Chapter 12. Vital Signs Assessment

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1 Chapter 12 Vital Signs Assessment

2 Pre-Test 1. What are vital signs? 2. List as many vital signs as you know.

3 Key Terms homeostasis: a state of equilibrium within the body maintained through the adaptation of body systems to changes in either the internal or external environment. vital signs: assessments of pulse, respiration, blood pressure, and temperature; body functions essential to life. veins: blood vessels that carry oxygendepleted blood to the heart.

4 Key Terms arteries: blood vessels that carry oxygenenriched blood away from the heart to the tissues. pulse: a vital sign; a quantitative measurement of the heartbeat using the fingers to palpate an artery or a stethoscope to listen to the heartbeat. tachycardia: a pulse rate above 100 beats per minute.

5 Key Terms bradycardia: a pulse rate below 60 beats per minute. radial pulse: the pulse located in the wrist near the radial bone. carotid pulse: the pulse that can be heard or felt at the carotid artery. apical pulse: the pulse that is obtained by listening to the heart rhythm at the apex of the heart.

6 Key Terms carotid artery: the large artery in the neck that carries oxygenated blood to the brain. cardiac arrest: asystole; the absence of a heartbeat. cardiac compressions: controlled and repeated application of pressure to the sternum of a cardiac arrest victim to keep the oxygen supply moving throughout the body.

7 Key Terms temporal artery: any one of the three arteries on each side of the head near the temporal bone. brachial artery: a large artery in the arm on the anterior aspect of the elbow. femoral artery: the major artery of the thigh that originates in the groin. groin: the area where the abdomen joins the thighs.

8 Key Terms popliteal artery: the large blood vessel located behind the knee. dorsalis pedis artery: the artery on top of the foot. respiration: breathing; the process of bringing oxygen into the body and expelling carbon dioxide from the body. diaphragm: the dome-shaped muscle separating the thoracic cavity from the abdominal cavity; the portion of the stethoscope used for picking up sound.

9 Key Terms metabolized: to produce energy within living cells through chemical changes for life processes and activities. inspiration: inhalation; the act of breathing something into the lungs. expiration: to exhale; the act of breathing out. abdominal: pertaining to the abdomen; respirations using primarily the abdominal muscles while the chest is mostly still.

10 Key Terms apnea: the temporary cessation of spontaneous breathing. bradypnea: breathing that is abnormally slow. Cheyne-Stokes respiration: a grossly irregular breathing pattern composed of a period of apnea lasting from 10 to 60 seconds, followed by respirations that gradually increase in frequency and depth.

11 Key Terms decreased: below normal; in lung function, refers to very little air movement in the lungs. dyspnea: difficult or painful breathing; shortness of breath. hyperpnea: breathing that is faster or deeper than that which is produced during normal activity. Kussmaul s breathing: deep, gasping respirations; air hunger.

12 Key Terms tachypnea: abnormally rapid breathing. blood pressure: the pressure exerted by the circulating blood against the walls of the arteries. systolic: the top number in a blood pressure reading; refers to the time between the first and second heart sounds in which the heart contracts.

13 Key Terms diastolic: the bottom number in a blood pressure reading; refers to the period of time between heart contractions in which the heart relaxes. hypotension: an abnormally low blood pressure that impairs normal functioning. hypertension: high blood pressure that has been diagnosed on the basis of several random readings of 140/90 or higher; known as the silent killer.

14 Key Terms sphygmomanometer: an instrument for measuring blood pressure. stethoscope: an instrument used to amplify sounds from within the body; the device used to listen for a pulse, blood pressure, and bowel or lung sounds. core temperature: the internal body temperature. hypothalamus: the portion of the brain that controls the temperature of the body.

