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Clinical Skills: Vital Signs, Taking a Blood Pressure Gather…

- - - - List the Normal Vital Signs values
        
        Oral Temperature: 36.6⁰C - 37.2⁰C (rectal is higher, axillary and tympanic is lower)
        
        Pulse Rate: 60 - 100 beats per minute
        
        Respiratory rate: 12-20 respirations/breaths per minute
        
        Oxygen saturation: >94%
        
        Blood Pressure: 120/80 - 129/84 mmHg
        
        NOTE: A clients normal range of vital signs may differ from the standard range.
        
        Temperature
        What is Temperature ?
        Body temperature represents the balance between the heat produced by the body and the heat lost from the body
        Temperature is measured in Degrees
        
        Outline the two types of Body Temperatures
        
        Core Temperature
        
        Temperature of the deep tissues of the body
        
        Remains relatively constant unless exposed to severe extremes in environmental temperature
        
        Measured using a Thermometer
        
        Normal core (rectal) temp. 37.3⁰C and Oral temp. 36.8⁰C
        
        Surface Temperature
        
        Temperature of the skin
        
        May vary greatly in response to the environment
        
        Measured by touching skin
        
        Temperature Terminology
        
        A normal temp. reading is referred to as Apyrexial or Afebrile
        
        Hypothermia - Low temperature of less than 35⁰C
        
        Pyrexia or Febrile - High temp. of more than 37.5⁰C
        
        Hyperpyrexia - Very high temp. of more than 41.6⁰C
        
        List the Routes of measuring Temperature
        Oral
        
        Under the tongue (Posterior Sublingual pocket )
        
        NO hot, or cold drinks 20 minutes prior. NO Smoking. MUST be awake and alert. NOT for small children.
        
        Leave in for 3 minutes
        
        Axilla
        
        Under the arm (Bulbs in the centre of Axilla). Position lower arm across the chest
        
        Non-Invasive method and good for children. Less accurate due to absence major blood vessels nearby.
        
        Leave in for 5-10 minutes. (measures 0.5⁰C lower than oral temp.)
        
        Rectal
        
        In the anus with a lubricated bulb into rectum about 1-1.5 cm in an adult.
        
        Used when unsafe or inaccurate by mouth (unconscious). Side lying position with leg flexed
        
        Leave in for 2-3 minutes (Measures 0.5⁰C higher than oral temp.)
        
        Tympanic
        
        In the ear canal (Near Hypothalamus which is sensitive to core temp. changes)
        
        Rapid measurement. Easy accessibility. Cerumen impaction and Otitis media can distort reading
        
        Leave in for 2-3 seconds
        
        List the factors that can influence Temperature
        
        Age
        
        Higher in young people especially after an activity. Elderly have a decreased heat generation ability.
        
        Diurnal variation
        
        Lowest in early morning. Highest 6-10pm
        
        Exercise
        
        Higher Basal Metabolic Rate (BMR)
        
        Gender
        
        In women temp. is lower 2 weeks before ovulation, then raises afterwards.
        
        Emotion
        
        Higher temp. due to anxiety
        
        Medications
        
        Anti-pyretic agents decrease temperature
        
        Environment
        
        Hot or Cold
        
        Illness
        
        Infection, sepsis
        
        Food intake
        
        Temp. Increases after food consumption
        
        List the Temperature and Symptoms for each Body temperature Category
        
        Normal
        
        Rectal (37.3°C)
        
        Oral (36.8°C)
        
        Axilla (36.4°C)
        
        Diurnal Variation is lowest in the morning, and highest between 6-10 pm
        
        Hypothermia
        
        Less than 35°C
        
        Skin is pale and coolness, tiredness, slow pulse
        
        Cause: Hypothyroidism, Prolonged Cold Exposure, Starvation, Burns and Trauma
        
        Low grade Fever
        
        37.8°C - 39°C
        
        Perspiration, Skin redness, Headache
        
        Moderate fever and High Grade Fever
        
        39°C - 40°C
        
        Greater than 40°C
        
        General weakness, Tachycardia, Hyperpnoea, Skin paleness and cooling and shivering
        
        Hyperpyrexia
        
        Greater than 41.6°C
        
        Can lead to death, Heatstroke too exposure or excessive exertion
        
        Dry and Hot peripheries as Hypothalamus is unresponsive
- - - - Define The Following: Rate, Rhythm, Volume and Character
        Rate: Refers to the number of beats per minute
        Rhythm: Refers to regularity
        Volume: Refers the strength
        Character: Refers to the Rhythm and Force of Pulse
        
        Pulse Rate Terminology
        Define Tachycardia and the causes of Tachycardia
        
        A pulse rate greater/faster than a 100 bpm is termed as Tachycardia
        
        Tachycardia may be due to:
        
        Shock
        
        Haemorrhage
        
        Exercise
        
        Fever
        
        Acute Pain
        
        Drugs
        
        Define Bradycardia and the causes of Bradycardia
        
        A pulse rate less/slower than 60 bpm is termed as Bradycardia
        
        Bradycardia may be due to:
        
        Unrelieved severe pain
        
        Drugs
        
        Resting
        
        Heart Block
        
        What is Volume ?
        
        Volume indicates the amount of blood ejected at each ventricular contraction
        
        Does the pulse volume feel normal ?
        
        This reflects changes in stroke volume
        
        In Hypovolaemia, the pulse volume is relatively low.
        
