Assessing Vitals and YouAssessing Vitals and You

By: Sean FrenchBy: Sean French

Anna MorganAnna Morgan

What is Blood Pressure What is Blood Pressure Measuring?Measuring?

The force of blood pushing against the The force of blood pushing against the arterial walls is known as blood pressure.arterial walls is known as blood pressure.

Measuring blood pressure helps assess Measuring blood pressure helps assess the overall health of the cardiovascular the overall health of the cardiovascular system and systemic circulation.system and systemic circulation.

There are 2 numbers recorded when There are 2 numbers recorded when measuring blood pressure. measuring blood pressure. Systolic and Diastolic pressures.Systolic and Diastolic pressures.

120/80120/80

Systolic pressure

Diastolic pressure

What is Blood Pressure Measuring What is Blood Pressure Measuring Cont.Cont.

The Systolic pressure measures the The Systolic pressure measures the amount of pressure that the blood exerts amount of pressure that the blood exerts on arterial vessel walls as it passes on arterial vessel walls as it passes through them (as the heart pumps it).through them (as the heart pumps it).

Diastolic pressure measures the amount Diastolic pressure measures the amount of pressure that the blood exerts on of pressure that the blood exerts on arterial vessel walls while the heart is arterial vessel walls while the heart is relaxed (in between beats).relaxed (in between beats).

What is Blood Pressure Measuring What is Blood Pressure Measuring Cont.Cont.

Blood pressure is measurements are in Blood pressure is measurements are in mmHg.mmHg.mmHg=millimeters of mercurymmHg=millimeters of mercury

What is ‘Normal’ Blood Pressure?What is ‘Normal’ Blood Pressure?

No individual is the same. Therefore, not No individual is the same. Therefore, not everyone’s ‘normal’ blood pressure will be everyone’s ‘normal’ blood pressure will be the same. the same.

The ‘normal’ agreed upon is 120/80 The ‘normal’ agreed upon is 120/80 mmHg. mmHg. Systolic pressure=120 mmHgSystolic pressure=120 mmHgDiastolic pressure=80 mmHgDiastolic pressure=80 mmHg

Blood Pressure ChartBlood Pressure Chart

Assessing Blood PressureAssessing Blood Pressure

1.1. Introduce yourself to the patient and Introduce yourself to the patient and inform them of what you are about to inform them of what you are about to perform.perform.

2.2. Palpate the patient’s brachial artery until Palpate the patient’s brachial artery until you can feel the pulseyou can feel the pulse

3.3. Place the cuff on the patient’s brachial Place the cuff on the patient’s brachial artery as indicatedartery as indicated

4.4. Place the stethoscope membrane Place the stethoscope membrane against the anterior of the elbow.against the anterior of the elbow.

Assessing Blood Pressure Cont.Assessing Blood Pressure Cont.

5.5. Pump the cuff to about 200mmHgPump the cuff to about 200mmHg6.6. Slowly release the pressure, listening Slowly release the pressure, listening

carefully for the patient’s heartbeat.carefully for the patient’s heartbeat.7.7. Record the measurement for the first Record the measurement for the first

heartbeat you notice. This is the Systolic heartbeat you notice. This is the Systolic pressure.pressure.

8.8. Listen for the very last audible Listen for the very last audible heartbeat, and record the measurement. heartbeat, and record the measurement. This is the Diastolic pressure.This is the Diastolic pressure.

Abnormal Blood PressuresAbnormal Blood Pressures

HypertensionHypertension Also known as high blood pressure.Also known as high blood pressure. 140/90 mmHg is the average readings for 140/90 mmHg is the average readings for

hypertensionhypertension Anything above the patient’s ‘normal’ blood pressure Anything above the patient’s ‘normal’ blood pressure

can be diagnosed as hypertension. can be diagnosed as hypertension.

HypotensionHypotension Also known as low blood pressure.Also known as low blood pressure. Anything significantly below the patient’s ‘normal’ Anything significantly below the patient’s ‘normal’

blood pressure. blood pressure.

