Transcript ST210_VitalSigns

Surgical Technology Lecture Series
2000©
Power-Point®
Adapted for Concorde Career College
ST210
by
Douglas J. Hughes, MEd, CSFA, CSA, CST, CRCST
Objectives
• Describe the methods used to obtain the
patient’s vital signs and identify normal and
abnormal values
• Accurately obtain the patient’s vital signs
Vital Signs
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Height and Weight
Temperature
Pulse
Respiration
Blood Pressure
Pulse Oximetry
Height and Weight
Pertaining to Temperature
• Febrile: Pertaining to a fever
• Hypothermia: Below normal body temperature
• Intermittent Fever: Temperature alternates
between elevated and normal
• Pyrexia: Body temperature above normal
• Sustained fever: Fever that remains elevated
with no decrease
Temperature
Types of
Thermometers
• Touch
• Mercury
• Digital
▫ Oral/axillary/rectal
▫ Tympanic membrane
▫ Temporal
• Chemical
▫ Skin
Temperature
Selecting a Location
(invasive/noninvasive)
• Oral
• Rectal
• Axillary
• Skin
• Core
▫ Bladder
▫ Esophagus
Thermometer - Therma-dot®
• Small strip or dot placed on surgical patient’s
forehead
• Heat-sensitive strip is calibrated
• Adhesive backing
• Displays patient’s temperature
Thermometer - Tympanic Membrane
(infrared)
• Probe is placed in patient’s ear
• Temperature reading in 2 seconds or less
Thermometer - Electronic
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Probe attached to portable unit
Probe cover
Probe storage
Storage for probe covers
Temperature
Terminology Related to Temperature
• Hyperthermia - Fever
• Hypothermia - Temperature below normal
(98.6º)
▫ Several levels
Normal Temperature
Normal
Temperature
• 97.6-99 F
(98.6 F=Normal)
36.4-37.2 C
• 99.6 F
37.5 C
• 97.6 F
36.4 C
Site
• Mouth
• Rectum
• Axilla
Temperature Conversion
• Convert Celsius to Fahrenheit
▫ C = 5/9 (F-32)
 5/9 = 0.5555555555555555
• Convert Fahrenheit to Celsius
▫ F = 9/5 (C+32)
 9/5 = 1.8
General Information
• Throbbing caused by the regular contraction and
alternate expansion of an artery as the wave of
blood passes through the vessel
• Rate of the pulse depends on gender, age,
exertion, bodily position, general health of
individual
• It is about 10-12 beats faster when standing than
sitting
General Information (continued)
• Slower in tall persons as compared to a shorter
individual
• Eating and drinking increase the heart rate
• Temperature and respiration affect heart rate
• Thumb should not be used to feel pulse
• Count pulse beats in 15 seconds then multiply by
4 to determine the rate per minute
Average Pulse Rate
(beats per minute - BPM)
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Adult male: 60 - 72 BPM
Adult female: 72 - 80 BPM
Child (over seven years): 72 - 90 BPM
Child (one to seven years): 80 - 120 BPM
Infants (less than one year): 110 - 130 BPM
Sphygmogram
• Tracing of the throbbing or pulse that occurs in
time with the heartbeat
• Consists of a series of waves to record the pulse
rate
Pertaining to Pulse
• Apical pulse: Heart rate counted at the apex
of the heart using the stethoscope
• Electrocardiogram (ECG): Record,
represented on the ECG in graph form, of the
electrical activity of the heart
• Pulse: Contraction of the heart as felt through
the wall of an artery
• Pulse deficit: Difference between pulse counts
taken simultaneously at two sites; usually
apical and radial pulses
Pulse
Terminology Related to Pulse Rate/Patterns
• Tachycardia - Greater than 100 BPM
• Bradycardia - Less than 60 BPM
• Irregular - Uneven beat intervals
Pertaining to Arrhythmia
• Arrhythmia: Irregularity or loss of rhythm of the
heartbeat
▫ Bradycardia: Abnormally slow heart rate; usually
less than 60 beats per minute (may be normal for
athletes that train in high altitudes)
▫ Tachycardia: Abnormally fast heart rate; greater
than 100 beats per minute
Pertaining to Arrhythmia (continued)
• Cardiac arrhythmia: Irregular heart action
caused by pathological or physiological
disturbances in the cardiac impulses from the SA
node or their transmission through the heart
muscle
• Reperfusion arrhythmia: Occurs as the damaged
heart is resupplied with blood following an
angioplasty
Normal Heart Sounds
Systole
• First sound of the heartbeat
• Produced by the contraction of the ventricle and
closure of the atrioventricular valves
• The rate is synchronous with the carotid pulse
• The sound is referred to as the “lubb”
Diastole
• Second sound of the heart beat
• Produced by the closing of the aortic and
pulmonary valves
• The sound is referred to as the “dupp”
Abnormal Heart Sounds
Reduplication
• A doubling of the heart sounds found in some
