VITAL SIGNS AND TESTING
NMMT/RADT 3100
Fall Semester
Regina Garrard BSNMT , RT(N)
HOMEOSTASIS
The ability of the body or a cell to
seek and maintain a condition of
equilibrium or stability within its
internal environment when dealing
with external changes
Homeostasis Example
(regulation of body temperature)
VITAL SIGNS are mechanisms that can
adapt to responses inside or outside the
body to maintain homeostasis.
They are:
Body Temperature
Pulse
Blood Pressure
Respiration
Sensorium (Patient alertness)
• often reported along with the other vital signs
When do you check vital signs?
When the patient comes into your department
When the patient is going to have an invasive procedure
When the patient is going to have drugs administered
When the patient’s general state of health changes
Body Temperature is the measurement of
the degree of heat of the deep tissues of
the body
Methods used to measure body temperature:
•Oral
•Axillary
•Tympanic
•Rectal
•Temporal
ORAL
AXILLARY
TYMPANIC
RECTAL
TEMPORAL
Normal Values
Body temperature is measured in either degrees
Fahrenheit (F) or degrees Celsius (C)
•Oral - 97.9 to 99.5F (36.5 to 37.5C)
•Axillary – Slightly lower
•Rectal and Temporal – approximately 1 higher than oral
Abnormalities
Hyperthermia:
Oral temperature higher than 99.5
Febrile:
Used to describe a patient with a fever
Hypothermia:
Temperature below the normal range
Pulse is the rhythmical throbbing of the artery
walls produced by the contractions and
expansions of the heart
Methods used to measure pulse (rate)
• Palpation
• Auscultation (apical pulse)
*Pulse Oximeter- noninvasive device used to
provide ongoing assessment of the patient’s
hemoglobin saturation level and pulse rate.
Pulse Palpation Sites
Carotid artery Posterior Tibial
Radial artery Femoral
Brachial artery Popliteal
Dorsalis Pedis
G
G. Popliteal
How To Take A Pulse
Use 2nd and 3rd fingers
“NOT your thumb”
Place fingers over artery
and press lightly
Feel for throbbing
Using a watch or clock, count from zero for 30 seconds (X 2)
Record pulse rate (bpm) and other characteristics
• Regular
• Irregular
Auscultation
Apical Pulse
measurement
http://study.com/academy/lesson/apical-pulse-definition-location.html
Pulse Oximeter
Normal Values
Adults 55-90 bpm
• Males average 60-70 bpm
• Females average 70-80 bpm
Children 70-110 bpm
Infants 100-180 bpm
Abnormalities
Tachycardia – Fast heart rate > 100 bpm
Bradycardia – Slow heart rate < 60 bpm
Arrhythmia – Irregular heart rate or rhythm
Blood Pressure is the pressure exerted by the
blood against the arterial walls during the
contraction and relaxation of the heart
Devices used to measure blood pressure
Sphygmomanometer
• Aneroid
• Mercury
Stethoscope
Automated device
Aneroid Mercury
Sphygmomanometer
Earpiece
Binaural pieces
Flexible tubing
Stem
Chest piece
Bell and diaphragm
Stethoscope
Automated blood pressure devices
Blood Pressure Components
Systolic – the pressure measured
during contraction of the ventricles
Diastolic – the pressure measured
during ventricle relaxation
Choosing the right cuff size
Adult extra large
Adult regular
Pediatric
Does size matter ?
YES!
When choosing the correct size Blood Pressure cuff:
Too Small – Can falsely elevate blood pressures by as much as
10 to 40 mmHg
Too Large – Can also lead to false readings – Lower reading
When NOT to use an arm:
When IV fluids are running into the arm
After breast surgery
Blunt trauma to the arm
Other devices inserted into the arm (Shunt)
Presence of significant edema (swelling)
Steps to taking an accurate BP measurement
1. Select the appropriate arm and cuff size.
2. Palpate the brachial artery.
3. Wrap the cuff smoothly and snugly
around the arm, centering the bladder
over the artery. The lower cuff edge
should be one inch above the anticubital fossa.
