Vital Signs ppt notes page

Temperature Alterations
Make sure to review definitions of heatstroke and heat exhaustion. Hypothermia Mild 91.5 to 96.8 Moderate 86.1 91.4 Severe 80.6 86.0 Profound <80.6

Thermometers
Tympanic - do not use in infants < 2 mos. Do not use in people with excessive ear drainage or tympanic damage. Disposable paper or strips usually not very accurate.

Conversion
Celsius to Fahrenheit temp in celsius and multiply by 1.8 and add 32. Fahrenheit to Celsius temp in Fahrenheit subtract 32 and didvide by 1.8

Treating a Fever
May give bath with alcohol in bathing water, but generally believed to promote too rapid cooling. Fever in children are usually related to viral origin. Freq run fever > 101.8 degrees. Dehydration and febrile seizures more common with infants > 6 mos and < 3 yrs of age. Seizures rarely occur after age 5. Important to stress liquids and oral intake. Elderly tend to run a lower temp. Important to know what is the normal temp. Temp of 100.4 may be within normal range, but in elderly may indicate fever. Cultures may be ordered. Usually give meds after the culture is drawn.

Pulse Pulse increase can be affected by blood pressure and temp also. Factors affecting pulse: age, autonomic nervous system, medications.

Assessment of the Pulse

Discuss parts of stethoscope. Bell is for low-pitched sounds. Diaphragm is for high-pitched sounds . Rate Rhythm Tachycardia hr >100bpm Bradycardia - < 60bpm Dysrhythmia irregular, early, late, or missed beat

Pulse deficit pulse wave is not transmitted to extremities. Requires two nurses, one assesses peripheral pulse while other assesses apical pulse and then compare rates. The difference between apical and radial rate is the pulse deficit. Strength normal, weak, thready, bounding

Equality equal between extremities. Never palpate carotid bilaterally at the same time. May use Doppler if unable to palpate pulse.

Physiological Control
High levels of O2 in COPD patients can lead to respiratory depression

Assessment of Respirations
Rate assess without clients knowledge of action. Rhythm Men and children tend to be diaphragmatic breathers. Women tend to use thoracic muscles more. Labored respirations require use of accessory muscles. Infants breathing more irregularly. Depth deep, normal, or shallow.

Blood Pressure
Adult BP range systolic: <130 diastolic < 85

Physiology of Blood Pressure

Cardiac output can be increased by increased heart rate, increased volume, increased contractility of the heart muscle. Peripheral vascular resistance the resistance to blood flow determined by the tone of vascular musculature and diameter of blood vessels. The smaller the vessel, the greater the PVR to the flow. When PVR increases then blood pressure increases. Decreased PVR (vasodilation), leads to decreases blood pressure. Blood volume Normal circulating volume is about 5 liters. If volume increases, then more pressure is exerted against the walls (overhydration). Hypovolemia causes decreased BP and decreased CO. Viscosity Thickness of blood. Increased viscosity requires more pressure to push the blood thru the vessels. Hematocrit, % of RBC in the blood. Increased hematocrit would increase viscosity. Elasticity Normally walls are elastic. In certain diseases, the walls lose their elasticity and are replaced by fibrous tissue that does not stretch. With reduced elasticity, there is increased pressure or resistance to blood flow. This leads to increased systolic blood pressure, esp in older adults.

Factors Affecting Blood Pressure

Age: Normal adult 120/80 with acceptable values< 130/< 85. Older adults have a higher systolic pressure d/t decreased vascular elasticity. Stress contributes to elevated Bp Race: Afro-Americans at higher risk for stroke and MI Medications: Antihypertensive, cardiac drugs, and narcotic analgesics. Diurnal Variation: Lowest in morning and gradually rises during day. Gender: Men higher than women until after menopause and women become higher.

What is the purpose of taking vital signs o Allows to establish a database of values, assists in goal setting, assists in aility to see how pt is reponding to treatment and progress What are factors affecting vital signs? Age, gender. drugs, meds, emotional, status, pain, stress, infection, time of day, time of month What is thermoregulation receptors into temp regulatory center (hypothalamus) then if hot or cold send message to body's vascular, metaolic, muscular, skin adjustments What is a vasuclar change in thermoregulation if hot= red cheeks vasularization if cold= lips blue Metabolic changes in thermoregulation? more norephrinephrine to increase metabolism Skeletal muscle thermoreguation shivering if cold Skin of thermoregulation Sweat glands and goosbumps Normal values for temperature? 98.6 +/- 1.8 F What is pyrogen? A fever What are sites to monitor temperature? forehead, ears, armpit, rectum, subglinal