Vital signs Dr H.A.Soleimani MD. Gasteroentologist.

Vital signsVital signs

Dr H.A.SoleimaniDr H.A.Soleimani

MD. Gasteroentologist MD. Gasteroentologist

GeneralGeneral


Vital signVital sign

Vital signs are Vital signs are physical signs that physical signs that indicate an indicate an individual individual is aliveis alive, such as heart , such as heart beat, breathing rate, beat, breathing rate, temperature, blood temperature, blood pressures and pressures and recently oxygen recently oxygen saturationsaturation. .


These signs may be These signs may be observed, measured, observed, measured, and monitoredand monitored to to assess an individual's assess an individual's level of physical level of physical functioning. functioning.


NormalNormal vital signs vital signs change with change with age, sex, age, sex, weight, exerciseweight, exercise tolerance, and tolerance, and condition. condition.


All measurements All measurements are made while the are made while the patient is patient is seated.seated.


Prior Prior to measuring to measuring vital signs, the patient vital signs, the patient should have had the should have had the opportunity to opportunity to sit for sit for approximately fiveapproximately five minutes.minutes.

ObservationObservation

Before diving inBefore diving in, , take a take a minuteminute or so or so to look at the to look at the patient in patient in their their entiretyentirety..

ObservationObservation

Does the patient Does the patient seem seem anxiousanxious, in , in pain, upset? What pain, upset? What about their dress and about their dress and hygiene? Remember, hygiene? Remember, the the exam beginsexam begins as as soon as yousoon as you lay lay eyes eyes on the patient. on the patient.

TemperatureTemperature



Old peopleOld people, people , people with disabilities, with disabilities, babiesbabies and young and young children typically children typically feel more feel more comfortablecomfortable at at higher higher temperatures. temperatures.


Women notice that Women notice that they are they are feeling feeling cool quicker than cool quicker than menmen, which may be , which may be related to their related to their different body size.different body size.


The normal body The normal body temperature of a temperature of a person varies person varies depending on depending on gender, gender, recent activity, food recent activity, food and fluid and fluid consumptionconsumption, , timetime of of day, and, in women, day, and, in women, the stage of the the stage of the menstrual cycle. menstrual cycle.


Temperature is Temperature is measured in either measured in either Celcius or Celcius or FarenheitFarenheit, with a , with a fever defined as fever defined as greater then greater then 38-38-38.5 C or 101-38.5 C or 101-101.5 F. 101.5 F.


Rectally tRectally temperaturesemperatures taken rectally (using a taken rectally (using a mercury or digital mercury or digital thermometer) tend to be thermometer) tend to be 0.5 to 0.7°0.5 to 0.7° (Fahrenheit) (Fahrenheit) higherhigher than when taken than when taken by mouth.by mouth.


Oral tOral temperatureemperature can be taken by can be taken by mouth using mouth using classic glass classic glass mercury-filledmercury-filled or or digital digital thermometersthermometers..


Axillary tAxillary temperaturesemperatures can be taken under the can be taken under the arm. Temperatures taken arm. Temperatures taken by this route tend to be by this route tend to be 0.3 to 0.4°0.3 to 0.4° (Fahrenheit) (Fahrenheit) lowerlower than those than those temperatures taken by temperatures taken by mouth.mouth.


By ear aBy ear a special special thermometerthermometer can can quickly measure the quickly measure the temperature of the temperature of the ear drum, which ear drum, which reflects the reflects the body's body's core temperaturecore temperature..

FeverFever

A fever is indicated A fever is indicated when body when body temperature rises temperature rises above above 98.6° F 98.6° F orally or 99.8° F orally or 99.8° F rectally.rectally.

HypothermiaHypothermia

HypothermiaHypothermia is is defined as a drop in defined as a drop in body temperature body temperature below 95° Fbelow 95° F..

Respiration rateRespiration rate


What is the respiration rate?What is the respiration rate?

The respiration rate is The respiration rate is the the number of breathsnumber of breaths a person takes per a person takes per minute. minute.