15 I. The Vital Signs A. Homeostasis A state of equilibrium 1. Ability to maintain a relatively constant internal environment 2. Our brain monitors changes in: a. Oxygen b. Body temperature c. Blood pressure

16 Short Answer 1. Explain homeostasis using your own words.

17 True or False Homeostasis is a constantly changing internal environment.

18 I. The Vital Signs B. Vital signs are used to assess the conditions of the various body systems 1. Pulse 2. Respiration 3. Blood Pressure 4. Temperature 5. Level of Consciousness

19 Short Answer 2. The five basic vital signs are:

20 I. The Vital Signs C. Vital signs change as the body reacts to an injury or illness D. Results must be documented using the correct terminology and abbreviations E. Gloves are not worn during routine care unless there is exposure to blood or other body fluids, or to broken skin, including open lesions

21 II. The Pulse A. Blood vessels expand and contract every time the heart contracts (beats) B. Veins carry blood from the body to the heart C. Arteries carry blood away from the heart to the rest of the body 1. A pulse can only be felt in large arteries close to the skin and next to a bone D. Reflects the condition of the patient s circulatory system and cardiac function

22 True or False The pulse reflects the condition of the patient s circulatory system and cardiac function.

23 II. The Pulse E. A rapid but weak pulse may indicate shock, bleeding, diabetic coma, or heat exhaustion F. A rapid and strong pulse may indicate heat stroke, hypertension, or severe fright G. A strong and slow pulse may indicate a stroke or skull Fx H. The absence of a pulse indicates cardiac arrest or death I. Taking a pulse requires accurate counting and sensitivity to rhythms and quality

24 II. The Pulse J. Pulse rates vary according to the size of the patient, physical condition, and age 1. Recorded in terms of beats per minute (bpm) a. Adult with an average of Rates higher than 100 are known as tachycardia 3. Rates below 60 are called bradycardia

25 II. The Pulse 4. Trained athletes will have a lower resting heart rate (50-60 bpm) a. Exercise strengthens the heart and improves efficiency

26 True or False The normal pulse rate for an adult is 60 to 100 beats per minute, with the average heart rate being 70 to 80 beats per minute.

27 Short Answer 3. What are the pulse rate ranges for: a. Normal pulse rate: b. Tachycardia pulse rate: c. Bradycardia pulse rate: d. Trained athlete pulse rate:

28 II. The Pulse K. The rhythm of the pulse is described as regular or irregular 1. Regular doesn t change 2. Irregular speeds up and/or slows down

29 II. The Pulse L. The quality refers to the strength of the pulse 1. Weak 2. Strong 3. Thready (weak and rapid) 4. Bounding (unusually full and strong) May indicate high blood pressure 5. Regular

30 II. The Pulse M. The radial pulse is located on the thumb side of the wrist 1. Most common location for assessing the pulse 2. Assess with the pads of the first two fingers a. Never use your thumb N. The carotid pulse is assessed on an unresponsive person

31 II. The Pulse O. Always tell the patient what you are doing in terms he or she will understand 1. This keeps the patient calm 2. Provides the patient with necessary information to give informed consent

32 II. The Pulse P. Other common pulse sites 1. Temporal artery On the face in front of the ear 2. Brachial artery On the inside of the arm at the crease near the elbow. a. used for a blood pressure check 3. Femoral artery Bilateral groin to check for circulation in the legs

33 II. The Pulse 4. Popliteal artery Behind the knee to check for circulation in the legs 5. Dorsalis pedis On the top of the foot to check for circulation in the feet

34 II. The Pulse

35 Draw and Label the Diagram

36 Short Answer 4. Which two arteries may be used to check for circulation in the legs?

37 III. Respiration A. The process of bringing oxygen into the body where it can be utilized by the cells, and expelling carbon dioxide, which is eliminated as a waste product from the cells B. The ribs, chest muscles, and diaphragm move spontaneously in response to messages from the brain

38 Fill in the Blank 5. is the process of bringing oxygen into the body and expelling carbon dioxide.

39 Multiple Choice The process of bringing oxygen into the body where it can be used by the cells, and expelling carbon dioxide is called a. inspiration b. expiration c. respiration d. inhalation

40 III. Respiration C. Oxygen provides cells energy to perform specific functions 1. The conversion of food to energy requires oxygen 2. When more energy is required, the rate of respiration increases D. Normal rate can be altered by excitement, drugs, disease, pain, fever, and trauma

41 True or False Respiration provides the cells of the body with the energy required to perform their specific functions.

