CLINICAL SKILLS

Dr. Zeinab Hakim Jr. Instructor,RAKMHSU

October,2012

Vital Signs Measurement

Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions.

The act of taking vital signs normally entails recording:body temperature, pulse rate, blood pressure and respiratory rate, but may also include other measurements. Vital signs often vary by age.

Why to measure ??

Can identify the existence of an acute medical problem.

Are a means of rapidly quantifying the magnitude of an illness and how well the body is coping with the resultant physiologic stress. The more deranged the vitals, the sicker the patient.

Are a marker of chronic disease states

Temperature Temperature control (thermoregulation) is part of a homeostatic

mechanism that keeps the organism at optimum operating temperature, as it affects the rate of chemical reactions.

Normal human body temperature, also known as normothermia or euthermia.

In humans the average internal temperature is 37.0 °C (98.6 °F), though it varies among individuals.

However, no person always has exactly the same temperature at every moment of the day.

Common Parts of Body Where Temp is Measured

• Oral • Rectal• Axillary or groin• Tympanic

Generally, oral, rectal, gut, and core body temperatures, although slightly different, are well-correlated, with oral temperature being the lowest of the four.

Oral temperatures are generally about 0.4 °C (0.9 °F) lower than rectal temperatures.

Parts of Body Where Temp is Measured

• Oral (in the mouth under the tongue)

– Most common, convenient and comfortable method

– Clinical thermometer left in place for 3 to 5 minutes

– Normal oral temp is 37.0 °C (98.6°F)– Range: 36.4 °C to 37.5 °C (97.6°F to 99.6°F)

Parts of Body Where Temp is Measured

• Rectal (in the rectum)– Most accurate because it is an internal

measurement– Clinical thermometer left in place for 3 to 5

minutes– Normal rectal temp is 37.5 °C (99.6°F)– Range: 37.0 °C to 38.1 °C (98.6°F to 100.6°F)

Parts of Body Where Temp is Measured

• Axillary or groin– Axillary is taken in armpit while upper arm is held close to

body and thermometer is inserted between two folds of skin

– Groin is taken between two folds of skin formed by the inner part of the thigh and lower abdomen

– Less accurate because they are external temps– Clinical thermometer left in place for 10 minutes– Normal axillary or groin temp is 36.4 °C (97.6°)– Range: 35.8 °C to 36.9 °C (96.6°F to 98.6°F)

Parts of Body Where Temp is Measured

• Tympanic – Taken with a special thermometer that is place din

the ear or auditory canal– Thermometer detects and measures the thermal,

infrared energy radiating from blood vessels in the tympanic membrane

– Since this provides a measurements of body core temp, there is no normal range

– Most tympanic thermometers will record the temp in less than 2 seconds

Measuring device

• Glass thermometers• Electronic thermometers• Plastic thermometer strip• Ear thermometers

Natural rhythm

Body temperature normally fluctuates over the day, with the lowest levels around 4 a.m. and the highest in the late afternoon, between 4:00 and 6:00 p.m. (assuming the person sleeps at night and stays awake during the day).

An individual's body temperature typically changes by about 0.5 °C (0.9 °F) between its highest and lowest points each day.

Factors Causing an Increase in Body Temperature

• Illness and infection• Exercise and/or excitement• High temperatures in the environment• Starvation or fasting• Sleep• Decrease in muscle activity• Mouth breathing• Cold temperatures in the environment

Abnormal Conditions Related ToTemperature

• Hypothermiais a condition in which core temperature drops

below the required temperature for normal metabolism and body functions which is defined as 35.0 °C (95.0 °F)rectally– Can be caused by prolonged exposure to the cold– Death usually occurs if temp drops below 33.8 °C

(93°F) for a period of time

Abnormal Conditions Related ToTemperature

• Fever– Elevated body temp.– Usually above 38.2 °C (101°F) rectally.– Usually caused by infection or injury.

Abnormal Conditions Related ToTemperature

• Hyperthermia– Body temp above about 40 °C (104 °F) rectally.– Can be caused by prolonged exposure to hot

temperatures, brain damage or serious infection– Immediate actions must be taken to lower temp.– Can lead to convulsions and death.

Step Step Details ( To be done Appropriately in sequence)

No Title Mark

1.Greeting and introduction

Greet the patient , introduce yourself, explain what you will do and take verbal consent.

2

2.Before you start

Wash your hands and make sure equipments are ready 1

3.before you start

Ask if the patient ate or drank something hot or cold, smoked, chewed gum or did any strenuous activity within the last 10 minutes. If the patient has done any of these things, wait to take the temperature for 10 minutes.

1

4.Take patient’s temperature

Mercury thermometer Digital thermometer 2

Take the thermometer and shake it so the mercury goes below normal temperature.Place the thermometer under the tongue

Take the thermometer Place a disposable cap on the thermometer. Place the thermometer under the tongue

5.Wait and read wait for 3-5 minutes toread the recordedtemperature.

Wait until the digital thermometer beeps to read the display

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6.Record your data

Write down the patient's temperature, where on the body it was taken, and the time.

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7. End THANKTHEPATIENT 2

Total Mark 10

1.

2.Place disposable cap cap

3.Place under tounge For 3-5 min

4.Read

Pulse

One's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips (The pulse is the physical expansion of the artery)

The pulse may be palpated in any place that allows an artery to be compressed against a bone.

