: PHYSICAL EXAM INTRODUCTION TO VITAL SIGNS : {Pharm 563}

BACKGROUND Vital signs are coarse OBJECTIVE measurements for a patient’s physical state. The four vital signs are: blood pressure, pulse, respiratory rate, and temperature. You will work with a partner to practice obtaining vital signs.

STEPS TO OBTAINING VITAL SIGNS 1. Make sure you have all needed equipment 2. Sanitize devices and hands before performing 3. Introduce yourself and ask for permission 4. Make sure the patient is seated and comfortable (or standing or sitting if taking various blood pressure measurements) 5. Measure vital signs 6. Record results 7. Sanitize devices and hands after performing

BLOOD PRESSURE . The normal values and targets for blood pressure range and vary based on age and co- morbidities . JVC 7 classifies normal as a systolic blood pressure < 120 mmHg and a diastolic blood pressure < 80 mmHg . Measuring Blood Pressure o The patient should be seated with her/his arm bared, supported on a smooth surface and positioned at heart level. The patient should be relaxed and should not have smoked or ingested caffeine within 30 minutes prior to measurement. Ideally, measurement should begin after five minutes rest. o Locate the brachial artery along the upper inner arm by palpation. o Wrap the deflated cuff of appropriate size snugly and firmly around the arm about 2.5 cm above the antecubital space. The arrow on the cuff should point to the area where the brachial artery is palpable. o You can determine the level for maximal inflation by observing the pressure at which the radial pulse is no longer palpable as the cuff is rapidly inflated and adding 30mm Hg. Then rapidly and steadily deflate the cuff. Wait at least 15-30 seconds before reinflating. o Position the head of the stethoscope over the palpated brachial artery below the cuff at the antecubital fossa. The stethoscope head should be applied with light pressure, ensuring skin contact at all points. Heavy pressure may distort sounds. Because sound generated over the vessels is relatively low in frequency, use of the bell head may enhance sound detection. o Rapidly and steadily inflate the cuff. o Release the air in the cuff so that the pressure falls at a rate of 2 to 3 mm per second. o Note the systolic pressure at the onset of at least two consecutive beats. Blood pressure levels should be recorded in even numbers and read to the nearest 2 mmHg mark on the manometer. o Note the diastolic pressure at cessation of sound for adults. Listen for 10 to 20 mm Hg below the last sound heard to confirm disappearance, and then deflate the cuff rapidly and completely. . Your turn o Measurement 1: ______o Measurement 2: ______o Measurement 3: ______PULSE

. The normal range for pulse in adults is 60 to 100 beats per minute (bpm) o Bradycardia is pulse lower than 60 bpm o Tachycardia is pulse greater than 100 bpm . Measuring Pulse o Palpate the radial pulse at the wrist . Avoid using the thumb o Count the beats for 30 seconds and multiply by 2 . May count for 15 seconds and multiply by 4 o Note the rhythm . Regular, irregular, regularly irregular, irregularly irregular . Your turn: o Measurement 1: ______o Measurement 2: ______o Measurement 3: ______

RESPIRATORY RATE . Normal adult respiratory rate is 8 to 20 breaths per minute (bpm) o Bradypnea is respiratory rate lower than 8 bpm o Tachypnea is respiratory rate greater than 20 bpm o Apnea is the cessation of breathing for 20 or more seconds . Measuring Respiratory Rate o Observe patient breathing and count respirations for 30 seconds and multiply by 2 . Alternately count for 15 seconds and multiply by 4 o Count by listening to breaths via stethoscope OR watching rise and fall of chest o Best to perform discretely (i.e., continue “taking pulse” while watching for rise and fall of chest) . Your turn: o Measurement 1: ______o Measurement 2: ______o Measurement 3: ______

TEMPERATURE

Route of Normal Values Measurement 35.8-37.3°C Oral (96.4-99.1°F) 35.3-36.8°C Axillary (95.9-99.6°F) 36.6-37.8°C Rectal (94.9-99.6°F)

o Fever is defined as oral temp > 37.9°C (100.9°F) o Hypothermia is defined as core temp < 35.0°C (95°F) . Measuring Temperature o Instant Thermometers . Utilize infrared heat given off in ear canal . Gently, but firmly pull ear up and back . Point lens into ear canal . Gently insert lens as far as comfortably possible . Take measurement . Read and record measurement o Mercury Thermometers . Shake down mercury column . Place under tongue, under arm, or in rectum . Keep in place for two minutes . Read and record measurement . Your turn: o Measurement 1: ______o Measurement 2: ______o Measurement 3: ______

Please detach page here and turn in bottom portion to your instructor. ______

I have practiced taking 3 blood pressures, 3 pulses, 3 respiratory rates, and 3 temperatures. I have asked my instructor to watch my technique and all of my questions have been answered at this time.

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