Patient Care and Management

Nicodemus, Kamille Joyce M.

➢ And others; bladder, heart
BSRT [Link]
chamber, external auditory
canal
LESSON 6: VITAL SIGNS AND PATIENT
ASSESSMENT Normal Values
- Body temperature is
1. TEMPERATURE altered by:
- Body temperature is the Age - infants and children have a
balance between heat lost wider range of body
and heat gained by the temperatures while the elderly
body have ↑ temperatures
- Measured in heat units
Diurnal variations - ↓ early
called degrees (°)
morning and ↓ at night
- core temperature -
internal temperature Exercise - ↑ after during/after
- surface temperature - the exercise
temperature of the skin
Hormones - C for conception in family
planning
➢ Thermometer - the device used
to measure body temperature Stress
1. Digital thermometer
2. Glass thermometer Environment
3. Electric thermometer
➢ Normal body temperature
➢ Monitoring - A variation of 0.5°F to
- Sites of body temperature 1.0°F is considered within
measurement normal limits
- Adult rectal
1. Mouth
temperature is 0.5°F to
- Readily accessible
1.0°F ↑ than oral
- Oral thermometer is
- Adult axillary
placed 3-5 mins.
temperature is 0.5°F to
sublingual
1.0°F ↓ than oral
2. Axilla
- Easy access and safest NORMAL BODY TEMPERATURE
- The axillary thermometer Adult oral 37.0°C 98.6°F
is placed 5-10 mins. (O)
under the axilla
Adult 37.4- 99.1-
3. Rectum rectal (R) 37.7°C 99.6°F
- Most accurate and most
reliable - close to the
Adult 36.4- 97.6-
pelvic viscera axillary 36.7°C 98.1°F
- The rounded rectal (Ax)
thermometer tip is
placed 2-3 mins. 1½ Infant - 4 37.2- 99.0-
inch. (3-4 cm) inside the years 37.7°C 99.7°F
rectum Child 5 - 36.6- 97.8-
- Inserted in Sims position 13 years 37.0°C 98.6°F
- Contraindicated with
cardiac pathologic
condition
 Patient Care and Management
Remittent - A wide range
of temperature
fluctuations
TERMINOLOGY occur over a
24 hour
Hyperthermia - A body period
temperatur
e above Relapsing - Short febrile
normal period of a few
days and
Hypothermia - A body interspersed
temperatur with 1-2 days
e below of normal
normal temperature
Pyrexia - Fever, Constant - Body
temp temperature
higher than fluctuates
37.0°C or but is always
98.6°F above normal
Hyperpyrexia - Life Fever - Occurs only
threatening spike/strike/shoc hours then
temperatur k becomes
e, above normal on the
41°C or day until the
105.8°F next day
Febrile - Client who
has fever 2. PULSE
Afebrile - Client - A wave of blood created
without by the contraction of the
fever left ventricle of the heart
- Body areas having
FEVER superficial arteries are
➢ Increased body temperature best suited for
➢ Usually signifies infection determination of a patient's
➢ Symptoms include: pulse rate.
- General malaise
- Increased pulse and
PULSE LOCATION USES
respiratory rates
POINT
- Flushed skin that is hot
and dry to the touch Radial Wrist, base of Most
- Occasional chills thumb frequently
➢ Very high, prolonged fevers can used
cause irreparable brain damage
Carotid Neck below Measured in
the jaw, case of
FEVER TYPE DESCRIPTION lateral to the cardiac arrest,
larynx/trache used in an
Intermittent - The body a unconscious
temperature patient
alternates at
regular interval, Temporal Anterior to Assess
between periods of the ear circulation to
fever, normal the brain; if
temperature, radial and
subnormal brachial is not
temperature accessible
 Patient Care and Management
Brachial Anterior Used in Fever
aspect of the infants, used - Fever will ↑ pulse rate
elbow; to measure
antecubital BP using a Medications
area stethoscope - Alcohol and drug use ↑
and a pulse rate
sphygmomano
meter Hemorrhage