42 III. Respiration E. If the body is deprived of oxygen, serious damage can occur to the vital organs F. The absence of respiration indicates a blocked airway, respiratory arrest or death G. A single respiration consists of one inspiration and one expiration

43 Fill in the Blank 6. A single respiration consists of one and one.

44 III. Respiration H. Normal rates of respiration years and older 12 to 20 breaths per minute 2. A well trained athlete 6 to 8 breaths per minute I. Try to conceal the fact that you are counting respirations 1. Prevents the patient from inadvertently altering the true rate

45 Multiple Choice The normal rate of respiration in populations 15 years of age or older is a. 6 to 8 breaths per minute b. 12 to 20 breaths per minute c. 20 to 25 breaths per minute d. 4 to 6 breaths per minute

46 Multiple Choice The normal rate of respiration in a well-trained athlete is a. 6 to 8 breaths per minute b. 12 to 20 breaths per minute c. 20 to 25 breaths per minute d. 4 to 6 breaths per minute

47 III. Respiration J. Observe the patterns of the respirations 1. abdominal respirations using primarily the abdominal muscles while the chest is mostly still 2. apnea the cessation of breathing; may be temporary or permanent 3. bradypnea breathing that is abnormally slow

48 III. Respiration 4. Cheyne-Stokes respiration a grossly irregular breathing pattern composed of intermittent periods of apnea lasting from seconds followed by periods of fast and slow breathing 5. decreased very little air movement in the lungs 6. dyspnea difficult or painful breathing; shortness of breath

49 III. Respiration 7. hyperpnea breathing that is faster or deeper than that which is produced during normal activity 8. Kussmaul s breathing deep, gasping respirations; air hunger 9. labored breathing difficult breathing that uses the shoulder, neck, and abdominal muscles 10. Tachypnea abnormally rapid breathing

50 Multiple Choice Deep, gasping respirations and air hunger describe a. Cheyne-Stokes respiration b. Dyspnea c. Apnea d. Kusssmaul s breathing

51 III. Respiration K. The volume and rate can be determined by placing your hand on the patient s chest 1. The volume may be deep or shallow (restricted) a. Shallow may indicate shock

52 III. Respiration L. Noisy respirations may indicate an obstruction in the air passages M. Patients with difficulty breathing will usually sit up and lean forward (tripod position) N. The first signs of oxygen deprivation are mental confusion and restlessness

53 Multiple Choice Patients who have difficulty breathing will usually a. roll on their side to get more air in and out of the lungs b. sit up and lean forward in an effort to breathe easier c. stand up and put their arms over their head d. sit up and begin to cough

54 Short Answer 7. What are the first signs of oxygen deprivation?

55 IV. Blood Pressure (BP) A. A measurement of the pressure of the blood exerted against the walls of the arteries B. Recorded in two measurements 1. Systolic pressure is the top/first number in a reading. a. It reflects the blood pressure when the heart contracts

56 IV. Blood Pressure (BP) 2. Diastolic pressure is the bottom/second number in a reading a. It reflects the blood pressure when the heart is at rest 3. Recorded as 120/80

57 Short Answer 8. Blood pressure has two measurements. What are they? Which number is on top?

58 IV. Blood Pressure (BP) C. Affected by a number of factors 1. Amount of blood and other fluids that are present in the body 2. Condition of the arteries 3. Force of the heartbeat 4. Gender 5. Genetics D. May increase due to exercise, obesity, food, pain, stress, stimulants, and steroids

59 Blood Pressure

60 Short Answer 9. Blood pressure is affected by a number of factors. Name three of them.

61 IV. Blood Pressure (BP) E. May decrease due to weight loss, fasting, depression, and blood loss F. If BP is either too high or too low, medical assistance should be sought immediately 1. A systolic value below 100 mm Hg or above 140 mm Hg (millimeters of mercury) 2. A diastolic value below 65 mm Hg or above 90 mm Hg G. Low BP (hypotension) may indicate shock, dehydration, or internal injury

62 Fill in the Blank 10. Low blood pressure may indicate,, or.

63 IV. Blood Pressure (BP) H. High BP indicates hypertension 1. Dangerous precursor to cardiac problems and strokes I. BP is taken with a sphygmomanometer (blood pressure cuff) and a stethoscope

64 IV. Blood Pressure (BP) J. For an accurate reading, the width of the sphygmomanometer should cover approximately ¾ of the patient s upper arm 1. If the cuff is too narrow, a false high reading can be obtained 2. If the cuff is too wide, a false low reading can be obtained

65 IV. Blood Pressure (BP)

67 IV. Blood Pressure (BP)

68 Short Answer 11. What equipment do you need to take a blood pressure? 12. To get an accurate blood pressure reading, the width of the sphygmomanometer should cover approximately of the patient s upper arm. 13. Why is it important for the blood pressure cuff to fit properly?

