Provide Support to Meet Personal Care Needs

Vital Signs

Updated by Jo Lewis BHS

Fiona OToole & Josie Ashmore

PERSONAL CARE WORKERS ROLE

Record
According to workplace protocol Report Supervisor GP

VITAL SIGNS
Most frequent measurements taken by health care professionals Temperature, Pulse, Blood Pressure and Respirations Indicators of health status - measure the effectiveness of circulatory, respiratory, neural and endocrine body functions Alteration in vital signs may signal the need for further intervention

TEMPERATURE
Oral Via Mouth, rarely used Axilla Per Axilla (underarm) Used infrequently Tympanic Most common Temple Recent introduction

Oral
Oral: No longer used in Residential Care, may still be used in home setting 3 minutes Under tongue, lips closed No hot or cold drinks beforehand

Per Axilla
Armpit
Previously most common in aged care Used now if tympanic/temple not available 3 minutes Skin surfaces to touch bulb Record as p/a

Tympanic
Most commonly used in aged care As per instructions for each type Apply cover Pull the ear lobe up and backwards to straighten the ear canal. Insert into canal Wait for beep

THE PULSE
The bounding of blood flow we can feel at various points around our body Indicator of effective circulation For our cells to function normally we need continuous blood flow and volume Blood flows around the body in a continuous circuit, pumped by the heart

 Cardiac output = volume of blood pumped by the heart in one minute

Changes in heart rate alter how well the heart pumps - leads to changes in BP As heart rate increases less time for heart to fill -less volume reduces BP As heart rate decreases filling time increases - normalises BP

Assessing the Pulse

Any artery can be used to assess pulse rate Radial and carotid easiest Carotid best in emergency situation - heart will pump blood to brain for as long as possible When cardiac output drastically reduces peripheral pulses difficult to feel

Carotid pulse

Personal Care Workers

Use only the radial pulse point

Pulse points in the body

Radial and apical locations most commonly used

Equipment needed:

Watch with second hand Pen Documentation as per organisation protocol

Factors which might affect pulse rate

Age
Exercise

Position changes
Medications Temperature Emotional distress/anxiety/fear

Collect equipment Explain to client Wash hands Provide privacy if required Place clients forearm alongside or across lower chest or abdomen (lying) Bend clients forearm at 90 deg angle and support lower arm on chair Make sure palm is facing downward

The steps for taking a radial pulse

Steps for taking a radial pulse

Place the tips of your first two fingers over the groove along the thumb side (radial side) of the clients wrist Do not use your thumb!!!! Lightly compress against the radius to feel a pumping sensation Determine the strength of the pulse Is it strong, thready, bounding or weak ?

Work out the rate

After pulse can be felt regularly, look at watchs second hand and begin to count rate If pulse is regular count for 30 seconds and multiply by 2 (x2) If pulse is irregular, count rate for 60 seconds

Things to consider
Rate Rhythm - regular, regularly irregular, irregularly irregular Strength

Factors influencing pulse rates

Exercise Temperature - fever and heat Drugs Loss of blood (haemorrhage) Postural changes - sitting or standing Lung conditions - poor oxygenation

Normal ranges
INFANT - 120-160 bpm
TODDLER - 90-140 bpm SCHOOLAGE - 75-100 bpm ADOLESCENT - 60-90 bpm ADULT - 60-100 bpm

Respiration
Our survival depends on the ability of O2 and CO2 to be removed from the cells Respiration exchanges gases between the atmosphere and the blood and cells Ventilation = the movement of gases in and out of the lungs Regulated by the respiratory centre in our brain

 Chest wall gently rises and falls Abdominal cavity rises and falls due to diaphragmatic movement No use of accessory muscles intercostal, muscles in neck and shoulders Accurate measurement necessary as breathing tied to numerous body systems Look at rate and depth

Normal breathing

Normal rates
Newborn - 30-60 Infant - 30-50 Toddler - 25-35 Child - 20-30 Adolescent - 16-20 Adult - 12-20

How to assess respiration

Equipment: watch, Obs chart, pen Explain to client ???? Make sure chest is visible-place client arm over abdomen/ or your arm Observe complete cycle (insp and exp) Begin to count rate If regular count for 30 seconds and multiply by 2 (x2) If irregular, less than 12 or more than 20 count for full minute

 Note depth of respirations, skin color and effort Replace linen Wash hands Record on obs chart Report abnormal findings

 Bradypnea - slow breathing Tachypnea - fast breathing Apnoea - no breathing for several seconds Hyperventilation - fast rate and depth Hypoventilation - slow rate and depth Cheyne-stokes respiration - irregular -apnoea - hyperventilation - shallower - apnoea

Other terms you might hear

Blood pressure
The force applied to the inside of our artery by the blood pulsing from our heart

Blood pressure
Can be affected by: Effectiveness of heart pumping Resistance in extremities Blood volume Thickness of the blood Elasticity of arteries and blood vessels

Systolic vs Diastolic BP
Systolic pressure = peak maximum pressure when heart contraction forces blood into aorta (major blood vessel to body) Diastolic pressure = the amount of blood left in the ventricles of the heart when they relax between contractions

Factors influencing BP
Age Stress Race Medications Time of day Gender

Common conditions of BP
Hypertension high BP
Hypotension low BP Postural hypotension dropping

of BP when rising to an
upright position

Normal values
Category
Optimal Normal Hypertension Severe Hypertension

Systolic
< 120 mm hg <130mm hg >140 mm hg 180 mmhg > 180 mm hg

Diastolic
<80 mm hg < 85 mm hg > 90 110 mm hg > 110 mm hg

Equipment needed
Sphygmomanometer and cuff Stethoscope Obs chart and pen

Getting started
Gather equipment Explain to client - rest 5 min if anxious Select appropriate cuff size - S - XL Client can lie or sit or stand Wash hands Expose extremity by removing constricting clothes

 Palpate the brachial pulse (arm) Place cuff about 2.5 cm above pulse site Making sure cuff is fully deflated wrap evenly and snugly around extremity (use arrow to centre on cuff)

 Position the manometer < 1m away from you so you can see it Place stethoscope pieces in ears and ensure sounds are clear and not muffled ? Estimate systolic pressure (30 mmHg >) Relocate pulse and place bell of the stethoscope over it (dont cover it with clothing/cuff

Steps cont.
Close valve of pressure bulb clockwise until tight Rapidly inflate cuff to 30 mmHg than palpated/previous BP SLOWLY release bulb pressure valve allow mercury to fall at a rate of 2-3 mmHg per second

Listen carefully...
Listen for the first thumping sound and note the measurement on the manometer (systolic reading) Sound increases in intensity Continue to deflate cuff and sound will become muffled/dampened and note the measurement again (diastolic reading)

 Continue to deflate cuff gradually listen for 10-20 mmHg after the last sound - let the rest of the air escape quickly Remove cuff Assist client to comfortable position, wash hands Document reading on obs chart Notify of abnormalities

What if the BP is abnormal ?

Repeat the process
Check on other arm

Ask client how they feel

Compare old readings Get someone else to check reading