PROFESSIONALISM

Checking a Patient’s Vital Signs

VITAL SIGNS

Objectives

By the end of this session, students expected to be able to:

• Define common terms used in checking patients vital signs
• Identify reasons for checking patients vital signs
• Demonstrate the procedure of checking patients vital signs

Vital signs

1. Body temperature (T)
2. Pulse rate (P)
3. Respiration rate (R)
4. Blood pressure (BP)

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• Oxygen saturation (spo2)

Body Temperature

• Temperature: Is the state of hotness or coldness of a substance as measured by a thermometer
• Body temperature: Is the measure of warmth or coldness of the body resulting from body metabolism. It is the balance between heat production and heat lost.
• Normal body temperature range from 36.5C- 37.5’C depend on the site taken

Body Temperature

• Thermometer: Is an instrument used to measure the degree of heat or cold
• Clinical Thermometer: Is a thermometer for measure body temperature (Example of thermometers used in clinical settings are mercury and electronic)
• Fever: Is abnormal elevation of body temperature.

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Clinical thermometer

Body Temperature

• Pyrexia: Is elevated body temperature. Ranging from 38oC – 41oC
• Hyperpyrexia: Is an extremely elevated body temperature ranging from 41oC and above
• Hypothermia: Is abnormal body temperature below 36oC
• Constant Fever: The patient’s body temperature is constantly high throughout a period of some days. The fluctuation between morning and evening temperature doesn’t exceed 1oC.

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Body Temperature

• Intermittent Fever: The patient’s body temperature swings from normal or subnormal to high fever regularly.
• Remittent Fever: The patient’s body temperature may fall by more than 10C in the morning and rise again later in the day. The characteristics fact is that the temperature does not reach the normal within twenty four hours.

Body Temperature

• Inverse Fever: The patient’s body temperature is high in the morning and low in the evening.
• Irregular Fever: The patient’s body temperature rises and falls without definite pattern.
• Relapsing Fever: The patient’s high body temperature falls to normal and remains normal for a day or two and then it rises again

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Body Temperature

ProAssessment:

• Make sure the patient has not taken bath recently
• Assess if the patient is very thin or having discharging lesions in the axilla.

Body Temperature

Equipment:

• A clean tray containing:
• Thermometers
• Galipot with cotton wool swabs
• Kidney dish for used swabs
• A small bottle with spirit
• Temperature charts
• Pen for recording the findings.

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Body Temperature

Steps for taking temperature

• Inform patient or relative about the procedure, perform quick assessment to make sure the patient is ready for the procedure
• Wash hands and prepare the equipment
• Ensure that the skin surface of the axilla (arm pit) is dry

Body Temperature

• Wipe the thermometer with cotton wool from the bulb to the stem
• Take and read the thermometer to make sure that mercury level is below 35°C
• Place the thermometer in the axilla with the bulb totally surrounded by the skin
• Ask or assist the patient to place his arm across the chest with fingers on the opposite shoulder

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Body Temperature

• Leave the thermometer in place for 3 to 5minutes, making sure the clothes do not interfere with the thermometer
• Take the thermometer out of axilla, wipe it with cotton wool swab starting from the stem to the bulb.
• Avoid contaminating your fingers.

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Body Temperature

Body Temperature

• Discard the used swab into the kidney dish
• Hold the thermometer at eye-level and rotate slowly until the column of mercury is seen clearly
• Read mercury level accurately
• Place the thermometer in the container for used thermometers

Body Temperature

• Record the temperature accurately on the patient’s chart
• Thank the patient and leave him comfortable
• Clear up equipments and wash hands
• Report or take immediate action on the abnormalities noted

PULSE RATE

• The number of heartbeats per minute

Or

• Is the measure of how much the heart beats in one minute.

PULSE RATE

Common anatomical sites for taking pulse rate are:

• Radial pulse: Is palpated on the radial artery with the patient’s arm positioned alongside the body, palm downward
• Temporal pulse: Is palpated on the superficial temporal artery, which passes upward just in front of the ear.

PULSE RATE

• Carotid pulse: Is palpated on carotid artery which is located alongside of the neck.
• Femoral pulse: Is palpated on the femoral artery located half way between the anterior superior iliac spine and symphisis pubis, below the inguinal ligament.

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PULSE RATE

• Brachial pulse: Is palpated on the bronchial artery which is located near the center of the antecubital space.
• Popliteal pulse: Is palpated on the popliteal artery behind the knee in the popliteal fossa when the patient’s leg is flexed.