What is a Pulse?What is a Pulse? Pulse is the tactile arterial palpation of the heartbeat.Pulse is the tactile arterial palpation of the heartbeat. The pulse may be palpated in any place that allows an The pulse may be palpated in any place that allows an

artery to be compressed against a bone.artery to be compressed against a bone. Common places of arterial palpation:Common places of arterial palpation:

Carotid arteryCarotid artery Radial arteryRadial artery Popliteal arteryPopliteal artery Brachial arteryBrachial artery Posterior tibeal arteryPosterior tibeal artery

Pulse is measured in bpmPulse is measured in bpm Bpm=beats per minuteBpm=beats per minute

Assessing a Patient’s PulseAssessing a Patient’s Pulse

1.1. Introduce yourself to the patient and inform Introduce yourself to the patient and inform them of what you are about to perform.them of what you are about to perform.

2.2. Gently place 2 fingers (usually index and Gently place 2 fingers (usually index and middle finger) against the artery of your desire middle finger) against the artery of your desire to palpate. Do NOT use your thumb, because to palpate. Do NOT use your thumb, because it has a pulse of its own.it has a pulse of its own.

3.3. Feel around until you can feel their heartbeat, Feel around until you can feel their heartbeat, and count for 30 seconds. Then multiply by 2 and count for 30 seconds. Then multiply by 2 and record on patient’s chart.and record on patient’s chart.

What is a ‘Normal’ Pulse?What is a ‘Normal’ Pulse?

The ‘normal’ pulse rate for an adult is The ‘normal’ pulse rate for an adult is around 60-100 bpm. around 60-100 bpm.

Abnormal Pulse’sAbnormal Pulse’s Pulsus alternansPulsus alternans: an ominous medical sign that indicates : an ominous medical sign that indicates

progressive systolic heart failure. To trained fingertips, progressive systolic heart failure. To trained fingertips, the examiner notes a pattern of a strong pulse followed the examiner notes a pattern of a strong pulse followed by a weak pulse over and over again. This pulse signals by a weak pulse over and over again. This pulse signals a flagging effort of the heart to sustain itself in systole. a flagging effort of the heart to sustain itself in systole.

Pulsus bigeminusPulsus bigeminus : indicates a pair of hoofbeats within : indicates a pair of hoofbeats within each heartbeat. Concurrent auscultation of the heart each heartbeat. Concurrent auscultation of the heart may reveal a gallop rhythm of the native heartbeat. may reveal a gallop rhythm of the native heartbeat.

Pulsus bisferiensPulsus bisferiens: an unusual physical finding typically : an unusual physical finding typically seen in patients with aortic valve diseases. If the aortic seen in patients with aortic valve diseases. If the aortic valve does not normally open and close, trained valve does not normally open and close, trained fingertips will observe two pulses to each heartbeat fingertips will observe two pulses to each heartbeat instead of one. instead of one.

Abnormal Pulse’s Cont. Abnormal Pulse’s Cont. Pulsus paradoxusPulsus paradoxus: a condition in which some heartbeats : a condition in which some heartbeats

cannot be detected at the radial artery during the cannot be detected at the radial artery during the inspiration phase of respiration. It is caused by an inspiration phase of respiration. It is caused by an exaggerated decrease in blood pressure during this exaggerated decrease in blood pressure during this phase, and is diagnostic of a variety of cardiac and phase, and is diagnostic of a variety of cardiac and respiratory conditions of varying urgency. respiratory conditions of varying urgency.

Pulsus tardus et parvusPulsus tardus et parvus: a slower than normal rise in the : a slower than normal rise in the tactile pulse caused by an increasingly stiff aortic valve. tactile pulse caused by an increasingly stiff aortic valve. Loss of compliance in the aortic valve makes it Loss of compliance in the aortic valve makes it progressively harder to open, thus requiring increased progressively harder to open, thus requiring increased generation of blood pressure in the left ventricle. generation of blood pressure in the left ventricle.

What is a ‘Normal’ Temperature?What is a ‘Normal’ Temperature?

The ‘normal’ oral temperature for an adult The ‘normal’ oral temperature for an adult patient is roughly 98.6patient is roughly 98.6°F give or take 0.9°F°F give or take 0.9°F

Normal rectal temperature for an adult is Normal rectal temperature for an adult is roughly 99.6°Froughly 99.6°F

Normal axillary or groin temperature for an Normal axillary or groin temperature for an adult is roughly 97.6°Fadult is roughly 97.6°F

Assessing a Patient’s TemperatureAssessing a Patient’s Temperature

1.1. Introduce yourself to the patient and inform Introduce yourself to the patient and inform them on what you are about to perform.them on what you are about to perform.

