Chapter 19: Vital Signs

What is a pulse deficit?

A pulse deficit exists when the radial pulse rate is less than the apical pulse rate.

Describe the following fever patterns: Continuous fever: Intermittent fever: Remittent fever:

Continuous fever: Body temperature fluctuates minimally but always remains elevated. Intermittent fever: Temperature alternately rises and falls, and at times returns to normal or becomes subnormal. Remittent fever: Wide range of temperature fluctuations occur, all of which are above normal.

What are the two types of stethoscope chest pieces and the use of each?

Diaphragm: For hearing high-pitched sounds such as lung and bowel sounds. Bell: For hearing low-pitched sounds such as those produced by the heart and vascular system.

Why is the diastolic pressure lower than the systolic pressure?

Diastolic pressure is recorded during the relaxation of the heart.

List two reasons for taking the pulse at the apical pulse site.

Difficulty is encountered in feeling the pulse; the pulse is irregular or abnormally slow or rapid; pulse must be measured in an infant or child younger than 3 years of age, because other sites are difficult to palpate in these age groups.

List and describe the four types of thermometers available for taking body temperature.

Electronic thermometer: consists of interchangeable oral and rectal probes attached to a battery-operated portable unit. Tympanic membrane thermometer: consists of a hand-held device with a sensor probe. Temporal artery thermometer: consists of a probe attached to a portable unit. Chemical thermometer: Contains chemicals that are heat sensitive; includes disposable single- use thermometers and temperature-sensitive strips.

What may cause tachycardia?

Hemorrhaging or heart disease, vigorous exercise, strong emotional states.

What does blood pressure measure?

Pressure or force exerted by the blood on the walls of the arteries in which it is contained.

Describe the character of normal breath sounds.

Quiet and barely audible.

What can occur if the oxygen saturation level falls between 85% and 90%?

Respiratory failure resulting in tissue damage.

How can dark fingernail polish cause a falsely low SpO2 reading?

The coating interferes with proper light transmission through the finger.

What general guidelines should be followed when measuring vital signs?

Be familiar with the normal ranges for all vital signs, ensure that all equipment for measuring vital signs is in proper working condition, attempt to eliminate or minimize factors that may affect the vital signs, and use an organized approach when measuring the vital signs.

What is the unit of measurement for pulse rate?

Beats per minute.

Why must respiration be measured without the patient's awareness?

Because the patient can control his or her respiration.

What is a fever?

Body temperature that is above normal, or 100.4°F (38°C).

What is the purpose of pulse oximetry?

To measure the oxygen saturation of hemoglobin in arterial blood, which provides information on the amount of oxygen being delivered to the tissues of the body.

What is the purpose of respiration?

To provide for the exchange of oxygen and carbon dioxide between the atmosphere and the blood.

What is the purpose of exhalation?

To remove carbon dioxide from the body.

What may occur if blood pressure is taken using a cuff that is too small or too large?

With a cuff that is too small, the reading may be falsely high; with a cuff that is too large, the reading may be falsely low.

When would each of the following cuffs be used to measure blood pressure? a. Child: b. Adult: c. Thigh:

a. Child: For children and for adults with small arms. b. Adult: For adults with average-sized arms. c. Thigh: For measurement of blood pressure at the thigh or for adults with large arms.

Explain how a tympanic membrane thermometer measures body temperature.

A tympanic membrane thermometer detects thermal energy that is naturally radiated from the body and calculates body temperature from this energy.

What is the purpose of placing a probe cover on a tympanic membrane thermometer?

The probe cover protects the lens and provides infection control.

How does a temperature taken through the rectal and axillary methods compare (in terms of degrees) with a temperature taken through the oral method?

A temperature taken with the rectal method measures approximately 1°F higher than the same temperature taken with the oral method. A temperature taken with the axillary method measures approximately 1°F lower than the same temperature taken with the oral method.

What symptoms occur with a fever?

The patient has an increased pulse and respiratory rate, is warm to the touch, has a flushed appearance, and experiences increased thirst, loss of appetite, headache, and malaise.

How should the blood pressure be measured if the patient's arm circumference is greater than 50cm (20 inches)?

The patient's blood pressure can be measured using the forearm and radial artery. An appropriate-sized cuff is positioned midway between the elbow and wrist with the center of the bladder over the radial pulse. The diaphragm is placed over the radial pulse, and the blood pressure is measured using the same technique as for brachial artery blood pressure measurement.

What is the normal respiratory rate (range) for a normal adult?

12 to 20 respirations per minute.

State the normal range for a pulse rate for an adult.

60 to 100 beats per minute.

What is the oxygen saturation level of a healthy individual?

95% to 99%.

What can cause hyperventilation?

Acute anxiety conditions such as panic attacks.

List three patient conditions that can cause a decreased SpO2 value.

Acute pulmonary disease, chronic pulmonary disease, cardiac problems.

