Surgical Technology Lecture Series 2000©

Power-Point®

Adapted for Concorde Career CollegeST210

byDouglas J. Hughes, MEd, CSFA, CSA, CST,

CRCST

Objectives•Describe the methods used to obtain the

patient’s vital signs and identify normal and abnormal values

•Accurately obtain the patient’s vital signs

Vital Signs•Height and Weight•Temperature•Pulse•Respiration•Blood Pressure•Pulse Oximetry

Height and Weight

Pertaining to Temperature•Febrile: Pertaining to a fever•Hypothermia: Below normal body

temperature•Intermittent Fever: Temperature

alternates between elevated and normal•Pyrexia: Body temperature above normal•Sustained fever: Fever that remains

elevated with no decrease

TemperatureTypes of

Thermometers•Touch•Mercury•Digital

▫Oral/axillary/rectal▫Tympanic membrane▫Temporal

•Chemical▫Skin

TemperatureSelecting a Location

(invasive/noninvasive)•Oral •Rectal•Axillary•Skin•Core

▫Bladder▫Esophagus

Thermometer - Therma-dot®

•Small strip or dot placed on surgical patient’s forehead

•Heat-sensitive strip is calibrated•Adhesive backing•Displays patient’s temperature

Thermometer - Tympanic Membrane (infrared)

•Probe is placed in patient’s ear

•Temperature reading in 2 seconds or less

Thermometer - Electronic

•Probe attached to portable unit•Probe cover•Probe storage •Storage for probe covers

TemperatureTerminology Related to Temperature

•Hyperthermia - Fever•Hypothermia - Temperature below normal

(98.6º)▫Several levels

Normal TemperatureNormal

Temperature• 97.6-99 F

(98.6 F=Normal)36.4-37.2 C

• 99.6 F37.5 C

• 97.6 F36.4 C

Site

• Mouth

• Rectum

• Axilla

Temperature Conversion

•Convert Celsius to Fahrenheit▫C = 5/9 (F-32)

5/9 = 0.5555555555555555

•Convert Fahrenheit to Celsius▫F = 9/5 (C+32)9/5 = 1.8

General Information•Throbbing caused by the regular

contraction and alternate expansion of an artery as the wave of blood passes through the vessel

•Rate of the pulse depends on gender, age, exertion, bodily position, general health of individual

•It is about 10-12 beats faster when standing than sitting

General Information (continued)•Slower in tall persons as compared to a

shorter individual•Eating and drinking increase the heart rate•Temperature and respiration affect heart

rate•Thumb should not be used to feel pulse•Count pulse beats in 15 seconds then

multiply by 4 to determine the rate per minute

Average Pulse Rate (beats per minute - BPM)•Adult male: 60 - 72 BPM•Adult female: 72 - 80 BPM•Child (over seven years): 72 - 90 BPM•Child (one to seven years): 80 - 120 BPM•Infants (less than one year): 110 - 130

BPM

Sphygmogram

•Tracing of the throbbing or pulse that occurs in time with the heartbeat

•Consists of a series of waves to record the pulse rate

Pertaining to Pulse•Apical pulse: Heart rate counted at the

apex of the heart using the stethoscope•Electrocardiogram (ECG): Record,

represented on the ECG in graph form, of the electrical activity of the heart

•Pulse: Contraction of the heart as felt through the wall of an artery

•Pulse deficit: Difference between pulse counts taken simultaneously at two sites; usually apical and radial pulses

PulseTerminology Related to Pulse Rate/Patterns

•Tachycardia - Greater than 100 BPM•Bradycardia - Less than 60 BPM•Irregular - Uneven beat intervals

Pertaining to Arrhythmia

•Arrhythmia: Irregularity or loss of rhythm of the heartbeat▫Bradycardia: Abnormally slow heart rate;

usually less than 60 beats per minute (may be normal for athletes that train in high altitudes)

▫Tachycardia: Abnormally fast heart rate; greater than 100 beats per minute

Pertaining to Arrhythmia (continued)•Cardiac arrhythmia: Irregular heart

action caused by pathological or physiological disturbances in the cardiac impulses from the SA node or their transmission through the heart muscle

•Reperfusion arrhythmia: Occurs as the damaged heart is resupplied with blood following an angioplasty

Normal Heart Sounds

Systole •First sound of the heartbeat•Produced by the contraction of the

ventricle and closure of the atrioventricular valves

•The rate is synchronous with the carotid pulse

•The sound is referred to as the “lubb”

Diastole

•Second sound of the heart beat•Produced by the closing of the aortic and

pulmonary valves•The sound is referred to as the “dupp”