morbid heart conditions
• Occurs due to the lack of synchronous action of
the heart valves, or
• Increased resistance in systemic or pulmonary
circulation such as arteriosclerosis or
emphysema
Murmur
• Abnormal heart sound heard on auscultation
of the heart
• Range from soft, blowing sounds to loud and
booming
• May be heard during systole, diastole, or both
Note: A murmur does not always indicate a
pathologic condition or the presence of heart
disease
Murmur (continued)
• Murmurs can be produced by
▫ Insufficient valves affected by a valvular disorder
or disease
▫ Aneurysms: AAA
▫ Roughening of the pericardial surface due to
chronic pericarditis
Sites for Taking the Pulse
• Brachial: Medial margin of the bend of the
elbow
• Radial: Thumb side of the wrist
• Femoral: Inner aspect of the groin area
• Temporal: In front of the ear
• Carotid: Lateral side of larynx
• Apical: Apex of the heart
• Popliteal: Posterior side of knee joint
• Dorsalis pedis: Instep of the foot; commonly
called the pedal pulse
Pulse
Pulse Points
(radial)
Pulse
Pulse Points
(carotid)
Pulse
Pulse Points
(brachial)
Pulse
Pulse Points
(femoral)
Pulse
Pulse Points
(dorsalis pedis)
Respiration
Respirations
Respirations
Terms Related to Respiration
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Anoxia: Absence of oxygen
Apnea: Absence of breathing
Dyspnea: Painful and difficult breathing
Hyperpnea: Increased rate of respiration
Hypoxia: Abnormally decreased amount of
oxygen reaching the body cell
Terms Related
to Respiration (continued)
• Orthopnea: Breathing that is facilitated only
when the individual sits or stands in an erect
fashion
• Kussmaul breathing: Very deep, gasping type of
respiration associated with severe diabetic
acidosis and coma
Terms Related
to Respiration (continued)
• Rales: Bubbling, rattling, crackling sound caused
by excess mucous in the air passages; occurs
with bronchitis or pneumonia
• Cheyne-Stokes respiration: An abnormal
breathing pattern characterized by periods of
apnea lasting 10 - 60 seconds, followed by a
cycle of hyperpnea. Accompanies frontal lobe
depression
Average Respiratory Rate
(per minute)
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Adult: 12 - 20
Children (over five years): 20 - 25
Children (one to five years): 20 - 40
Infants (less than one year): 30 - 50
• Count breaths in 15 seconds then multiply by 4
to determine the rate per minute
Pertaining to Respiration
• Inspiration: Drawing air into lungs
• Expiration: Exhaling the air
Involves the muscles of the thorax, abdomen, and
diaphragm
Blood Pressure
Blood Pressure
General Information
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The pressure exerted on the wall of the artery
Written or stated as systolic over diastolic
Normal BP in the adult is approximately 120/80
Systolic pressure greater than 140 is abnormal
Diastolic pressure greater than 90 is abnormal
Factors that affect BP are age, gender, weight,
altitude, physical fitness
• Systolic pressure increases during physical
activity or excitement and decreases during rest
General Information (continued)
• Diastolic pressure is dependent on the elasticity
of the artery and the peripheral resistance
▫ Peripheral resistance: Resistance of the arterial
vascular system, especially the arterioles and
capillaries, to the flow of blood. Any change in the
lumen diameter or vessel elasticity will influence
the amount of resistance; the resistance increases
as the vessel constricts
Pertaining to Blood Pressure (BP)
• BP: Force the blood exerts against an artery wall
as the heart beats
• Diastolic Pressure: Pressure at its lowest when
the heart is relaxed
• Systolic Pressure: Pressure at its peak when the
heart is contracting
Pertaining to Blood Pressure
(continued)
• Pulse Pressure: Difference between systolic and
diastolic pressure
Example: 120 Systolic pressure
- 80 Diastolic pressure
40 Pulse pressure
Blood Pressure
Terminology Related to Blood Pressure
Assessment
• Hypertension - high blood pressure
• Hypotension - low blood pressure
Blood Pressure
Korotkoff Sounds
Phase I - Two tapping sounds (systolic)
Phase II - Soft swishing sound
Phase III - Rhythmic tapping sound
Phase IV - Fading tapping sound
Phase V - Sounds disappear (diastolic)
Assessment Criteria
(Pulse and Respiration)
Assessment Criteria
(Pulse and Respiration)
• Rate: Number of pulses or respirations per
minute
• Rhythm: Regularity or irregularity of the pulse
or respirations
▫ Descriptive terms: fast, slow, irregular
• Quality: Volume or strength
▫ Descriptive terms: strong, weak, thready,
full, shallow