Medical Assistant Clinical and Administrative Procedures - Chapter 19: Vital Signs

Inhalation

the diaphragm descends and the lungs expand

Aural Temperature

the ear site is used with the tympanic membrane thermometer.

Conditions that can cause a decrease SpO2 valve (hypoxemia) include the following

- Acute pulmonary disease (e.g., pneumonia) - Chronic pulmonary disease (e.g., emphysema, asthma, bronchitis) - Cardiac problems (e.g., congestive heart failure, coronary artery disease)

What is the oxygen level for a healthy individual?

95%-99%; because the air we breathe is only 21% saturated (filled) with oxygen, it is unusual for an individual's hemoglobin to be fully or 100% saturated unless the patient is on a supplement for oxygen

What is the normal body temperature range?

97F to 99F (37C to 37.2C)

What is the average temperature?

98.6F (37C)

fahrenheit scale

a temperature scale on which the freezing point of water is 32 degrees and the boiling point of water is 212 degrees.

dyspnea

shortness of breath or difficulty breathing

axilla

the armpit

frenulum linguae

The midline fold that connects the undersurface of the tongue with the floor of the mouth.

cyanosis

a bluish discoloration of the skin and mucous membranes caused by hypoxia.

Fever (pyrexia)

a body temperature greater than 100.4 degrees Fahrenheit

hypoxemia

a decrease in the oxygen saturation of the blood; less than 95%; may lead to hypoxia

thread pulse

a pulse with a decreased volume that feels weak and thin.

bouncing pulse

a pulse with an increased volume that feels very strong and full.

hypoxia

a reduction in the oxygen supply to the tissues of the body.

Hypothermia

a subnormal body temperature less than 97 degrees Fahrenheit. This means that the heat the body is losing is greater than the heat it is producing. A person cannot usually survive with a temperature below 93.2 degrees Fahrenheit.

Crisis

a sudden falling of an elevated body temperature to normal.

Celsius Scale

a temperature scale on which the freezing point of water is 0 degrees and the boiling point of water is 100 degrees; also called the centigrade scale.

apnea

a temporary absence of respirations. Some individuals experience apnea during sleep; this condition is known as sleep apnea.

alveolus

a thin-walled air sac of the lungs in which the exchange of oxygen and carbon dioxide takes place.

malaise

a vague sense of body discomfort, weakness, and fatigue.

SpO2 (saturation of peripheral oxygen)

abbreviation for the percentage of hemoglobin that is saturated with oxygen in arterial blood as measured by a pulse oximeter. Measures the oxygen saturation of peripheral capillaries

SaO2 (saturation of arterial oxygen)

abbreviation for the percentage of hemoglobin that is saturated with oxygen in arterial blood.

adventitious breath sounds

abnormal breath sounds

hypopnea

an abnormal decrease in the rate and depth of respiration

bradypnea

an abnormal decrease in the respiratory rate of less that 12 respirations per minute

tachypnea

an abnormal increase in the respiratory rate of more than 20 respirations per minute

hyperventilation

an abnormally fast and deep type of breathing, usually associated with acute anxiety conditions.

tachycardia

an abnormally fast heart rate of more than 100 beats per minute.

bradycardia

an abnormally slow heart rate that is less than 60 beats per minute.

dysrhythmia

any irregularity in the heart's rhythm, also termed arrhythmia and is characterized by unequal or irregular intervals between the heartbeats.

infrared waves

are heat waves the tympanic membrane gives off.

electronic thermometer

are often portable and measure oral, axillary, and rectal temperatures ranging from 84-100 degrees Fahrenheit.

What are the purposes of measuring body temperature?

are to establish the patient's baseline temperature and to monitor an abnormally high or low body temperature.

Chemical Thermometers

contain chemicals that are heat sensitive and include disposable chemical sing-use thermometers and temperature-sensitive strips.

pulse rhythm

denotes the time interval between heart beats; a normal rhythm has the same time interval between beats.

hypoxia

is defined as reduction in the oxygen supply to the tissue of the body, and if not treated can lead to tissue damage and death. The first symptoms of hypoxia include headache, mental confusion, nausea, dizziness, shortness of breath, and tachycardia. The tissues most sensitive to this condition are the brain, heart, pulmonary vessels and liver.

Femoral pulse site

is in the middle of the groin. This site is used to measure pulse in infants and children and in adults during cardiac arrest and to assess the status of circulation in the lower leg.

apical-radial pulse

is measured to determine whether a pulse deficit is present. It involves measuring the apical pulse at the same time as the radial pulse for a duration of 1 full minute.