Respiratory RateRespiratory Rate

Try to do this as Try to do this as surreptitiously as surreptitiously as possiblepossible. . Observing the rise Observing the rise and fall of the and fall of the patient's hospital patient's hospital gown while you gown while you appear to be appear to be taking taking their pulsetheir pulse. .


They should be They should be counted for counted for at leastat least 30 30 seconds seconds 15 15 second period is second period is rather small and rather small and any miscounting any miscounting can result in rather can result in rather large errors when large errors when multiplied by 4multiplied by 4. .


Respiration rates Respiration rates may increase with may increase with fever, illness,…fever, illness,…. . When checking When checking respiration, also respiration, also note whether a note whether a person has person has any any difficulty breathingdifficulty breathing..

Abnormal Respiratory RateAbnormal Respiratory Rate

Respiration rates Respiration rates over 25over 25 or under or under 12 breaths12 breaths per per minute (when at minute (when at rest) may be rest) may be considered considered abnormalabnormal

under 12 breathsunder 12 breaths

over 25 breathsover 25 breaths


Normal respiration Normal respiration rates at rest range rates at rest range from from 15 to 20 15 to 20 breathsbreaths per minute. per minute. In the In the cardio-cardio-pulmonarypulmonary illness, illness, it can be a very it can be a very reliablereliable marker of marker of disease activity. disease activity.

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PulsePulseVital signsVital signs

Pulse ratePulse rate

The normal The normal pulse for healthy pulse for healthy adults ranges adults ranges from from 60 to 10060 to 100 beats per beats per minute. minute.


The pulse rate may The pulse rate may fluctuate and increase fluctuate and increase with with exercise, illnessexercise, illness, , injuryinjury, and , and emotionsemotions. . Girls ages Girls ages 12 12 and and older andolder and women women, in , in general, tend to have general, tend to have fasterfaster heart rates than heart rates than do boys and men. do boys and men.


Athletes, such as Athletes, such as runnersrunners, may , may have heart rates have heart rates in the in the 40's 40's and and experience no experience no problems.problems.

How to check your pulseHow to check your pulse

You feel the You feel the beatsbeats by by firmly pressingfirmly pressing on the on the arteries, which are arteries, which are located located close to the close to the surfacesurface of the skin at of the skin at certain points of the certain points of the body. body.

How to check your pulseHow to check your pulse

The pulse can be The pulse can be found on the found on the side side of the lower neckof the lower neck, , on the on the inside of the inside of the elbowelbow, or at the, or at the wristwrist. .

PulsePulse

Place thePlace the tips tips of your of your index index andand middle middle fingersfingers just proximal just proximal to the patients wrist to the patients wrist on the on the thumb sidethumb side, , orienting them so that orienting them so that they are both over the they are both over the length of the vessel. length of the vessel.

PulsePulse

Push lightly at first,Push lightly at first, adding pressure if adding pressure if there is a lot of there is a lot of subcutaneous fat or subcutaneous fat or you are you are unable to unable to detect a pulsedetect a pulse. If you . If you push too hardpush too hard, you , you might might occlude the occlude the vesselvessel and mistake and mistake your own pulseyour own pulse for for that of the patient. that of the patient.

PulsePulse: Quantity: Quantity

Measure the rate of Measure the rate of the pulse (recorded in the pulse (recorded in beats per minute). beats per minute). Count for Count for 30 seconds30 seconds and multiply by 2 (or and multiply by 2 (or 15 seconds x 415 seconds x 4). ).

PulsePulse: Quantity: Quantity

If the rate is If the rate is particularly particularly slow or slow or fastfast, it is probably , it is probably best to measure for best to measure for a a full 60 secondsfull 60 seconds in in order to minimize order to minimize the error. the error.

PulsePulse: Regularity: Regularity

Is the time Is the time between beats between beats constantconstant?. ?. Irregular Irregular rhythmsrhythms, are , are quite quite commoncommon. .

