Vital Signs Learning Materials

Vital Signs Temperature • • • • • • • Temperature should always be recorded. Usually recorded using a tympanic thermometer. Normal temperature: - In mouth: 36.6 to 37.2 - Axilla: 36.4 - Rectum: 37.3 In very hot temperatures there may be a rise of 0.5. When a patient says that they have a fever, they are usually correct. There is a diurnal variation: - Temperature is lowest in the morning. - Reaches the peak at 6 p.m. to 10 p.m. Fever is also known as pyrexia and the pattern may be variable. Type of fever Continued Character Does not remit Intermittent Temperature falls to normal each day. Remittent Daily fluctuations of more than 2 degrees Celsius and does not return to normal. Temperature returns to normal for days before rising again. Relapsing Examples Thyroid fever, drug fever, typhus, malignant hyperthermia. Pyrogenic infections, lymphoma, miliary tuberculosis. Not characteristic of any particular disease. Malaria, lymphoma. Types of Temperature Pathologies • • Sepsis: - Due to a pathogen in the blood that also causes multiple organ dysfunction and may cause death. - Systemic inflammatory response syndrome (SIRS) refers to two or more features that often occur in sepsis. These are fever, tachycardia, tachypnoea and high blood cell count. - Look for obvious source of infection such as wounds after surgery, oozing pus. - Increasing wound pain is an indicator of possible underlying infection. - SIRS do not only occur in infection, but also after surgery, pancreatitis, burns, PE or autoimmune disease. Hyperpyrexia: - A serious problem and may result in death. - Causes: heat stroke from exposure or excessive exertion (e.g., marathon runners), malignant hyperthermia, muscle relaxants (e.g., suxamethonium), neuroleptic • malignant syndrome (a reaction to antipsychotic medication) and hypothalamic disease. Hypothermia: - Normal thermometers do not record temperatures below 35. Special low reading thermometers are required. - Causes: hypothyroidism and prolonged exposure to cold. Pulse When measuring the pulse note: 1. Rate: normal is between 60 and 80 beats per minute. 2. Rhythm: - Premature beats: occur as occasional or repeated irregularities superimposed on a regular pulse rhythm. 3. Presence or absence of delay (radio femoral) 4. Character and volume - Carotid pulsations: when visible -> Corrigan’s sign -> associated with large-volume pulse, including high output states (e.g., fever) and aortic regurgitation, AV fistulas, hyperthyroidism, increase SNS activity. - Collapsing/water hammer pulse: large volume pulse characterised by a short duration with a brisk rise and fall -> aortic valve registration or persistent ducts arteriosus. - Small volume pulse: cardiac failure, shock and obstructive valvular or vascular diseases and tachycardias. - Alternating pulse: Regular alternate beats that are weak and strong -> severe myocardial failure and is due to the prolonged recovery time of damaged myocardium; it indicates a very poor prognosis. It is easily noticed when taking the blood pressure because the systolic pressure may vary from beat to beat by as much as 50 mmHg. - Bigeminal pulse (pulsus bigeminus) -> premature ectopic beat following every sinus beat -> rhythm is not regular because the beat is weak and premature. - Pulsus bisferiens -> hypertrophic cardiomyopathy and in mixed aortic valve disease (regurgitation combined with stenosis) -> The first systolic wave is the ‘percussion’ wave produced by the transmission of the left ventricular pressure in early systole. The second peak is the ‘tidal’ wave caused by recoil of the vascular bed. This normally happens in diastole (the dicrotic wave), but when the left ventricle empties slowly or is obstructed from emptying completely, the tidal wave occurs in late systole. The result is a palpable double pulse. - Dicrotic pulse: results from an accentuated dicrotic wave. It occurs in sepsis, hypovolaemic shock and after aortic valve replacement. - Paradoxical pulse: exaggeration of the normal pattern -> The normal fall of systolic pressure -> due to increased pulmonary intravascular volume during inspiration -> severe airflow limitation (especially severe asthma) there is an increased negative intrathoracic pressure on inspiration which enhances the normal fall in blood pressure. • Carotid • Femoral • Radial • Brachial • Popliteal Respiration • Rate • Rhythm • • • • Posture Pallor Purpose lips, chest/intercoastal recession, tracheal tug, wheeze/stridor Auscultation • - SAGO chart Yellow zone: clinical review. Red zone: rapid response. Yellow and red are used as triggers to activate the facility’s Clinical Emergency Response System (CERS). Blood Pressure Key Information • • • • • A thready pulse suggests -> decreased stroke volume. A bounding pulse suggests -> rapid heart rhythms. Some causes of an absent pulse -> cardiac arrest and shock. Clinical adjuncts or tools that can be used to determine a patient’s pulse at the bedside -> palpations, doppler US, pulse oximetry, ECG. Normal pulse rate -> 60 – 90/100 beats per minute