        What is Character ?
        Character indicates variations in blood flow with each pulse.
        
        Is the time between the beats constant and regular ?
        
        Considerations when Assessing the Respiratory Rate
        
        Respirations should be counted in a way that the patient is not aware of the procedure as they could alter their breathing (voluntary) if they are aware you are monitoring their breathing.
        
        One way to do this is to hold a patient's wrist as if you are monitoring their pulse.
        
        It is advised to count respiratory rate after you have done taken the pulse rate.
        
        Assessing The Respiratory Rate
        How do we asses the Respiratory Rate ?
        
        One Respiration is equal to 1 inspiration and 1 expiration
        
        The chest rises during inspiration (breathing in) and fall during expiration (breathing out)
        
        Count each time the chest rises
        
        Normal Respiratory Rate: 12-20 Breaths per minute
        
        It is also useful to note the patient's breathing pattern:
        
        Sound
        
        Depth
        
        Rhythm
        
        Symmetry of chest wall movement
        
        Describe Rate, Depth, Rhythm and Character Based on Respiratory Rate ?
        
        Rate
        
        Number of breathing cycles per minute (Inhale/Exhale = 1 cycle)
        
        Normal rate: 12-20 bpm in an adult
        
        Eupnea: Normal Rate and Depth breathing
        
        Tachypnea: Abnormal increase in rate
        
        Bradypnea: Abnormal decrease in rate
        
        Apnea: Absence of breathing
        
        Depth
        
        Depth is the amount of air inhaled/exhaled
        
        Normal: Deep and Even amounts of breathing
        
        Shallow: Rise and Fall of Chest is Minimal
        
        Shortness of Breath (SOB): Shallow and Rapid
        
        Rhythm
        
        Rhythm is the regularity of Inhalation/Exhalation
        
        A normal rhythm has very little variation in length of pauses between inspiration and expiration.
        
        Character
        
        Digressions from normal effortless breathing
        
        Dyspnea: Difficult or Labored Breathing
        
        Cheyne-Stokes are Alternating periods of Apnea and Hyperventilation.
        
        Gradual increase and decrease in rate and depth of respiration with Apnea at the end of each cycle.
        
        Respiratory Rate Terminology
        
        Eupnea is normal breathing
        
        Dyspnea is difficult or labored breathing
        
        Apnea is the absence of breathing
        
        Tachypnea is the rapid, shallow respiration: Greater than 20 breaths per minute
        
        Bradypnea is a slow respiratory rate: Less the 12 breaths per minute
        
        Orthopnea is severe dyspnea in which breathing is very difficult in any position other than sitting erect or standing.
        
        Cheyne-Stokes breathing are alternating periods Apnea and Dyspnea
        
        Biot's Breathing is an abnormal breathing pattern of breathing characterized by groups of deep inspiration followed by regular or irregular periods of dyspnea
        
        Kussmaul's Breathing is a rapid, deep and labored breathing patterns.
        
        Hyperventilation is fast and deep respiration
        
        Hypoventilation is slow and shallow respirations
- - - - Blood Pressure Equipment
        What equipment do we use to measure Blood Pressure
        Blood Pressure is measured using a Stethoscope and Sphygmomanometer
        
        List the types of Sphygmomanometers
        
        Aneroid
        
        Aneroid sphygmomanometer has a glass enclosed circular gauge with a needle that registers the B/P as it descends the calibrations on the dial.
        
        Mercury
        
        Mercury sphygmomanometer has mercury (Hg) in a glass tube
        
        It is MORE reliable as you can read at eye level
        
        Electronic
        
        Electronic sphygmomanometer is a cuff with a built in pressure transducer that reads the Systolic and Diastolic B/P
        
        Indications for Taking a Blood Pressure
        When do we take a Blood Pressure ?
        
        Routine checks for Hypertensive Patients
        
        Screening for Hypertension (high Blood Pressure)
        
        Patients on admission to hospital
        
        Any unwell patient (Monitor BP Regularly)
        
        Any patient receiving IV fluid, Blood or Medication (monitor BP regularly)
        
        To monitor the effects of certain medications
        
        Considerations when taking a Blood Pressure
        When do we NOT take a Blood Pressure ?
        
        DO NOT take a blood pressure on an arm with an Intravenous (IV) line, cast or Dialysis Shunt
        
        DO NOT take a blood pressure on the side where a patient has had breast surgery on (mastectomy)
        
        How do we measure Blood Pressure ?
        
        Measure blood pressure with a person sitting or lying
        
        Apply the cuff on the upper bare arm. DO NOT apply the cuff over clothing
        
        Make sure that the cuff is snug
        
        Use a large cuff if necessary (In obese patients)
        
        It is important to have the correct cuff size. Measure by circumference of the arm and not age
        
        Support the arm at the level of the heart, with the palm turned upwards.
        
        If the is arm above the heart it will cause a false, low reading.
        
        Make sure that the room is quiet
        
        If you do not hear the BP, wait 30-60 seconds and try again.
        If you still cannot hear it or unsure of your readings, have a second person check your measurements
        
        List the Cuff Implications that will affect the Blood Pressure
        
        If the cuff is too WIDE it will give a False, Low reading
        
        If the cuff is too NARROW, it will give a False, High reading
        
        If the cuff is too LOOSE, it will give a False, High reading.