What can cause cyanosis?

Advanced emphysema and cardiac arrest.

Where is the apex of the heart located?

In the fifth intercostal space at the junction of the left midclavicular line.

Where is cyanosis first observed?

In the nail beds and lips.

How is apical-radial pulse taken?

Measurement of the apical pulse at the same time as the radial pulse is taken for a duration of 1 full minute.

What is the name of the control center for involuntary respiration?

Medulla oblongata.

List the two types of sphygmomanometers.

Mercury and aneroid.

What five sites are used for taking body temperature?

Mouth, axilla, rectum, ear, and forehead.

What are the four vital signs?

Temperature, pulse, respiration, and blood pressure; another indicator of a patient's health status is pulse oximetry reading.

Why does the rectal method for taking body temperature provide a very accurate temperature measurement?

The rectum is highly vascular, and of the five sites, it provides the most closed cavity.

How does age affect blood pressure?

As age increases, the blood pressure gradually increases.

Explain how to clean the lens of a tympanic membrane thermometer.

Gently wipe the surface of the lens with an antiseptic wipe and immediately wipe it dry with a cotton swab. Allow at least 5 minutes before taking a temperature.

What is considered normal blood pressure for an adult?

Less than 120/80mm Hg.

List four ways in which heat is lost from the body.

In the urine and feces, in moisture droplets from the lungs, and through perspiration, conduction, convection, and radiation.

What are the parts of a sphygmomanometer?

Manometer, inner inflatable bladder covered by a cuff, pressure bulb with a control valve.

How can patient movement cause an inaccurate SpO2 reading?

Motion affects the ability of the light to travel from the LED to the photodetector and prevents the probe from picking up the pulse signal.

What is included in one complete respiration?

One inhalation and one exhalation.

What is the ratio of respirations to pulse beats?

One respiration to every four pulse beats.

Describe the advantages of a tympanic membrane thermometer.

Prevents the transmission of microorganisms from one patient to another.

What is the most common site for taking the pulse?

Radial artery.

What type of patients may make it difficult to properly align the oximeter probe?

Thin patients, children, and patients with very large fingers such as obese patients.

When is the brachial artery used as a pulse site?

When taking blood pressure and measuring the pulse rate in infants during cardiac arrest; when assessing circulation to the lower arm.

List three instances in which the axillary site for taking body temperature would be preferred over the oral site.

When body temperature must be taken in toddlers and preschoolers, in mouth-breathing patients, and in patients who have oral inflammation or have undergone oral surgery.

When is the carotid artery used as a pulse site?

When measuring pulse in children and adults during cardiac arrest; also used by individuals to monitor pulse during exercise.

When is the femoral artery used as a pulse site?

When measuring pulse in infants and children; when measuring pulse in adults during cardiac arrest; when assessing circulation to the lower leg.

When can pulse oximetry be used for the short-term continuous monitoring of a patient?

When monitoring a patient who is experiencing an asthmatic attack or monitoring a sedated patient during minor office surgery.

How do diurnal variations affect blood pressure?

When one awakens, the blood pressure is lower as a result of the decreased metabolism and physical activity that occur during sleep. As metabolism and activity increase during the day, the blood pressure increases.

What is the normal pulse range for a well-trained athlete?

40 to 60 beats per minute.

Why should blood pressure readings always be interpreted using the patient's baseline blood pressure?

A rise or fall of 20 to 30mm Hg in a patient's baseline blood pressure is significant even if it is still within the normal accepted blood pressure range.

What are two conditions in which dyspnea may occur?

Asthma, emphysema, vigorous physical exertion.

Why must a reusable oximeter probe be free of all dirt and grime before it is used?

Dirt and grime can interfere with proper light transmission, which leads to an inaccurate reading.

List four factors that can result in an inaccurate temporal artery temperature reading.

Dirty probe lens, sweating of the patient's forehead, too rapid scanning of the forehead, and failure to keep the button depressed while the forehead and the area behind the earlobe is scanned.

Where should a chemical thermometer be stored? Explain why.

Chemical thermometers should be stored in a cool area and should not be exposed to direct sunlight, because heat may cause the chemical thermometer to register a higher temperature.

List five advantages of an automated blood pressure monitor.

Device automatically determines how much the cuff should be inflated to reach a pressure that is approximately 30mm Hg above the systolic pressure. Cuff does not have to be manually inflated and deflated because this function is performed automatically. Brachial artery does not need to be located, and the bladder of the cuff does not need to be centered over the brachial artery. Stethoscope and user listening skills are not required to obtain the reading because the electron- ic sensor in the automated device measures oscillations from the wall of the brachial artery to obtain the reading. Automated devices are less susceptible to external environmental noise than manual devices. Blood pressure measurement is easy to read on a digital display screen. Multiple blood pressure measurements can be taken. Most automated devices come with an internal memory for storing multiple blood pressure measurements.