PulsePulse: Volume: Volume

Does the pulse Does the pulse volumevolume feel normal? This feel normal? This reflects changes in reflects changes in stroke volumestroke volume. In . In hypovolemiahypovolemia, the pulse volume is relatively , the pulse volume is relatively low low

Blood pressureBlood pressure


Preparation for Preparation for measurementmeasurement

Preparation for measurementPreparation for measurement

Patient should Patient should abstain from eating, abstain from eating, drinking, smoking and drinking, smoking and taking drugs that taking drugs that affect the blood affect the blood pressure one hour pressure one hour before measurement. before measurement.

Remember the followingRemember the following for for accuracy of your readingsaccuracy of your readings

Instruct your patients Instruct your patients to avoid to avoid coffeecoffee, , smokingsmoking or any other or any other unprescribed drug unprescribed drug with sympathomimetic with sympathomimetic activity on the day of activity on the day of the measurement the measurement


Because a Because a full full bladderbladder affects the affects the blood pressure it blood pressure it should have been should have been emptied. emptied.


Painful proceduresPainful procedures and exercise should and exercise should not have occurred not have occurred within one hour. within one hour.

Patient should have Patient should have been sitting quietly for been sitting quietly for about 5 minutes. about 5 minutes.


BP take in quiet room BP take in quiet room and comfortable and comfortable temperature, must temperature, must record room record room temperature and time temperature and time of day.of day.

Position of the PatientPosition of the Patient

Position of the PatientPosition of the Patient

Sitting position Sitting position

Arm and back are Arm and back are supported. supported.

Feet should be Feet should be resting firmly on the resting firmly on the floorfloor

Feet not dangling. Feet not dangling.

Position of the armPosition of the arm

The measurements should be made on the The measurements should be made on the right armright arm whenever possible. whenever possible.

Patient Patient arm should be resting on the deskarm should be resting on the desk and raised (by and raised (by using a pillow)using a pillow)


Raise patient arm so that the Raise patient arm so that the brachial artery is roughly brachial artery is roughly at the same height as the heartat the same height as the heart. If the arm is held too . If the arm is held too high,high, the reading will be artifactually the reading will be artifactually lowered,lowered, and vice and vice versa.versa.


Palm is Palm is facing upfacing up. .

The arm should remain The arm should remain somewhat bentsomewhat bent and and completely relaxedcompletely relaxed

EquipmentEquipment

In order to measure the Blood In order to measure the Blood Pressure (equipment)Pressure (equipment)

Pediatric Cuff size Pediatric Cuff size – Minimum Cuff Width: Minimum Cuff Width:

2/3 length of upper 2/3 length of upper armarm

– Minimum Cuff length: Minimum Cuff length: Bladder nearly Bladder nearly encircles armencircles arm


Adult Cuff size Adult Cuff size – Cuff Width: Cuff Width: 40% of 40% of

limb'slimb's circumference circumference – Cuff Length: Bladder Cuff Length: Bladder

at 80% of limb's at 80% of limb's circumference circumference


Adult Cuff size Adult Cuff size – Indications for large Indications for large

cuff or thigh cuff cuff or thigh cuff Upper arm Upper arm circumference >34 cmcircumference >34 cm

– Indications for Indications for forearm forearm cuffcuff (with radial (with radial palpation) palpation)

Upper arm Upper arm circumference >50 cm circumference >50 cm

Blood Pressure Blood Pressure

If it is tooIf it is too small small, the , the readings will be readings will be artificially artificially elevatedelevated. . The opposite occurs if The opposite occurs if the cuff is toothe cuff is too large large. . Clinics should have at Clinics should have at least least 2 cuff sizes2 cuff sizes available, normal and available, normal and large. large.