The pulse commonly taken is from the radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries.

The pulse varies with age Newborn (0-3 months old) 100-150 infants (3 — 6 months) 90–120 Infants (6 — 12 months) 80-120 Children (1 — 10 years) 70–130 over 10 years& adults, including seniors 60–100 well-trainedadult athletes 40–60

Rate, Rhythm

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

If the rate is particularly slow or fast, it is probably best to measure for a full 60 seconds.

• Regularity: Is the time between beats constant? In the normal setting, the heart rate should appear metronomic.

Bradycardia

in an adult is any heart rate less than 60 beats per minute (bpm).

Causes: • Cardiac arrythmias• Cardiac diseases • Recreactional drug abuse• Metabolic and endocrine disease • Electrolyte imbalance • Prolonged bed rest

Tachycardia

Typically refers to a heart rate that exceeds the normal range. A heart rate over 100 beats per minute is generally accepted as tachycardia.

Causes:• Cardiac arrythmias• Anxiety and stress • Recreactional drug abuse• Metabolic and endocrine disease • Electrolyte imbalance

Step Step Details ( To be done Appropriately in sequence)

No Title

1. Greeting and introduction

Greet the patient, introduce yourself, explain what you will do and take verbal consent.

2.Before you start Ask if the patient did any strenuous activity within the last 10 minutes. If so wait for 10 minutes.

3.Find the patient's pulse with your index, middle and ring fingers.

–Place the tips of your index and middle and ring fingers on the radial artery ( remember the surface marking ) Take care not to press too hard.– If you can't find the pulse in the wrist, try finding other pulses.

4.Find your data – Count the number of pulse for 30 seconds and Multiply by 2 to get the heart rate. If the pulse is irregular, count for a full minute.

5.Record your data Write down the heart rate, any irregularities and the time and the place the pulse was taken.

6.End THANK THE PATIENTTotal Mark

Respiratory rate

Human respiration rate is measured when a person is at rest and involves counting the number of

breaths for one minute by counting how many times the chest rises.

Varies with age, but the normal reference range for an adult is 14–20 breaths/minute.

Respiration rates may increase with fever, illness, or other medical conditions.

Abnormal R,R

• Apnea: suspension of external breathing.

• Tachypnea: ventilatory rate greater than 20 breaths per minute.

• Bradypnea: slow breathing rate.

Step Step Details ( To be done Appropriately in sequence)

No Title Mark

1. Greeting and introduction

Greet the patient, introduce yourself, explain what you will do and take verbal consent.

2

2.Before you start Ask if the patient did any strenuous activity within the last 10 minutes. If so wait for 10 minutes.

1

3.Measure

Without informing the patient observe the rise and fall of the patient's hospital gown while you appear to be taking their pulse.

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4.Count the R.R Count the number of inhalations that occur in 30 seconds and multiply by 2 to get the respiration rate. Note any abnormalities.

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5.Recor your data Write down the respiration rate, whether it seems abnormal, and the time.

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6.End THANKTHEPATIENT 2

Total Mark 10

Blood pressure (BP)

sometimes referred to as arterial blood pressure, is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs.

• BP=CO X PVR

During each heartbeat, blood pressure varies between a maximum (systolic) and a minimum (diastolic) pressure.

AHA Classification of BP

American Heart Association

Hypotension is abnormally low blood pressure, especially in the arteries of the systemic circulation. It is best understood as a physiological state, rather than a disease. It is often associated with shock. If it is lower than normal, then it is called low blood pressure SBP<90 mmHgDBP<60 mmHg

• However in practice, blood pressure is considered too low only if noticeable symptoms are present.

Blood pressure (BP) is measured using mercury based manometers, with readings reported in millimeters of mercury (mm Hg).

The size of the BP cuff will affect the accuracy of these readings.

The inflatable bladder, which can be felt through the vinyl covering of the cuff, should reach roughly 80% around the circumference of the arm while its width should cover roughly 40%. If it is too small, the readings will be artificially elevated. The opposite occurs if the cuff is too large.

Step Step Details ( To be done Appropriately in sequence) No Title Mark

1. Greeting and introduction

Introduce yourself, explain what you will do and take verbal consent. 2

1. Getting started Make sure patient is comfortable, equipments are ready,expose the arm up to 2/3rds. 1

1. Wrap the cuff around the

arm

Wrap the cuff around the patient's upper arm so that the balloon is roughly over the brachial artery, 1inchabove cubital fossa.

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4. Place the stethoscope

With your left hand, place the diaphragm of the stethoscope over the area of the brachial artery. In the cubital fossa.

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5. Open the valve

With right hand turn the valve on the pumping bulb clockwise until it no longer moves. 1

6. Pump to generate pressure

Use your right hand to pump the bulb until you have generated 150 -160 mmHg on the manometer.

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7. Finding the SBP & DBP Slowly deflate the blood pressure cuff by turning the valve in a counter-clockwise direct. The first sound you hear is the SBP.When the sound completely disappears this is DBP.Open the valve completely and remove the cuff.

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8. Compare with the other arm Repeat the measurement on the patient's other arm(if required) 0.5

9. Record your data Write down the blood pressure. First list systolic pressure, then forward slash, then diastolic pressure, (eg: 120/70), the patients position (sitting, supine etc) and the time at which you took it.

0.5

10. End THANK THE PATIENT 1

Total Mark

THANK YOU