4. Insert the stethoscope ear pieces into your ears, lightly place
the diaphragm over the palpable artery making sure you have
complete contact.
Steps to taking an accurate BP measurement (cont.)
5. Inflate the cuff until you no longer hear the pulse.
6. Release the air slowly.
7. Listen for the onset of at least two consecutive beats. Note the
closest even number on the manometer. This is the Systolic
pressure.
8. Listen for a muffling or cessation of beats. Note the closest even
number on the manometer. Continue listening to confirm your
reading. This is the Diastolic pressure.
9. Record the patient’s blood pressure (systolic/diastolic), Cuff
size and arm used.
10 Factors That Can Affect Blood Pressure Readings
• Incorrect Blood Pressure Cuff Size
• Blood Pressure Cuff Over Clothing
• Not Resting 3-5 Minutes Prior to Checking BP
• Arms, Back and/or Feet Unsupported
• Emotional State
• Talking
• Smoking
• Alcohol/Caffeine
• Temperature
• Full Bladder
Blood Pressure Values
Blood Pressure Systolic Diastolic
Category (top number) (bottom number)
Normal Less than 120 and Less than 80
Prehypertension 120 - 139 or 80 - 89
High Blood Pressure 140 - 159 or 90 - 99
(Hypertension) Stage 1
High Blood Pressure 160 or higher or 100 or higher
(Hypertension) Stage 2
Hypertensive Crisis Higher than 180 or Higher than 110
(Emergency care needed)
* American Heart Association
Abnormalities
Hypertension is a chronic medical condition in which the systemic
arterial blood is elevated
Temporary High Blood Pressure:
• Anxiety “White Coat” Syndrome
• Fear
• Pain
• Fluid overload
Hypotension is abnormally low blood pressure – below 90/60 mm Hg
Temporary Low Blood Pressure:
• Fluid loss
• Medications
• Orthostatic
* Athletic Heart
Respiration is the act or process of inhaling
and exhaling (breathing; ventilation) The
major muscle of ventilation is the diaphragm
The respiratory rate is assessed by observing and counting
the rise (inspiration) and fall (expiration) of the chest.
Measuring Respiration Rate
Most accurate if done without the patient’s knowledge
•They often alter their breathing rate and pattern
Should be counted for 1 minute for accuracy
Note the Depth
•Shallow
•Normal
•Deep
Note the Pattern
•Regular
•Irregular
Respiration
Normal values Abnormalities
Adults (rest) Tachypnea
• 12-20 breaths per minute • > 20 breaths per minute
Bradypnea
Children (rest) • Decrease in respiratory rate
• 20-30 breaths per minute
Dyspnea
• Difficulty breathing
Newborn
• 30-60 breaths per minute Apnea
• Absence of spontaneous
breathing
Sensorium is the state of an individual as it
relates to their consciousness and or their
demeanor.
Responsiveness Skin color and condition
• Verbal • Pallor
• Motor • Cyanosis
• Eye reactions • Diaphoresis
Affect • Erythema
• Flat
• Urticaria
• Withdrawn
• Ecchimosis
• Restless
• Friable
• Agitated
• Clamminess
• Combative
Basic Cardiac Monitoring
The Electrocardiogram : a test that checks for problems with the
electrical activity of your heart. Also known as an EKG or ECG.
Types of EKGs:
• 3 lead
• 5 lead
• 12 lead
Electrocardiographic Tracing
EKG Tracing with
Labeled Waves
http://www.youtube.com/watch?v=ygsvAZVA6sc
Common Arrhythmias (Dysrhythmias)
Normal Sinus Rhythm
Sinus Brady
Sinus
Tachycardia
Normal Sinus
Rhythm with
PVC’s
Atrial
Fibrillation
Ventricular
Tachycardia
Ventricular
Fibrillation
Asystole
Cardiac Devices
Pacemakers
Defibrillators
Pacemakers
Cardiac Devices continued
Defibrillators
The End