Cuff PositionCuff Position

In order to measure the Blood In order to measure the Blood Pressure (Cuff Position)Pressure (Cuff Position)

Patient's arm Patient's arm slightly slightly flexed at flexed at elbow elbow

Push the Push the sleeve upsleeve up, , wrap the cuff wrap the cuff around the bare armaround the bare arm

In order to measure the Blood In order to measure the Blood Pressure (Cuff Position)Pressure (Cuff Position)

Cuff applied directly Cuff applied directly over skinover skin (Clothes (Clothes artificially raises artificially raises blood pressure )blood pressure )Position lower cuff Position lower cuff border border 2.5 cm 2.5 cm above antecubitalabove antecubitalCenter inflatable Center inflatable bladder over bladder over brachial artery brachial artery

Measurement of the pulse rateMeasurement of the pulse rate

The The manometer scale manometer scale should be at eye should be at eye levellevel, and the column , and the column vertical. vertical. The patient The patient should not be able to should not be able to see the columnsee the column of the of the manometer manometer

Technique of BP Technique of BP measurementmeasurement

In order to measure the BPIn order to measure the BP

Feel for a pulse Feel for a pulse from the artery from the artery coursing through coursing through the the inside of the inside of the elbowelbow (antecubital (antecubital fossa). fossa).


Wrap the cuffWrap the cuff around around the patient's upper the patient's upper armarm

Close the thumb-Close the thumb-screw.screw.


With your left hand With your left hand place theplace the stethoscope stethoscope head directly over the head directly over the artery you foundartery you found. . Press in firmly but not Press in firmly but not so hard that you block so hard that you block the artery. the artery.

Technique of BP measurementTechnique of BP measurement

Use your right hand to Use your right hand to pump the squeeze pump the squeeze bulbbulb several times several times and Inflate the cuff and Inflate the cuff until you can no until you can no longer feel the pulse longer feel the pulse to level above to level above suspected SBPsuspected SBP


If you immediately If you immediately hear sound, pump up hear sound, pump up an additionalan additional 20 20 mmHg and repeat mmHg and repeat


Deflate cuff slowlyDeflate cuff slowly at at a rate of 2-3 mmHg a rate of 2-3 mmHg per second until you per second until you can again detect a can again detect a radial pulseradial pulse


Listen for auditory Listen for auditory vibrations from artery vibrations from artery "bump, bump, bump""bump, bump, bump" (Korotkoff) (Korotkoff)


Systolic blood Systolic blood pressurepressure is the is the pressure at which you pressure at which you can first hear the can first hear the pulse. pulse.


Diastolic blood pressureDiastolic blood pressure is the last pressure at is the last pressure at which you can still hear the pulsewhich you can still hear the pulse


Avoid moving Avoid moving your your handshands or the or the head of head of the stethescopethe stethescope while while you are taking you are taking readings as this may readings as this may produce noise that produce noise that can obscure the can obscure the Sounds of Koratkoff. Sounds of Koratkoff.


BP must take BP must take in in both armsboth arms and one lower and one lower extremity.extremity.


The two arm readings The two arm readings should be within should be within 10-10-15 mm Hg.15 mm Hg. Differences greater Differences greater then then 10-1510-15 imply imply differential blood flow.differential blood flow.


If you wish to If you wish to repeatrepeat the BP measurement the BP measurement you should you should allow the allow the cuff to completely cuff to completely deflatedeflate, permit any , permit any venous congestion in venous congestion in the arm to resolve the arm to resolve and then and then repeat a repeat a minute or so laterminute or so later. .


If the BP is If the BP is surprisingly high or surprisingly high or low, low, repeat the repeat the measurementmeasurement towards thetowards the end end of of your exam your exam ((RepeatedRepeated blood blood pressure pressure measurement can measurement can be be uncomfortable)uncomfortable). .


You can verify the You can verify the SBP by palpation. SBP by palpation. Place the index Place the index and middle fingersand middle fingers of your right hand of your right hand over the over the radial radial artery.artery.

What Abnormal Results What Abnormal Results MeanMean


Diastolic blood Diastolic blood pressurepressure allow free allow free flow of blood without flow of blood without turbulenceturbulence and thus and thus no audible sound. no audible sound. These are known as These are known as the Sounds of the Sounds of KoratkoffKoratkoff. .

Blood pressureBlood pressure

The minimal SBP The minimal SBP required to maintain required to maintain perfusionperfusion variesvaries with with the the individual.individual. Interpretation of low Interpretation of low values must take into values must take into account the account the clinical clinical situation. situation.

