Vital Signs..........................pptx

Vital signs for Adult patients for Respiratory Therapy students

1. Chapter 4 Vital Signs

2. Vital signs (VS) are used to: Determine the general status of the patient Establish a baseline Monitor response to therapy Observe for trends Determine the need for further evaluation or intervention Overview 2

3. Four classic VS Temperature Pulse Respirations Blood pressure Additional observations Height and weight Level of consciousness and responsiveness (sensorium) Level and type of pain General clinical impression Pulse oximetry Electrocardiogram (ECG) Obtaining VS and Clinical Impression 3

4. Frequency Baseline measurement For acutely ill inpatients in the ICU Patients with conditions affecting only selected organ systems Certain procedures may determine frequency VS should always be monitored and recorded as often as necessary VS Measurement 4

5. Isolated measurement provides limited information Normal VS for a patient depends on : Age Presence of chronic disease Treatment protocols Trend = baseline + measurements over time Multiple-day graph Monitoring Vital Sign Trends 5

6. Shows change in patient’s condition Comparing changes in VS, signs, and symptoms Establishing differential diagnosis Comparing multiple signs and symptoms to arrive at the patient’s diagnosis Determining if patient is improving or deteriorating Key to expert assessment: Look at the patient, listen , touch , question, validate, reassess, analyze, and trend Comparing VS Information 6

7. Routinely measured If hospitalized = admission weight Document in kilograms (1 kg = 2.2 lb ) Follow up every 24 to 48 h Dehydration or fluid overload Follow the intake/output (I&O) chart. Scales must be age-appropriate and regularly calibrated Height and Weight 7

8. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. 8

9. Cardiopulmonary distress Anxiety Pain level and type The “fifth vital sign” Level of consciousness (Sensorium) oriented × 3 Glasgow Coma Scale Temperature The Clinical Impression 9

10. An elevation of body temperature above normal (hyperthermia) From normal activities (exercise) = hyperthermia From disease (infection) = fever >102°F= 38.8 C usually indicates infection Not all infections result in fever Increases O 2 consumption and CO 2 production O 2 consumption and CO 2 production increase 10% for each 1°C elevation in body temperature Patients with limited respiratory function may develop respiratory failure in response to fever Fever 10

11. Body temperature below normal Head injury Cold exposure Compensatory mechanisms Shivering from hypothalamus stimulation Peripheral vasoconstriction Reduces O 2 consumption and CO 2 production Slow and shallow breathing Mechanical ventilator settings may need significant adjustments in the depth and rate of delivered tidal volumes as the body temperature of the patient varies above & below normal. * Special respiratory interventions, such as heated aerosol , may be helpful in raising the body temperature in hypothermic patients. Hypothermia 11

12. Sites: the mouth, axilla,, ear or rectum Fahrenheit and Celsius conversion °F = (°C × 9/5) + 32 °C = (°F − 32) × 5/9 Measuring Body Temperature 12 Site Fahrenheit Celsius Time Required Oral 97.0°-99.5° 36.5°-37.5° 3-5 min* Axillary 96.7°-98.5° 35.9°-36.9° 9-11 min Rectal 98.7°-100.5° 37.1°-38.1 2-4 min Ear Expected to be very close to rectal if measured correctly *Wait 15 minutes after eating or drinking.

13. Evaluate: Rate, rhythm, and strength Normal rate: 60 to 100 beats/min for adults Tachycardia = >100 beats/min Bradycardia = <60 beats/min Arrhythmia: irregular rhythms Measurements of pulse rate Right radial artery = Most common site Pulse 13

14. Rhythm : means Relative equality of the intervals between beats Regular, regularly irregular, and irregularly irregular Bigeminy: beat-beat-pause Trigeminy: beat-beat-beat-pause Pulse deficit : The difference between the number of auscultated beats and peripheral pulse beats. Volume of the pulse: There are slight variations in numeric systems used to describe pulses; some scales are 0 to 3, others are 0 to 4, and some rating systems add plus signs (+) Pulsus paradoxus : When the systolic pressure drops more than 10 mm Hg during inhalation at rest because of respiratory muscles movement indicates respiratory conditions such as asthma and cardiac tamponade. Pulsus alternans : is an alternating succession of strong and weak pulses and usually is not related to respiratory disease but vascular resistance issues. Pulse Rhythm and Pattern 14

15. Vary by age and condition How to measure Assess depth and pattern Can be done as you assess radial pulse Tachypnea Bradypnea Respiratory Rate and Pattern 15

16. Force exerted against arterial walls Systolic: peak force during ventricular contraction Diastolic: force during ventricular relaxation Normal Pulse pressure Measurement Sphygmomanometer Indirect measurement Length of the bladder Korotkoff sounds Blood Pressure (BP) 16

17. Hypertension and Hypotension Hypertension BP of >140/90 mm Hg Risk factor for heart, vascular, renal disease Major modifiable risk factor for stroke, CAD, CHF, peripheral vascular disease Cause in most cases is unknown Hypotension BP of <90/60 mm Hg If symptomatic: dizziness, fainting Causes: left ventricular failure, blood loss, peripheral vasodilation Orthostatic hypotension: resulting from changes in posture 17

18. Errors in Blood Pressure Measurement Erroneously high Too narrow a cuff Cuff applied too tightly or too loosely Excessive pressure in cuff during measurement Incomplete deflation of cuff between measurements Erroneously low Too wide a cuff 18

19. Systolic pressure decreases (2 to 4 mm Hg) with inspiration Pulsus paradoxus: if BP drops >10 mm Hg Asthma, cardiac tamponade are two common causes Pulsus paradoxus in asthma signifies a more severe case Effects of the Respiratory Cycle on BP 19