2.2. Take the thermometer out of its holder, and Take the thermometer out of its holder, and place a new throw-away plastic cover.place a new throw-away plastic cover.

3.3. Place the covered tip under the patient’s Place the covered tip under the patient’s mouth, and ask them to close their mouth mouth, and ask them to close their mouth keeping the thermometer under their tongue.keeping the thermometer under their tongue.

4.4. Remove once thermometer beeps, and record Remove once thermometer beeps, and record temperature onto patient’s chart.temperature onto patient’s chart.

Sites on a Patient That Gives the Sites on a Patient That Gives the Most Accurate Temperature Most Accurate Temperature

Reading. Reading. Rectal temperatures are said to be the Rectal temperatures are said to be the

most accurate site to obtain a most accurate site to obtain a temperature.temperature.This is because it is inside the body itself This is because it is inside the body itself

(granted oral is too, but not within the (granted oral is too, but not within the viscera).viscera).

What is ‘Normal’ Respirations?What is ‘Normal’ Respirations?

The normal rate for respirations in adults is The normal rate for respirations in adults is 14 to 18 breaths per minute, although 14 to 18 breaths per minute, although wider ranges may be observed (12 to 20 wider ranges may be observed (12 to 20 breaths per minute).breaths per minute).

In children, respirations are slightly faster In children, respirations are slightly faster than those for adults and average 16 to 25 than those for adults and average 16 to 25 per minute. per minute.

In infants, the rate may be 30 to 50 per In infants, the rate may be 30 to 50 per minute. minute.

How to Assess a Patient’s How to Assess a Patient’s RespirationsRespirations

Do NOT inform the patient that you will be Do NOT inform the patient that you will be observing their respirations. This will affect observing their respirations. This will affect how they breathe.how they breathe.

While taking the patient’s pulse, observe While taking the patient’s pulse, observe the patient’s chest and count how many the patient’s chest and count how many breaths they take within the 30 seconds. breaths they take within the 30 seconds. Multiply by 2 and record on the patient’s Multiply by 2 and record on the patient’s chart.chart.

Just a Little Extra Terms to KnowJust a Little Extra Terms to Know

ApneaApnea-Absence of respirations, usually -Absence of respirations, usually only temporary (acute).only temporary (acute).

DyspneaDyspnea-Difficult or labored breathing; -Difficult or labored breathing; Usually rather painful.Usually rather painful.

Cheyne-stokesCheyne-stokes-Respirations-Respirations—periods of —periods of dyspnea followed by periods of apnea; dyspnea followed by periods of apnea; frequently noted in the dying patient.frequently noted in the dying patient.

Just a Little Extra Terms to Know Just a Little Extra Terms to Know Cont.Cont.

WheezingWheezing-Difficult breathing with a high--Difficult breathing with a high-pitched whistling or sighing sound during pitched whistling or sighing sound during expiration; caused by a narrowing of expiration; caused by a narrowing of bronchioles (as seen in asthma) and/or an bronchioles (as seen in asthma) and/or an obstruction or mucus accumulation in the obstruction or mucus accumulation in the bronchi.bronchi.

OrthopneaOrthopnea-Severe dyspnea in which -Severe dyspnea in which breathing is very difficult in any position breathing is very difficult in any position other than sitting erect or standing.other than sitting erect or standing.

Just a Little Extra Terms to Know Just a Little Extra Terms to Know Cont.Cont.

HyperthermiaHyperthermia-An elevated body -An elevated body temperature due to failed temperature due to failed thermoregulation; occurs when the body thermoregulation; occurs when the body produces or absorbs more heat than it can produces or absorbs more heat than it can dissipate.dissipate.When the elevated body temperatures are When the elevated body temperatures are

sufficiently high, hyperthermia is a medical sufficiently high, hyperthermia is a medical emergency and requires immediate treatment emergency and requires immediate treatment to prevent disability or death.to prevent disability or death.

Just a Little Extra Terms to Know Just a Little Extra Terms to Know Cont.Cont.

TachycardiaTachycardia-A pulse rate over 100 beats -A pulse rate over 100 beats per minute (except in children).per minute (except in children).

BradycardiaBradycardia-A pulse rate under 60 beats -A pulse rate under 60 beats per minute.per minute.