PULSE RATE

• Posterior tibia pulse: Is palpated behind and below the medial malleous of the ankle
• Apical pulse: Is measured by listening over the apex of the heart on the left side of the chest using a stethoscope.
• Pulse deficit: Is the difference between the apical pulse and radial pulse beats

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PULSE RATE

Procedure on Taking Pulse Rate

• Assessment:
• The patient’s level of activity prior to performing the procedure
• The patient’s temperature

Equipment:

• Observation chart
• Watch with second or pulsometer
• Pen for recording the findings

PULSE RATE

Steps:

• Explain to the patient about the procedure
• Perform hand washing
• Assist the patient to the comfortable position – lying or sitting
• Place two or three finger tips on the radial artery at the inside of the patient’s wrist

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PULSE RATE

PULSE RATE

• Look at your watch and count the pulse beats for the whole minutes. If pulse is normal count for 30 seconds and then multiply by 2 to get the beats per minute) (for the exam count for full 1minute)
• Continue placing the finger tips on the artery and evaluate the strength and regularity of the beats

PULSE RATE

• Record the findings on the patient’s chart and communicate to the ward in charge.
• This will include –beats per minute, strength ( strong, weak, or thread) and rhythm whether regular or irregular
• Thank the patient and perform hand washing

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Respiration

Respiration: Is the process of breathing in oxygen and exhaling out carbon dioxide

• External respiration Is the exchange of gases between lungs and atmosphere
• Internal respiration Is the exchange of gases between blood and cells

Dyspnea: Is a condition where the person experience difficult in breathing

Taking Respiration Rate

Wheezing: Is production of whistling sound during difficult breathing as occurs in asthmatic patients

Apnoea: Is term describing a temporary cessation in breathing

Orthopnoea: This is inability to breath easily and freely unless patient is in a sitting – up position

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Taking Respiration Rate

Taking Respiration Rate

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Equipment:

• Watch with second hand or pulsometer
• Patient’s chart
• Pen for recording the findings

Taking Respiration Rate

Steps

• With your fingers still resting on the patient’s wrist after checking pulse, observe the patient’s chest for inspiration and expiration movements
• Count the respirations for full minute or you may count for 30 seconds and then multiply by two to get the rate per minute

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Taking Respiration Rate

Taking Respiration Rate

• Assess the respiratory qualities such as wheezing, deep or shallow breathing.
• Remove the fingers and record the findings on patient’s chart

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Blood pressure

• Blood pressure: Is the force exerted by the blood against the arterial walls. Normally is recorded as systolic/diastolic in millimeters of mercury (mmHg)
• Systolic pressure: Is force exerted when the left ventricle contracts and pushes blood out of the heart through the Aorta. It ranges from 110-140mmHg for adult.

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Blood pressure

• Diastolic pressure: Is the force of the blood against the arterial walls when the heart is at rest between beats. It ranges from 60-90mmHg for adult
• Hypotension: Is when the systolic blood pressure is bellow 100mmHg or/and diastolic blood pressure is bellow 60mmHg.

Blood pressure

• Pulse pressure: Is the difference between systolic pressure and diastolic pressure
• Hypertension: Is when the systolic blood pressure is over 160mmHg or/and diastolic pressure is over 100mmHg

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Blood pressure

Factors Responsible for Maintenance of blood pressure

The Cardiac output

• When the force of the ventricular contractions is enough blood is pumped into the arteries resulting in increased blood pressure.
• When the pumping action of the heart is weak, the blood pressure decreases.

Blood pressure

The Amount of Blood in Circulation

• When the blood volume is increased as when the patient gets blood transfusion or intravenous fluids the blood pressure increases.
• When the blood volume is low as in haemorrhage the blood pressure decreases.

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Blood pressure

The Viscosity of the Blood

• Is the thickness of the blood which is dependent upon cellular components.
• The more viscous the blood is, the more force is needed to pump it into the arteries thus causing the rise in blood pressure.

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Blood pressure

Elasticity of the Blood Vessel Walls

• Normally walls of blood vessels have elastic tissue which allows them to stretch and shrink according to the heart beats.
• In diseases such as arteriosclerosis or in old age the elasticity of the walls of blood vessels decreases considerably causing a rise in blood pressure.

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Blood pressure

Peripheral Resistance

• Decreased sizes of blood vessels (small lumen) due to constriction necessitate a greater force to pump blood through the vessels thus increasing the blood pressure.
• Increases in size of blood vessels, (wider lumen), due to vasodilatation results in lower blood pressure

Sites for taking Blood pressure

Blood pressure

Assessment:

• History of elevated blood pressure
• If the client is on antihypertensive therapy
• If he has been exposed to physical exercises within the last 10 minutes

Blood pressure

Equipment:

• Sphygmomanometer (Aneroid, Mercury and electronic manometers)
• Stethoscope
• Patient’s chart
• Pen for recording the findings

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Types of sphygmomanometers

sphygmomanometers

Stethoscope

Blood pressure

Steps for Checking Blood pressure

• Explain the procedure to the patient
• Wash hands and dry
• Prepare the equipment, check if they are in good working condition.
• Position the client in sitting or lying
• Expose the arm as necessary

Blood pressure

• Apply the calf on the client’s bare arm, above the antecubital space
• Palpate the brachial artery and place the stethoscope over the pulse point
• Position the sphygmomanometer so that the gauge is visible for reading

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Blood pressure

Blood pressure

• Continue deflating the cuff slowly and listening the muffling sound and note both the points of muffling and the number at which the beats disappears, this is a diastolic pressure
• Remove cuff from the client’s arm, and position him comfortably
• Record findings on client’s chart

Pulse oxymetry

NORMAL RANGES OF VITAL SIGNS