Femoral Inguinal Assess Stress

region, groin circulation in
Position changes
upper leg,
- ↑ pulse rate in the standing
used in case
position
of cardiac
arrest
TERMINOLOGY
Popliteal posterior Assess
knee circulation to Tachycardia - ↑ pulse
lower limb rate; >
100 bpm
Posterior Medial aspect
tibial of the ankle Bradycardia - ↓ pulse
rate; < 60
Dorsalis Top of the Maybe bpm
pedis foot congenitally
absent to
determine 3. RESPIRATION MONITORING
discrepancy
Respiration
Apical Apex of the Need the use - Process of measuring a
heart of a patient’s breathing in and
stethoscope out
- The act of respiration
Normal Pulse Rates serves to deliver oxygen to
Adult 60 - 90 all the body cells and rid
the body
Men 70 - 72 - Measured in the span of
one minute, a wristwatch
Women 78 - 82
is commonly used
Children (4 - 10 90 -100
yrs old) Monitoring Patient Respiration
Infants Average of 120 Adult respiratory 12 to 18 or 20
rate
➢ Pulse rate is affected by: Childre up to 30
- Age - the very young and respiratory rate
very old
Respiratory Even, uneven
Age pattern
- the very young and very old
Respiratory Shallow, deep
↑ pulse rates
depth
Sex
- Pulse differs among men and ➢ A patient’s respiration should be
women controlled after counting the
Exercise pulse rate, while still holding the
- ↑ pulse rate after exertion, patient wrist
athletes often have ↓ pulse - Respiratory action may
rate become more deliberate
 Patient Care and Management
and less natural in the px > 1st contraction
who is ware that his/her heard
respirations are being
counted monitoring px
respiration
➢ The radiographer must be able to
recognize abnormalities or
changes in patient respiration
2. Diastolic pressure
Dyspnea
- blood pressure
- difficulty of breathing reading that occurs
during the
Uneven
relaxation of the
ventricles
Strident
> represents
- shrill, shaking sound pressure when the
heart is at rest
Stertorous
(relaxation;resting
- noisy and labored state)
> last contraction
Oligopnea
heard
- abnormally shallow, slow - Blood pressure within
vessels is greatest during
Spasmodic
ventricular systole
(contraction) and lowest
Tachypnea
during diastole
- abnormally rapid breathing
(relaxation)
Orthopnea
Blood pressure in range (mm Hg)
- difficulty breathing while
recumbent Category Systolic Diastolic

normal 110 - 140 60 - 90

4. BLOOD PRESSURE
➢ The force of blood pushing Hypotensi Below 90 Below 80
on
against the walls of the
arteries in the body Prehypert 120 -139 80 -90
➢ There are two numbers ension
associated with blood
Hypertens Above 140 Bove 90
pressure
ion
1. Systolic pressure -
blood pressure Stage 1 140 - 159 90 -100
reading that occurs hypertensi
during the on
contraction of the
Stage 2 Above 160 Above 100
ventricles while the hypertensi
blood is in the on
artery
> represents
➢ Factors affecting blood
pressure when the
pressure
heart contracts to
- Age
pump blood to the
- Sex
body (pumping
- Exercise
state)
- Fatigue, mental or physical
stress, race, obesity,
 Patient Care and Management
medications, disease and 8. The blood pressure read
trauma as systolic/diastolic
➢ Blood pressure is determined - 110/90 mm Hg
by ➢ Shock
a. Cardiac output - Indicated by the extremely
b. Blood volume low blood pressure
c. Vascular resistance - Systolic pressure reading
lower than 60 mm Hg
➢ Measuring and taking the
blood pressure ➢ Hypotension
1. Place the - Is seen in individuals with
sphygmomanometer cuff a decreased blood volume
around the person’s upper as a result of hemorrhage,
arm. The lower edge of the infection, fever and
cuff should be about an anemia
inch above the - Orthostatic hypotension
elbow/antecubital fossa. occurs in some individuals
Use a velcro fastener to when they rise quickly
snugly hold the cuff from recumbent position
around the arm.
2. The pressure gauge ➢ Hypertension
attached to the cuffs - An abnormal elevation of
should be easily readable. blood pressure for at least
Adjust the position of the two consecutive readings
pressure gauge if you - If left undiagnosed and
need too. untreated, hypertension
3. Attached to the cuff is an can lead to renal, cardiac,
inflatable bulb, which is or brain damage
used to inflate the cuff with - Etiology of hypertension
air. Notice that there is an > essential/primary
air valve. Check the hypertension - no known
inflatable air valve if it is cause or predisposed by
closed. risk factors such as family
4. Put the stethoscope history, increased sodium
earpiece into your ear. intake, physical inactivity
Place the diaphragm of the > secondary hypertension
stethoscope over the - associated with other
brachial artery. diseases
5. While holding the ➢ Common signs and symptoms
diaphragm of the of hypertension
stethoscope over the - headache
brachial artery, pump air - epistaxis
into the cuff until the - dizziness
gauge reads about 150- - tinnitus (ringing in the
180 mm Hg. ears)
6. Slowly begin to release air. - unsteadiness
The first pulse sound is the - blurred vision
systolic pressure. - usually, some people are
7. Continue to release air asymptomatic
slowly. You will still hear
the pulse sound. When the
sound disappear, that will
be the diastolic pressure.
 Patient Care and Management

➢ Symptoms of hypertensive
crisis - if blood pressure is
extremely high
- Severe headache
- Fatigue or confusion
- Vision problems (crossed
eye)
- Chest pain
- Difficulty in breathing
- Irregular heartbeat
- Hematuria
- Pounding in head, chest or
ears

5. PROCEDURE FOR PATIENT ASSESSMENT

➢ Physical Signs
- Patient condition may be
assessed through:
1. Chart info
2. Observation
3. Questioning
4. Vital signs
- RT must be alert to
patient’s appearance and
condition, and any
subsequent changes in
them
- Patient’s skin color,
temperature and
moistness is easily
observed and often
reflects current location

Paleness
- Frequently indicates weakness

Pale, cool skin

- The patient may be diaphoretic

Hot, dry skin

- Frequently accompanies fever

Sweaty palms
- May indicate anxiety

Cyanotic patient
- Patient needs oxygen and
requires immediate medical
attention