Abnormal Heart Sounds

Reduplication

•A doubling of the heart sounds found in some morbid heart conditions

•Occurs due to the lack of synchronous action of the heart valves, or

•Increased resistance in systemic or pulmonary circulation such as arteriosclerosis or emphysema

Murmur•Abnormal heart sound heard on

auscultation of the heart•Range from soft, blowing sounds to loud

and booming•May be heard during systole, diastole, or

both

Note: A murmur does not always indicate a pathologic condition or the presence of heart

disease

Murmur (continued)

•Murmurs can be produced by ▫Insufficient valves affected by a valvular

disorder or disease▫Aneurysms: AAA▫Roughening of the pericardial surface due

to chronic pericarditis

Sites for Taking the Pulse•Brachial: Medial margin of the bend of

the elbow•Radial: Thumb side of the wrist•Femoral: Inner aspect of the groin area•Temporal: In front of the ear •Carotid: Lateral side of larynx•Apical: Apex of the heart•Popliteal: Posterior side of knee joint•Dorsalis pedis: Instep of the foot;

commonly called the pedal pulse

Pulse

Pulse Points(radial)

Pulse

Pulse Points(carotid)

Pulse

Pulse Points(brachial)

Pulse

Pulse Points(femoral)

Pulse

Pulse Points(dorsalis pedis)

Respiration

Respirations

Respirations

Terms Related to Respiration•Anoxia: Absence of oxygen•Apnea: Absence of breathing•Dyspnea: Painful and difficult breathing•Hyperpnea: Increased rate of respiration•Hypoxia: Abnormally decreased amount of

oxygen reaching the body cell

Terms Related to Respiration (continued)•Orthopnea: Breathing that is facilitated

only when the individual sits or stands in an erect fashion

•Kussmaul breathing: Very deep, gasping type of respiration associated with severe diabetic acidosis and coma

Terms Related to Respiration (continued)•Rales: Bubbling, rattling, crackling sound

caused by excess mucous in the air passages; occurs with bronchitis or pneumonia

•Cheyne-Stokes respiration: An abnormal breathing pattern characterized by periods of apnea lasting 10 - 60 seconds, followed by a cycle of hyperpnea. Accompanies frontal lobe depression

Average Respiratory Rate (per minute)•Adult: 12 - 20•Children (over five years): 20 - 25 •Children (one to five years): 20 - 40•Infants (less than one year): 30 - 50

•Count breaths in 15 seconds then multiply by 4 to determine the rate per minute

Pertaining to Respiration

•Inspiration: Drawing air into lungs•Expiration: Exhaling the air

Involves the muscles of the thorax, abdomen, and diaphragm

Blood Pressure

Blood Pressure

General Information•The pressure exerted on the wall of the artery•Written or stated as systolic over diastolic•Normal BP in the adult is approximately 120/80•Systolic pressure greater than 140 is abnormal•Diastolic pressure greater than 90 is abnormal•Factors that affect BP are age, gender, weight,

altitude, physical fitness•Systolic pressure increases during physical activity

or excitement and decreases during rest

General Information (continued)•Diastolic pressure is dependent on the

elasticity of the artery and the peripheral resistance▫Peripheral resistance: Resistance of the

arterial vascular system, especially the arterioles and capillaries, to the flow of blood. Any change in the lumen diameter or vessel elasticity will influence the amount of resistance; the resistance increases as the vessel constricts

Pertaining to Blood Pressure (BP)•BP: Force the blood exerts against an

artery wall as the heart beats•Diastolic Pressure: Pressure at its lowest

when the heart is relaxed•Systolic Pressure: Pressure at its peak

when the heart is contracting

Pertaining to Blood Pressure (continued)•Pulse Pressure: Difference between

systolic and diastolic pressure

Example: 120 Systolic pressure - 80 Diastolic pressure 40 Pulse pressure

Blood PressureTerminology Related to Blood Pressure

Assessment

•Hypertension - high blood pressure•Hypotension - low blood pressure

Blood PressureKorotkoff Sounds

Phase I - Two tapping sounds (systolic)Phase II - Soft swishing soundPhase III - Rhythmic tapping soundPhase IV - Fading tapping soundPhase V - Sounds disappear (diastolic)

Assessment Criteria (Pulse and Respiration)

Assessment Criteria (Pulse and Respiration)•Rate: Number of pulses or respirations

per minute•Rhythm: Regularity or irregularity of the

pulse or respirations▫Descriptive terms: fast, slow, irregular

•Quality: Volume or strength▫Descriptive terms: strong, weak, thready, full, shallow