Patient Assessment Vital Signs

Objectives:

In today’s highly integrated, intensely technical and increasingly invasive diagnostic imaging environment it becomes necessary for today’s technologist to understand and practice good patient assessment. There is no getting around it; we are professionals who are responsible for our patient’s welfare while they are in our care.

The skills we need are not controlled acts, they are not the private domain of others and they are easily within our scope of practice.

What are vital signs?

Vital signs are measurements of the body's most basic functions. Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere.The four main vital signs routinely monitored by medical professionals and healthcare providers include the following:

• body temperature
• pulse rate
• respiration rate (rate of breathing)
• blood pressure (NB. blood pressure is not considered a vital sign, but is often measured along with the vital signs.)

What is body temperature?

The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature, according to the American Medical Association, can range from 97.8° F (or Fahrenheit, equivalent to 36.5° C, or Celsius) to 99° F (37.2° C).

What is fever?

Fever (also called pyrexia) is defined as body temperature that is higher than normal for each individual. It generally indicates that there is an abnormal process going on within the body. The severity of a condition is not necessarily reflected by the degree of fever. For example, influenza may cause a fever of 104° F, while pneumonia may cause a very low-grade fever or no fever at all. Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). A fever is indicated when body temperature rises above 98.6° F orally or 99.8° F rectally. Hypothermia is defined as a drop in body temperature below 95° F.

A person's body temperature can be taken in any of the following ways:

• Orally

Temperature can be taken by mouth using either the classic glass thermometer, or the more modern digital thermometers that use an electronic probe to measure body temperature.

• Rectally

Temperatures taken rectally (using a glass or digital thermometer) tend to be 0.5 to 0.7° F higher than when taken by mouth.

• Axillary

Temperatures can be taken under the arm using a glass or digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4° F lower than those temperatures taken by mouth.

• By ear

A special thermometer can quickly measure the temperature of the ear drum, which reflects the body's core temperature (the temperature of the internal organs).

NB. According to the Environmental Protection Agency (EPA), mercury is a toxic substance that poses a threat to the health of humans, as well as to the environment. Because of the risk of breaking, glass thermometers containing mercury should be removed from use and disposed of properly in accordance with local, state, and federal laws. Contact your local health department, waste disposal authority, or fire department for information on how to properly dispose of mercury thermometers.

What is the pulse rate?

The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. Taking a pulse not only measures the heart rate, but also can indicate the following:

• heart rhythm
• strength of the pulse

The normal pulse for healthy adults ranges from 60 to 100 beats per minute. The pulse rate may fluctuate and increase with exercise, illness, injury, and emotions. Females ages 12 and older, in general, tend to have faster heart rates than do males. Athletes, such as runners, who do a lot of cardiovascular conditioning, may have heart rates near 40 beats per minute and experience no problems.

Taking a Pulse: As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries, which are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the lower neck, on the inside of the elbow, or at the wrist. When taking your pulse:

• Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse.
• Begin counting the pulse when the clock's second hand is on the 12.
• Count your pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate beats per minute).
• When counting, do not watch the clock continuously, but concentrate on the beats of the pulse.
• If unsure about your results, ask another person to count for you.

What is the respiration rate?

The respiration rate is the number of breaths a person takes per minute. The rate is usually measured when a person is at rest and simply involves counting the number of breaths for one minute by counting how many times the chest rises. Respiration rates may increase with fever, illness, and with other medical conditions. When checking respiration, it is important to also note whether a person has any difficulty breathing.

Normal respiration rates for an adult person at rest range from 15 to 20 breaths per minute. Respiration rates over 25 breaths per minute or under 12 breaths per minute (when at rest) may be considered abnormal.

Conclusion

The skills of every profession change and evolve with the expanding of knowledge and the revising of best practice. If we want to continue to practice within this changing atmosphere then we must learn and carry out the skills to do so.