Axillary Temperature

is recommended as a site for measuring temperature in toddlers and preschoolers. Take note to tell the physician that the temp was taken through the axillary route.

pulse rate

is the number of heart pulsations or heart-beats that occur in 1 minute; pulse rate is measured in beats per minute.

conduction

is the transfer of heat from one object to another by direct contact; heat can be transferred by conduction from the body to a cooler object it touches.

radiation

is the transfer of heat in the form of waves; body heat is continually radiating into cooler surroundings.

convection

is the transfer of heat through the air currents; cool air currents can cause the body to lose heat.

Tympanic Membrane Thermometer

is used at the aural (ear) site.

Variations in Body Temperature by Age

Newborn: Axillary - Average Temp: 97-100F 1 yr: Oral - Average Temp: 99.7F/36.1-37.8C 5 yr: Oral - Average Temp: 98.6F/37.6C Adult: Oral - Average Temp: 98.6F/37C Rectal - Average Temp: 99.6F/37.5C Axillary - Average Temp: 97.6F/36.4C Aural - Average Temp: 98.6F/37C Elderly (over 70 yr): Oral - Average Temp: 96.8F/36C

What method is convenient and one of the most common ways of measuring a body temperature?

Oral method

Radial pulse site

most common site for measuring the pulse is the radial artery, which is located in a groove on the inner aspect of the wrist just below the thumb.

What are the five sites for measuring body temperature?

mouth, axilla, rectum, ear, and forehead

eupnea

normal respiration or breathing

febrile

one who has a fever

afebrile

one who is without a fever

Rectal Temperature

provides an extremely accurate measurement of the body temperature. This method is generally used for infants and young children, unconscious patients, and mouth-breathing patients and when greater accuracy in body temperature is desired. This method should not be used on newborns because of the danger of rectal trauma.

respiratory failure

resulting in tissue damage usually occurs when the oxygen saturation decreases to a level between 85% and 90%. Cyanosis typically appears when an individual's oxygen saturation reaches a level of 75%, and an oxygen saturation of less than 70% is life-threating.

Rhythm and Depth

should be noted when measuring respiration. The rhythm should be even and regular, and the pauses between inhalation and exhalation should be equal. The depth of respiration indicates the amount of air that is inhaled or exhaled during the process of breathing.

Ambient temperature

surrounding air temperature

Hyperpyrexia

temperature greater than 105.8 degrees Fahrenheit; it is a serious condition, and a temperature greater than 109.4 degrees Fahrenheit is generally fatal.

What do vital signs include?

temperature, pulse, and respiration (collectively called TPR) blood pressure, and pulse oximetry.

respiration

the purpose of respiration is to provide for the exchange of oxygen and carbon dioxide between the atmosphere and the blood. Each respirations divided into two phases: inhalation and exhalation.

Respiratory Rate

the respiratory rate of a normal healthy adult ranges from 12 to 20 respirations per minute.

Pulse Rates of Various Age Groups

- Infant (birth to 1 yr): 120-160 bpm (pulse range) - 140 bpm (average pulse) - Toddler (1-3 yr): 90-140 bpm (pulse range) - 115 bpm (average pulse) - Preschool child 3-6 yr): 80-110 bpm (pulse range) - 95 bpm (average pulse) - School-age child (6-12 yr): 75-100 bpm (pulse range) - 90 bpm (average pulse) - Adolescent (12-18 yr): 60-100 bpm (pulse range) - 80 bpm (average pulse) - Adult (after 18th yr): 60-100 bpm (pulse range) - 80 bpm (average pulse) - Adult (after 60th yr): 67-80 bpm (pulse range) - 84 bpm (average pulse) - Well-trained athletes 40-60 bpm (pulse range) - 50 bpm (average pulse)

Respiratory Rates of Various Age Groups

- Infant (birth to 1 yr): 30-40 bpm (average range) - 35 bpm (average) - Toddler (1-3 yr): 23-35 bpm (average range) - 30 bpm (average) - Preschool child (3-6 yr): 20-30 bpm (average range) - 25 bpm (average) - School-age child (6-12 yr): 18-26 bpm (average range) - 22 bpm (average) - Adolescent (12-18 yr): 12-20 bpm (average range) - 16 bpm (average) - Adult (after 18th yr): 12-20 bpm (average range) - 16 bpm (average) *BPM = Breathes Per Minute

