Vital signs: Wikis

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Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. The act of taking vital signs normally entails recording Body temperature, Pulse rate (or heart rate), Blood pressure, and Respiratory rate, but may also include other measurements. Vital signs often vary by age.

Contents

Primary four

There are four vital signs which are standard in most medical settings:

  1. Body temperature
  2. Pulse rate (or heart rate)
  3. Blood pressure
  4. Respiratory rate

The equipment needed is a thermometer, a sphygmomanometer, and a watch.

Though a pulse can often be taken by hand, a stethoscope may be required for a patient with a very weak pulse.

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Temperature

Temperature recording gives an indication of core body temperature which is normally tightly controlled (thermoregulation) as it affects the rate of chemical reactions.

Temperature can be recorded in order to establish a baseline for the individual's normal temperature for the site and measuring conditions. The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever (temp > 38.5°C or sustained temp > 38°C), or elevated significantly above the individuals normal temperature. Other causes of elevated temperature include hyperthermia.

Temperature depression (hypothermia) also needs to be evaluated. It is also noteworthy to review the trend of the patient's temperature. A patient with a fever of 38°C does not necessarily indicate an ominous sign if his previous temperature has been higher.

Blood pressure

The blood pressure is recorded as two readings; a high systolic pressure, which is the maximal contraction of the heart, and the lower diastolic or resting pressure. Usually the blood pressure is given in the left arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure. The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer. The classic measurement device is a mercury sphygmomanometer, using a column of mercury measured off in millimeters. In the United States and UK, the common form is millimeters of mercury, whilst elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Therefore, elevated blood pressure (hypertension) is variously defined when the systolic number is persistently over 140-160 mmHg. Low blood pressure is hypotension. Blood pressures are also taken at other portions of the extremities. These pressures is called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb (see Ankle brachial pressure index).

Pulse

The pulse is the physical expansion of the artery. Its rate is usually measured either at the wrist or the ankle and is recorded as beats per minute. The pulse commonly taken is the radial artery at the wrist. Sometimes the pulse cannot be taken at the wrist and is taken at the opposite of the elbow (brachial artery), at the neck against the carotid artery (carotid pulse), behind the knee (popliteal artery), or in the foot dorsalis pedis or posterior tibial arteries. The pulse rate can also be measured by listening directly to the heartbeat using a stethoscope. The pulse varies with age. A newborn or infant can have a heart rate of about 130-150 beats per minute. A toddler's heart will beat about 100-120 times per minute, an older child's heartbeat is around 90-110 beats per minute, adolescents around 80-100 beats per minute, and adults pulse rate is anywhere between 50 and 80 beats per minute.

Respiratory rate

Varies with age, but the normal reference range for an adult is 12-20 breaths/minute.[citation needed] The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it is of limited value.

Additional signs

While various additional signs have been proposed, none have been officially universally adopted due to the expense in obtaining equipment required to diagnose and the difficulty in training entry-level professionals.

Fifth sign

The phrase "fifth vital sign" usually refers to pain, as perceived by the patient on a Pain scale of 0–10.[1] For example, the Veterans Administration made this their policy in 1999. However, some doctors have noted that pain is actually a subjective symptom, not an objective sign, and therefore object to this classification.[2]

Other sources include oxygen saturation as their fifth sign.[3][4][5]

Some sources consider pupil size, equality, and reactivity to light to be a vital sign as well.[6]

Sixth sign

There is no standard "sixth vital sign", and the use is much more informal and discipline-dependent than with the above, but some proposals (excluding the fifth sign candidates above) include:

Variations by age

Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table:

Age Normal heart rate
(beats per minute)[15]
Normal respiratory rate
(breaths per minute)[16]
Newborn 100-160 [17] 30-50
0–5 months 90-150 25-40
6–12 months 80-140 20-30
1–3 years 80-130 20-30
3–5 years 80-120 20-30
6–10 years 70-110 15-30
11–14 years 60-105 12-20
14+ years 60-100 12-20

See also

References

  1. ^ Walid MS, Donahue SN, Darmohray DM, Hyer LA, Robinson JS (2008). "The Fifth Vital Sign—What Does It Mean?". Pain Practice 8 (6): 417. doi:10.1111/j.1533-2500.2008.00222.x. PMID 18662363. 
  2. ^ Lee HS (November 2004). "Letters to the Editor: Physical Diagnosis 101: A Lesson From the First Year of Medical School". American Society of Anesthesiologists Newsletter 68 (11). http://www.asahq.org/Newsletters/2004/11_04/lte11_04.html. 
  3. ^ Mower W, Myers G, Nicklin E, Kearin K, Baraff L, Sachs C (1998). "Pulse oximetry as a fifth vital sign in emergency geriatric assessment". Acad Emerg Med 5 (9): 858–65. PMID 9754497. 
  4. ^ Mower W, Sachs C, Nicklin E, Baraff L (1997). "Pulse oximetry as a fifth pediatric vital sign". Pediatrics 99 (5): 681–6. doi:10.1542/peds.99.5.681. PMID 9113944. 
  5. ^ Neff T (1988). "Routine oximetry. A fifth vital sign?". Chest 94 (2): 227. doi:10.1378/chest.94.2.227a. PMID 3396392. 
  6. ^ Dickinson, Edward C.; Limmer, Daniel; O'Keefe, Michael F., ed (2005). Emergency care (10th ed.). Upper Saddle River, N.J: Pearson/Prentice Hall. pp. 212, 218. ISBN 0-13-114233-X. 
  7. ^ Joseph A (2003). "Continence: the sixth vital sign?". Am J Nurs 103 (7): 11. PMID 12865635. 
  8. ^ Vardi A, Levin I, Paret G, Barzilay Z (2000). "The sixth vital sign: end-tidal CO2 in pediatric trauma patients during transport". Harefuah 139 (3-4): 85–7, 168. PMID 10979461. 
  9. ^ Bultz B, Carlson L (2006). "Emotional distress: the sixth vital sign—future directions in cancer care". Psychooncology 15 (2): 93–5. doi:10.1002/pon.1022. PMID 16444764. http://www.jco.org/cgi/content/full/23/26/6440. 
  10. ^ http://www.ohsu.edu/medicine/residency/handouts/0405handouts/COPD091304.ppt
  11. ^ "Glycemic Control in the Hospitalized Patient" (Powerpoint). University of Iowa. http://www.medicine.uiowa.edu/cme/about/documents/PrintHandout.ppt. 
  12. ^ Bierman A (2001). "Functional status: the sixth vital sign". J Gen Intern Med 16 (11): 785–6. doi:10.1111/j.1525-1497.2001.10918.x. PMID 11722694. 
  13. ^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD).". National Guideline Clearinghouse. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7008&nbr=4217#s21. 
  14. ^ Studenski S, Perera S, Wallace D, et al (2003). "Physical performance measures in the clinical setting". J Am Geriatr Soc 51 (9): 314–322. doi:10.1046/j.1532-5415.2003.51104.x. 
  15. ^ Emergency Care, Page 214
  16. ^ Emergency Care, Page 215
  17. ^ Profile of a healthy baby includes a normal newborn exam with no evidence of:

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