AfebrileAfebrile-Literally means without a fever.-Literally means without a fever.

Random Facts :]Random Facts :] A red blood cell can circumnavigate your body in A red blood cell can circumnavigate your body in

under 20 seconds. under 20 seconds. Nerve Impulses travel at over 400 km/hr (25 Nerve Impulses travel at over 400 km/hr (25

mi/hr). mi/hr). Our heart beats around 100,00 times every day. Our heart beats around 100,00 times every day. Our eyes can distinguish up to one million colour Our eyes can distinguish up to one million colour

surfaces and take in more information than the surfaces and take in more information than the largest telescope known to man. largest telescope known to man.

Our lungs inhale over two million litres of air Our lungs inhale over two million litres of air every day, without even thinking. They are large every day, without even thinking. They are large enough to cover a tennis court. enough to cover a tennis court.

Random Facts :]Random Facts :]

A person can expect to breathe in about A person can expect to breathe in about 40 pounds of dust over his/her lifetime. 40 pounds of dust over his/her lifetime.

In one square inch of our hand we have In one square inch of our hand we have nine feet of blood vessels, 600 pain nine feet of blood vessels, 600 pain sensors, 9000 nerve endings, 36 heat sensors, 9000 nerve endings, 36 heat sensors and 75 pressure sensors. sensors and 75 pressure sensors.

Quiz Time! Muahahaha >:]Quiz Time! Muahahaha >:]

1.1. What is the very first thing you must do What is the very first thing you must do before assessing a patient’s vitals?before assessing a patient’s vitals?

a)a) Slap them in the faceSlap them in the face

b)b) Introduce yourself and inform them of what Introduce yourself and inform them of what you’re going to doyou’re going to do

c)c) Introduce yourself and inform them of what Introduce yourself and inform them of what you’re going to do EXCEPT when taking you’re going to do EXCEPT when taking respirationsrespirations

d)d) Tell them they make you want to vomitTell them they make you want to vomit

2.2. What is Hyperthermia?What is Hyperthermia? An elevated body temperature due to An elevated body temperature due to

failed thermoregulation; occurs when the body failed thermoregulation; occurs when the body produces or absorbs more heat than it can produces or absorbs more heat than it can dissipate.dissipate.

3.3. I will give a dollar to the person who I will give a dollar to the person who can tell me what acidosis is WITHOUT can tell me what acidosis is WITHOUT cheating or looking it up.cheating or looking it up.Acidosis is a pathological condition resulting Acidosis is a pathological condition resulting

from a disturbance in the acid-base balance in from a disturbance in the acid-base balance in the blood and body tissues.the blood and body tissues.

4.4. What is considered a healthy, What is considered a healthy, normal blood pressure?normal blood pressure?

a)a) 140/90140/90

b)b) 7548/0.0215487548/0.021548

c)c) 100/50100/50

d)d) 120/80120/80

I got extremely bored making the I got extremely bored making the quiz, so here’s something to quiz, so here’s something to

hopefully make you chuckle :]hopefully make you chuckle :]

BibliographyBibliography http://images.vertex42.com/ExcelTemplates/blood-pressure-chart-1.http://images.vertex42.com/ExcelTemplates/blood-pressure-chart-1.

gifgif http://blood-pressure.emedtv.com/systolic-blood-pressure/systolic-http://blood-pressure.emedtv.com/systolic-blood-pressure/systolic-

blood-pressure.htmlblood-pressure.html http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001502/ http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004536/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004536/ http://www.webmd.com/heart-disease/pulse-measurementhttp://www.webmd.com/heart-disease/pulse-measurement http://www.webmd.com/heart/taking-a-pulse-heart-ratehttp://www.webmd.com/heart/taking-a-pulse-heart-rate http://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Pulse http://www.officialhealthcare.net/Normal-Body-Temperature.htmlhttp://www.officialhealthcare.net/Normal-Body-Temperature.html http://www.revolutionhealth.com/articles/rectal-ear-oral-and-axillary-http://www.revolutionhealth.com/articles/rectal-ear-oral-and-axillary-

temperature-comparison/tw9223temperature-comparison/tw9223 http://en.wikipedia.org/wiki/Hyperthermiahttp://en.wikipedia.org/wiki/Hyperthermia http://www.medindia.net/facts/index.asphttp://www.medindia.net/facts/index.asp