Abnormal breath sounds

- crackles (rales) - CAUSE: air moving through airways that contain fluid; CHARACTER: dry or wet intermittent sounds that vary in pitch - rhonchi - CAUSE: thick secretions, tumors, or spasms that partially obstruct air flow through large upper airways; CHARACTER: deep, low-pitched, rumbling sound more audible during expiration - wheezes - CAUSE: severely narrowed airways caused by partial obstruction in smaller bronchi and bronchioles; common symptom of asthma; CHARACTER: continuous, high-pitched, whistling musical sounds heard during inspiration and expiration - pleural friction rub - CAUSE: inflamed pleurae rubbing together; CHARACTER: high, grating sound similar to rubbing leather pieces together, heard on inspiration and expiration

Factors Affecting Pulse Rate

1. Age. As age increases, the pulse rate gradually decreases. 2. Gender. Women tend to have a slightly faster pulse than men. 3.Physical activity. 4. Emotional state. Strong emotional states, such as anxiety, fear, excitement, and anger, temporarily increase the pulse rate. 5. Metabolism. 6. Fever. Fever increases the pulse rate. 7. Medications. Medications may alter the pulse rate.

When measuring the respiratory rate, the following should be taken into consideration

1. Age. As age increases, the respiratory decreases. 2. Physical activity. 3. Emotional states. Strong emotional states temporarily increase the respiratory rate. 4. Fever. A patient with a fever has an increased respiratory rate. 5. Medications. Certain medications increase the respiratory rate, and others decrease it.

Points that should be taken into consideration when evaluating a patient's temperature.

1. Age. Infants and young children normally have a higher body temperature than adults because their moregulatory system is not fully developed. Elderly individuals usually have a lower body temperature 2. Diurnal variations. During sleep, body metabolism slows down, as do muscle contractions. The body's temperature is lowest in the morning. 3. Emotional states. Anger and crying can increase the body temperature. This is important to consider when working with you children when they are ill. 4. Environment. Cold weather decreases the body temperature. Warmer weather increases it. 5. Exercise. Physical exercise causes an increase in voluntary muscle contractions, which elevates the body temperature. 6. Patient's normal body temperature. Some patients normally run a low or high temperature. The medical assistant should review they patient's past vital sign recordings. 7. Pregnancy. The body temperature is usually elevated.

General guidelines that the medical assistant should follow when measuring the vital signs

1. Be familiar with the normal ranges for all vital signs. Normal ranges vary based on the different age groups (infant, child, adult, elder). 2. Make sure that all equipment for measuring vital signs is in proper working condition to ensure accurate findings. 3. Eliminate or minimize factors that affect the vital signs, such as exercise, food and beverage consumption, smoking, and emotional state. 4. Use an organized approach when measuring the vital signs. If all of the vital signs are ordered, they are usually measured starting with temperature, followed by pulse, respiration, blood pressure, and pulse oximetry.

Factors affecting pulse oximeter

1. Incorrect positioning of the probe. The probe consists of two parts: the LED and a photodetector. It is important that these two components be aligned directly opposite of each other during the measurement. 2. Fingernail polish or artificial nails. A dark coating on the fingernail may result in a falsely low reading. The darker the coating the more likely the SpO2 reading will be affected. If the patient has artificial fingernails, another site should be used to take the measurement, such as the ear lobe or the toe. 3. Poor peripheral blood flow. The oximeter works best when there is a strong pulse. Poor peripheral blood flow may cause the pulse to be so weak that the oximeter cannot obtain a reading. Conditions resulting in poor blood flow include peripheral vascular disease, vasoconstrictor medications, severe hypotension, and hypothermia. 4. Ambient (surrounding) light. Ambient light shining directly o the probe, such as bright fluorescent light, direct sunlight, or an overhead examination light, may result in an inaccurate reading. 5. Patient movement. Patient movement is a common cause of an inaccurate reading. Motion affects the ability of the light to travel from the LED to the photodetector and prevents the probe from picking up pulse signal.

Stages of a Fever

1. Onset - The temperature first begins to increase. The patient often experiences chills, and the pulse and respiratory rate increases. 2. Course of a fever - the temperature rises and falls in one of the following three fever patterns: - Continuous fever: body temperature fluctuates minimally but always remains elevated. Occurs with: Scarlet fever, Pneumococcal pneumonia) - Intermittent fever: body temperature alternately rises and falls and at times returns to normal or becomes subnormal. (Occurs with: Bacterial infections, viral infections) - Remittent fever: with range of temperature fluctuations occur, all of which are above normal. (Occurs with: Influenza, Pneumonia, Endocarditis) * The patient may also experience one or more of the following: flushed appearance, increased thirst, loss of appetite, headache, and malaise. 3. Subsiding stage - the temperature returns to normal.