How do emotional states affect the body temperature?

Increase the body temperature.

How does vigorous physical exercise affect body temperature?

Increases the body temperature.

How does physical activity affect the pulse rate?

Increases the pulse rate temporarily.

What type of patient may experience hypopnea?

Individuals with sleep disorders.

The exchange of oxygen and carbon dioxide between the body cells and blood is known as _____________________.

Internal respiration.

What is the normal body temperature range? What is the average body temperature?

Normal body temperature range: 97°F to 99°F (36.1°C to 37.2°C) Average body temperature: 98.6°F (37°C)

Define a vital sign.

Objective guidepost that provides data to determine a patient's state of health.

What type of site must be used for applying a pulse oximeter probe?

Peripheral site that is highly vascular and where the skin is thin.

List three conditions that can cause poor peripheral blood flow.

Peripheral vascular disease, use of vasoconstrictor medications, severe hypotension, hypothermia.

List the five phases included in Korotkoff's sounds and describe what type of sound is heard during each phase.

Phase I: This is the first clear tapping sound, which gradually increases in intensity. Phase II: The sounds have a murmuring or swishing quality. Phase III: The sounds become crisper and increase in intensity. Phase IV: The sounds become muffled and have a soft, blowing quality. Phase V: The sounds disappear.

List two factors that can increase the respiratory rate.

Physical activity, strong emotional states, fever, certain medications.

What two pulse sites can be used to assess circulation to the foot?

Posterior tibial and dorsalis pedis.

If the rhythm and volume of a patient's pulse are normal, the medical assistant records the information as _______________________.

Regular and strong.

Explain how to determine the proper cuff size for a patient.

The inner inflatable bladder of the cuff should encircle at least 80% (but no more than 100%) of the arm circumference and should be wide enough to cover two-thirds of the distance from the axilla to the antecubital space.

Describe a normal rhythm for respiration.

The rhythm should be even and regular, and the pauses between inhalation and exhalation should be equal.

How do diurnal variations affect body temperature?

The temperature of the body is lowest in the morning before metabolism and muscle contractions begin increasing.

List three reasons why the temporal artery is a good site to measure body temperature.

The temporal artery is located close to the surface of the skin and is easily accessible. The temporal artery has a constant steady flow of blood, which assists in providing an accurate measurement.

How does the temperature obtained through the temporal site compare with oral, rectal, and axillary body temperatures?

The temporal artery reading is 1°F higher than oral body temperature, about the same as rectal temperature, and 2°F higher than axillary body temperature.

What is the purpose of the pulse oximeter power-on self-test (POST)?

To check the internal systems of the oximeter to ensure that they are functioning properly.

List two reasons for measuring the pulse rate.

To establish the patient's baseline rate and to assess the pulse rate after special procedures, with use of certain medications, or in disease processes that affect heart functioning.

What is the purpose of inhalation?

To take oxygen into the lungs.

What is the function of hemoglobin?

Transports oxygen in the body.

List four ways in which heat is produced in the body.

Voluntary and involuntary muscle contractions, cell metabolism, fever, and strong emotional states.

When can the aural method be used to take body temperature?

When taking body temperature in children younger than 6 years of age, in uncooperative patients, and in patients who are unable to have the temperature taken orally.

When can the rectal method be used to take body temperature?

When taking body temperature in infants and young children, unconscious patients, or mouth- breathing patients, and when greater accuracy in body temperature is desired.

What causes the pulse to occur?

When the left ventricle of the heart contracts, blood is forced from the heart into the aorta. The aorta is already filled with blood and must expand. This creates a pulse wave that can be felt as a light tap by an examiner.

What is the subsiding stage of a fever?

When the temperature returns to normal.

Describe the character of the following abnormal breath sounds: a. Crackles: b. Rhonchi: c. Wheezes:

a. Crackles: Dry or wet intermittent sounds that vary in pitch. b. Rhonchi: Deep, low-pitched rumbling sounds that are more audible during expiration. c. Wheezes: Continuous, high-pitched, whistling musical sounds heard during inspiration and expiration.

What is the normal pulse range for the following age groups: a. Infant: b. Toddler: c. Preschooler: d. School-age: e. Adult after age 60:

a. Infant: 120 to 160 beats per minute. b. Toddler: 90 to 140 beats per minute. c. Preschooler: 80 to 110 beats per minute. d. School-age 75 to 105 beats per minute. e. Adult after age 60: 67 to 80 beats per minute.

State the blood pressure range for each of the following: a. Prehypertension: b. Hypertension, stage 1: c. Hypertension, stage 2:

a. Prehypertension: Systolic 120 to 139mm Hg and diastolic 80 to 89mm Hg. b. Hypertension, stage 1: Systolic 140 to 159mm Hg and diastolic 90 to 99mm Hg. c. Hypertension, stage 2: Systolic 160mm Hg or more and diastolic 100mm Hg or more.