Blood pressure for adultBlood pressure for adult

Physician will want to Physician will want to see see multiple blood multiple blood pressure pressure measurementsmeasurements over over several days or several days or weeksweeks before making before making a diagnosis of a diagnosis of hypertensionhypertension and and initiating treatment. initiating treatment.

What Abnormal Results MeanWhat Abnormal Results Mean

Pre-high blood Pre-high blood pressure: systolic pressure: systolic pressure consistently pressure consistently 120 to 139, or 120 to 139, or diastolic 80 to 89 diastolic 80 to 89

Stage 1 high blood Stage 1 high blood pressure: systolic pressure: systolic pressure consistently pressure consistently 140 to 159, or 140 to 159, or diastolic 90 to 99 diastolic 90 to 99


Stage 2 high blood Stage 2 high blood pressure: systolic pressure: systolic pressure consistently pressure consistently 160 or over, or 160 or over, or diastolic 100 or over diastolic 100 or over


Hypotension (blood Hypotension (blood pressure below pressure below normal): may be normal): may be indicated by a systolic indicated by a systolic pressure lower than pressure lower than 90, or a pressure 25 90, or a pressure 25 mmHg lower than mmHg lower than usualusual

HypertensionHypertension

High blood pressure greater High blood pressure greater than than 139-89..139-89..

Blood pressure (Blood pressure (mm Hg) mm Hg)

Normal blood Normal blood pressure 100/60 and pressure 100/60 and 139/89.139/89.

Prehypertension Prehypertension 120,139-80,89… 120,139-80,89…

Blood pressure may be affected Blood pressure may be affected by many different conditionsby many different conditions

Blood pressure may be affected by Blood pressure may be affected by many different conditionsmany different conditions

Cardiovascular Cardiovascular disorders disorders

Neurological Neurological conditions conditions

Kidney and urological Kidney and urological disorders disorders


Pre Pre eclampsiaeclampsia in in pregnant women pregnant women

Psychological factors Psychological factors such as stress, anger, such as stress, anger, or fear or fear

EclampsiaEclampsia


Various Various medications medications ""White coat hypertensionWhite coat hypertension" may occur if the " may occur if the medical visit itself produces extreme anxietymedical visit itself produces extreme anxiety

Orthostatic HypotentionOrthostatic Hypotention


Orthostatic (postural) Orthostatic (postural) measurements of measurements of pulse and blood pulse and blood pressure are part of pressure are part of the assessment for the assessment for hypovolemia. hypovolemia.


First measuring BP First measuring BP when the patient is when the patient is supinesupine and then and then repeating them repeating them after they have after they have stood for 2 stood for 2 minutesminutes, which , which allows for allows for equilibration. equilibration.


Systolic blood Systolic blood pressure does pressure does not vary by more not vary by more then then 20 points20 points when a patient when a patient moves from lying moves from lying to standing. to standing.


Orthostatic Orthostatic measurementsmeasurements may may also be used to also be used to determine if determine if postural postural dizzinessdizziness (diabethic (diabethic autonomic nervous autonomic nervous system dysfunction) is system dysfunction) is the result of a fall in the result of a fall in blood pressure. blood pressure.

Oxygen SaturationOxygen Saturation



Over the past decade, Over the past decade, Oxygen SaturationOxygen Saturation measurement of gas measurement of gas exchange and red exchange and red blood cell oxygen blood cell oxygen carrying capacity has carrying capacity has become available in become available in all hospitals and all hospitals and many clinicsmany clinics. .


Oxygen SaturationOxygen Saturation provide important provide important information about information about cardio-pulmonary cardio-pulmonary dysfunctiondysfunction and is and is considered by many considered by many to be a to be a fifth vital signfifth vital sign. .


For those suffering For those suffering from either from either acuteacute or or chronic cardio-chronic cardio-pulmonary disorderspulmonary disorders, , Oxygen SaturationOxygen Saturation can help can help quantifyquantify the the degree of impairment.degree of impairment.

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Vital signs Dr H.A.Soleimani MD. Gasteroentologist.

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