Assessment of Respiration

Because an individual can control his or her respiration, the medical assistant should measure respirations without the patient's knowledge. An ideal time to measure respiration is after the pulse is taken.

What three factors cause heat loss from the body?

Radiation, conduction, and convection. Heat is lost from the body through the urine, feces and water vapor during exhalation.

Mechanism of the pulse

The aorta is already filled with blood and must expand to accept the blood being pushed out of the left ventricle. This creates a pulsating wave that travels from the aorta through the walls of the arterial system. This wave, knows as the pulse, can be felt as a light tap by an examiner. The pulse is measured by counting the number of taps, or beat per minute.

Forehead Temperature

The temporal artery is a major artery of the head that runs laterally across the forehead and down the side of the neck. The forehead site can be used to measure body temperature using a temporal artery thermometer in individuals of all ages.

What are the four type of thermometers available to measure body temperature?

electronic thermometers, temporal artery thermometers, tympanic membrane thermometers, and chemical thermometers

hyperpnea

excessive (deep, rapid, and labored) breathing

pulse deficit

exists when the radial pulse rate is less than the apical pulse rate. A pulse deficit means that not all of the heartbeats are reaching the peripheral arteries.

Low grade fever

if the body temperature falls between 99 to 100.4 degrees Fahrenheit

When is fever common?

in illness; particularly inflammation and infection

Exhalation

involves the removal of carbon dioxide from the body. The diaphragm ascends, and the lungs return to their original state.

pulse oximeter

is a device used to measure and display the oxygen saturation of the blood

blood pressure

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

Popliteal pulse site

is at the back of the knee and is detected most easily when the knee is slightly flexed. This site is used to measure blood pressure when the brachial pulse is inaccessible and to assess the status of circulation to the lower leg.

Apical pulse site

the apical pulse site has a stronger beat and is easier to measure than the other pulse sites. If the medical assistant is having a difficulty feeling the radial pulse or the pulse is irregular, the apical pulse should be taken. This pulse site is usually measure on infants or in children up to 3. The pulse is measured using a stethoscope. The chest piece of the stethoscope is placed lightly over the apex of the heart, which is located in the fifth intercostal (between the ribs) space of the left midclavicular line.

Brachial pulse site

the brachial pulse is in the antecubital space, which is the space located at the front of the elbow. This site is used to take blood pressure, to measure pulse in infants during cardiac arrest, and to assess the status of the circulation of the lower arm.

Carotid pulse site

the carotid pulse site is located on the anterior side of the neck, slightly to one side of the midline, and is the best site to find a pulse quickly. This site is used to measure pulse in children during cardiac arrest, and to monitor pulse during exercise.

Where is the body temperature regulated?

the hypothalamus

Control of Respiration

the medulla oblongata, located in the brain, is the control center for involuntary respiration. Voluntary respiration is ultimately under the control of the medulla oblongata.

Color of the Patient

the patient's color should be observed while the respiration is being measured.

diastole

the phase in the cardiac cycle in which the heart relaxes between contractions

systole

the phase in the cardiac cycle in which the ventricles contract, sending blood out of the heart and into the aorta and pulmonary trunk.

systolic pressure

the point of maximum pressure on the arterial walls, which is recorded during systole.

pulse volume

the strength of the heartbeat

Temporal pulse site

the temporal pulse is located in front of the ear and just above eye level. This site is used to measure pulse when the radial pulse is inaccessible.

Ulnar pulse site

the ulnar pulse is located on the ulnar (little finger) side of the wrist. It is used to assess the status of circulation to the hand.

pulse oximetry

the use of a pulse oximeter to measure the oxygen saturation of arterial blood.

orthopnea

this condition in which in which breathing is easier when an individual is in a sitting or standing position.

What is the purpose of measuring the pulse?

to establish the patient's base line pulse rate and to assess the pulse rate after special procedures, medications, or disease processes that affect heart functioning.

Temporal Artery Thermometer

to perform procedure, a scan button is continually depressed while the probe is gently and slowly moved across the patient's forehead.

Why is a disposable plastic cover placed over the probe of an electric thermometer?

to prevent the transmission of microorganisms among patients