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Chapter 11: Basic Vital Signs and Measurements
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- 1Vital Signs-cardinal signs
temperature, pulse, and respiration (TPR), and blood pressure (BP)
pain assessment sometimes included
height and weight and patient's oxygen saturation - 2Patient Intakedescribes the process of obtaining vital signs and measurements, and conducting a brief patient interview
-reason for visit (complaint)
-patient history or update info
-height and weight
-vital signs - 3Height and Weightmensuration- means measurement
fluctuations with height or weight could indicate health disorder or illness - 4Body Mass Index (BMI)a numerical correlation between a patient's height and weight
*multiply weight in lbs by 703
*divide the total by height in inches
*divide by height in inches
*result is BMI
less than 18.5: underweight
18.6-24.9: acceptable
25.0-29.9: overweight
greater than 30: obese - 5Waist Circumferencemeasured in standing position, tape measure placed around patient's waist just superior to the hip bone
- 6Weight Circumference to establish body fat-measurements for a woman greater than 35 in would be considered excessive
-measurements for a man greater than 40 in considered excessive - 7Body Fat Calipersare devices that measure skin folds on different parts of the body
- 8Temperaturestaying within a particular temperature range is essential for the body to maintain homeostasis
tissues and cells in the body function best between 97F and 99F - 9Structures that Help Regulate Temperature-The Hypothalamus: within the brain; aka thermostat
-Blood Vessels: when hot; vasodilation occurs. when cold vasoconstriction
-The Integumentary System: allows the body o lose heat through perspiration
-The Neurmuscular System: controls shivering, and helps raise body temperature - 10Heat Produced Vs Heat Lostif the amount of heat produced exceeds the amount lost, a fever occurs and the patient is febrile
if the heat lost is greater than the amount produced, hypothermia can occur
Normal temp is afebrile - 11Normal Tempnormal temp is approx: 98.6F
must document the way the temp is taken
rectal temps run higher than oral, axillary temps run lower than oral, and generally less accurate. Tympanic membrane, or aural (ear) temps run higher than oral readings because they are within a closed cavity - 12Temperature ConversionCelsius to Fahrenheit: multiply the celsius reading by 9/5 and add 32
C= 36.1 X 9= 324.9/5= 64.98 + 32 = 97F
Fahrenheit to Celsius: subtract fahrenheit by 32 then multipy 5/9
F= 97- 32 = 65 X 5= 325/9 = 36.1C - 13Normal Temps by RouteOral: 98.6F-37.0C
Aural (ear): 99.6F- 37.7C
Rectal: 99.6-37.7C
Temporal(forehead): 99.6F-37.7C
Axillary(armpit): 97.6-36.3C - 14FeverLow Grade: 100.4F- 102.2F (38C-39C)
Moderate: 102.2F-104F (39C-40C)
High-Grade: 104-107.6 (40C-42C)
Hyperpyrexia: greater than 107.6 (42C)
Lethal: greater than 109F (43C) - 15Pulse- Temporallocate in the temple region of cranium, mainly used in emergency situations
- 16Pulse- Apexlocated at the apex of the heart or at the fifth intercostal
can be palpated or can be listening to with a stethoscope.
used to check pulse in infants and children up to the age of three - 17Pulse- Brachiallocated in the antecubital space at the front side of the elbow
used for blood pressure in adults, checkpoints for infants recieving CPR, and artery is compressed to control bleeding - 18Pulse- Carotidlocated laterally to midline of the anterior neck
easy to palpate - 19Pulse- Dorsalis Pedislocated on the superior surface of the foot
difficult to palpate
used to assess circulation in the foot - 20Pulse- Femorallocated in the center of the groin region
used to assess circulation and control bleeding - 21Pulse- Popliteallocated on the posterior surface of the knee
can be used for blood pressure
best palpated when the knee is slightly bent - 22Pulse- Posterior tibialthe medial aspect of ankle
used to assess circulation - 23Pulse- Radialradial or thumb side of wrist
checking pulse rates in adults - 24Average Pulse RatesNewborn:140
0-6 M: 130
6-12 M: 115
12- 24 M: 110
2-6 years: 100
Early school Age: 95
Adolescene through adulthood: 80
Geriatric: 74
Athletes: 60
Elite athletes:50 - 25Pulseheart rate over 100 BPM- tachycardia
heart rate below 60 BPM- bradycardia - 26Pulse rhytheminterval timing between measured beats
- 27Arrhythmias/Dysrhymiasare irregularities
may order EKG or ECG - 28Pulse Volumestrength of the pulse, the amount of blood being discharged from the heart
- 29Taking an Apical Pulseis taken with the aid of a stethoscope.
the diaphragm is placed over the apex of the heart - 30Resipratory Values in breaths per minuteNewborn: 30-60 min
12-24 M: 20-40 Min
8-15 years: 15-25 min
16 years- adult: 16-20 min - 31Describing Patient's Respiration-Dyspnea: difficult or labored breathing
-Orthopnea: easiest breathing while in sitting or standing postion
-Tachypnea: rapid rate with normal or shallow resiprations
-Hyperpnea/Hyperventilation: rapid and deep respiration
Bradypnea: breathing abnormally slow - 32systolewhen the cardiac ventricles contract
Systolic pressure- greatest amount of force is applied to the aterial vessels
the top number when recording blood pressure - 33Diastolewhen cardiac ventricles relax
the pressure is lower during this phase as the heart relaxes and is referred to as diastolic pressure
the bottom number - 34Adult Blood PressureNormal: Sys: less than 120 Dia: less than80
Prehypertensive: Sys: 120-139 Dia: 80-89
Stage 1 hypertension: 140-159 Dia: 90-99
Stage 2 hypertension: greater than 159 Dia: greater than 99 - 35Korotkoff SoundsPhase one-the first sound heard
Phase 2: sound intensifies to swooshing tone
Phase 3:sound becomes stronger
Phase 4: the pulsation become softer
Phase 5: totally inaudible
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- College (Clinical Medical Assisting) Clinical Medical Assisting Fichas sobre Chapter 11: Basic Vital Signs and Measurements, creado por La'Shae el 25/07/2015.
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