69 Internet Videos Korotkoff Blood Pressure Sights and Sounds Measuring Blood Pressure in the 21st Century

70 At Valley Community College the beginning of soccer season signals the need for every player to have a physical exam. It typically takes the entire athletic training staff all morning to perform the necessary physicals and this year promised to be no different. On the date set for the physicals Ms. Morgan, the head athletic trainer, set up a different station for each vital sign. She then assigned a student trainer to each station. Steve was assigned to take blood pressures. He was doing a good job of taking blood pressures. Ms. Morgan was getting the same pressures as he was nine out of ten times. One of Steve s friends, Rudy, was in line to have his blood pressure taken. To Steve s surprise, Rudy s blood pressure was 170 over 92. Steve did not know how to tell a friend that his blood pressure would jeopardize his chance to play soccer. So, Ms. Morgan and Steve sat down with Rudy to discuss his unusually high blood pressure. Rudy assured them that he had a condition called White Coat Syndrome in which he gets nervous when someone takes his blood pressure. He promised to have his family physician check him out and forward the results to the school s athletic department.

71 1. Why is it important for an athletic trainer to check the student athletic trainer's work periodically? 2. How elevated is Rudy s blood pressure when compared to the normal range? 3. Is it acceptable to have a family physician perform the physical and forward the results instead of having it performed by the athletic training staff? (Explain your answer)

72 V. The Temperature A. The core temperature must remain in a relatively narrow range in order for the various body systems to function properly B. Body temperature is regulated by the hypothalamus 1. Produce heat by shivering 2. Retain heat by constricting blood vessels 3. Disperse heat by dilating blood vessels and stimulating sweat glands

73 Fill in the Blank 14. The body s temperature is regulated by an area in the brain known as the.

74 V. The Temperature C. Normal body temperature is 98.6 Fahrenheit (37 Celsius) D. Oral and rectal temperature readings are preferred E. Tympanic membrane (eardrum) readings are more practical

75 True or False Tympanic membrane temperature readings are the most accurate.

76 Short Answer 15. The body s temperature is. 16. Name the two different types of temperature scales used to assess a patient s temperature.

77 V. The Temperature F. Changes in body temperature can be reflected in the skin 1. Hot, dry skin - disease, infection, or overexposure to environmental heat 2. Cool clammy skin - trauma, shock, or heat exhaustion 3. Cool dry skin overexposure to cold

78 Short Answer 17. What are three different sites where a temperature can be taken?

79 VI. Skin Color A. Can be an indicator of health B. Red - Elevated temp, heat stroke, or high blood pressure C. White - insufficient circulation, shock, fright, hemorrhage, heat exhaustion, or insulin shock D. Blue (cyanotic) - airway obstruction or respiratory insufficiency

80 VI. Skin Color E. Dark pigmented skin is slightly different in response F. Nail beds, and inside lips and mouth and tongue will be pinkish G. With shock, skin around mouth and nose will have grayish cast and mouth and tongue will be bluish H. During hemorrhaging, mouth and tongue will become gray I. Fever is indicated by red flush tips of ears

81 Short Answer 18. The skin can vary in appearance. What should you take note of when assessing a patient?

82 VII. Level of Consciousness (LOC) A. Must always be assessed B. Alertness and awareness of environment, as well as response relative to vocal stimulation C. Head injury, heat stroke, diabetic coma can alter athlete s level of consciousness

83 VII. Level of Consciousness (LOC) D. AVPU scale widely used by EMTs 1. Alert awake, responsive to voice and oriented to person, place and time 2. Verbal responds to voice but not fully oriented 3. Pain does not respond to voice but does respond to painful stimulus 4. Unresponsive does not respond to verbal or painful stimlus

84 Short Answer 19. List and describe the acronym AVPU.

Chapter 15: Measuring Height, Weight, and Vital Signs. Copyright 2012 Wolters Kluwer Health Lippincott Williams & Wilkins

Chapter 15: Measuring Height, Weight, and Vital Signs Height and Weight Weight Baseline measurement at patient s first visit Measured in kg or lbs Common types of scales Balance beam Dial Digital Height