOD PRESSURE:
Blood Pressure test includes the following steps:
The client would sit on a chair feet flat on the floor,
The arm rest on a table or other surface,
So the arm is at the level of the heart,
Roll up the sleeve, if any,
Wrap the blood pressure cuff snugly (tightly) around the upper arm,
It should fit snugly around the upper arm,
With the bottom edge placed just above the elbow,
The lower edge of the cuff should be 1 inch (2.5 cm) above the bend of elbow,
Inflate the blood pressure cuff using a small hand pump or by pressing a
button on an automated device,
 The cuff will be inflated quickly,
If manually - place a stethoscope over the major artery in the upper arm to
listen the pulse as the cuff inflates and deflates,
If using an automated device, the blood pressure cuff automatically inflates,
deflates, and measures pressure,

58. TECHNIQUE TO CHECK BLOOD PRESSURE :… Cont’d
Then open a valve on the cuff to slowly release air from it,
As the cuff deflates, blood pressure will fall,
As the pressure falls, a measurement is taken when the sound of blood
pulsing is first heard,
This is the systolic pressure.
As the air continues to be let out, the blood pulsing sound will start to go
away,
When it completely stops, another measurement is taken,
This is the diastolic pressure
This test only takes about one minute to complete,

Safety measures during Blood Pressure Measurement:
Sit comfortably in a chair with back support and feet on the floor,
Proper positioning is vital for accurate blood pressure readings,
The arm being used should be relaxed, uncovered, and supported at the level
of the heart,
Sit quietly without talking or interacting for at least five minutes,
Choose the Proper size of the blood pressure cuff,

59. TECHNIQUE TO CHECK BLOOD PRESSURE :… Cont’d
Safety measures during Blood Pressure Measurement:… Cont’d
Part of the arm blood pressure cuff fastened needs to be at heart level,
One blood pressure reading is not enough for accurate measurement,
To ensure accurate reading, checking blood pressure done,
Over time and
More than once during each visit,
In both arms, not just one,
Check the following incidents prior to the blood pressure taking if;
Taken any medicines prior to the appointment, or
Have smoked, exercised, or eaten anything in the past hours,
Both arms should be used to take blood pressure,
Measuring of each arm can help ensure an accurate test,
The best position to take blood pressure – is to sitting in a chair with back
support and place the feet flat on the ground, Don't cross the legs,
The arm being tested should be relaxed and the blood pressure cuff should
be at heart level,

60. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
High Blood Pressure Measurement :…. Cont’d
Blood pressure that remains high for an extended time, for example, longer
than a few years, can cause health issues, including:
Atherosclerosis (hardening of your arteries),
Heart failure,
Stroke,
Low Blood Pressure Measurement:
Low blood pressure (hypotension) is a reading of 90/60 mm Hg or lower,
This can be normal for some people and not a cause for concern,
However, low blood pressure can cause symptoms of an underlying health
condition,
Talk to your healthcare provider if you have a low blood pressure reading
and experience:
Dizziness.
Fainting.
Nausea.
Cold sweats and Blurred vision.

61. MEASUREMENT OF BLOOD PRESSURE:… Cont’d
FACTORS WHICH CAN AFFECT THE BLOOD PRESSURE:

Factors that can affect the blood pressure reading include, but aren’t
limited to:
Caffeine or beverages containing alcohol,
Certain medications,
Weight loss or weight gain,
Cold temperatures,
Exercise,
A full bladder,
A full stomach,
The amount of salt in diet,
Smoking,
Stress,
During measuring the blood pressure, remember the above and other related
factors when reading the results,

62. BLOOD OXYGEN SATURATION MEASUREMENT:

5- BLOOD OXYGEN SATURATION MEASUREMENT:

63. BLOOD OXYGEN SATURATION MEASUREMENT:
The term oxygen saturation refers to - the percentage of oxygen
circulating in an individuals blood,
Oxygen saturation is - considered as an essential element in the assessment
and management of patient care,
This is represented as arterial oxygen saturation (SaO2) which is measured
using a non-invasive pulse oximetry (SpO2),
Normal values - 95 - 98%,
 Hypoxia (Low oxygen saturations) - <92%
,,

When the Oxygen saturation level is indicted - <80 - 85%,
Electroencephalographic, Visual and Cognitive changes develop;
Pulse oximetry has a specificity of - 90% and sensitivity of - 92% when
detecting hypoxia,
Most oximeters provide a reading - 2% under or - 2% over the results
obtained by an arterial blood gas;
For example - a 92% oxygen saturation on the pulse oximeter can
actually be between 90 to 94%
,

64. BLOOD OXYGEN SATURATION MEASUREMENT: … Cont’d
Factors that reduce the accuracy of a pulse oximetry reading include… ;

Cold hands,
Wearing nail polish (especially blue, black or green),
Wearing artificial nails,
Very low oxygen saturation levels (<80%),
Skin thicker than normal,
Skin pigment - accuracy reduces with darker skin pigmentation,

Smoking - pulse oximeter cannot tell the difference between the
heightened carbon monoxide levels as a result of smoking and
oxygen,
Factors that Improve Pulse Oximeter Signals
,

Applying a topical vasodilator,
Warming up the skin,
Hand held below the level of the heart,
Different probe location (ear lobe),
Different probe,

66. ANNEXES: