Vital signs - Wikipedia

There are four primary vital signs: body temperature, blood pressure, pulse (heart rate), and breathing rate (respiratory rate), often notated as BT, BP, HR, ... Vitalsigns FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Groupofthe4-6importantmedicalsignsthatindicatethestatusofthebody'svitalfunctions Forotheruses,seeVitalsigns(disambiguation). VitalsignsAnanestheticmachinewithintegratedsystemsformonitoringofseveralvitalparameters,includingbloodpressureandheartratePurposeassessthegeneralphysicalhealthofaperson Vitalsigns(alsoknownasvitals)areagroupofthefourtosixmostcrucialmedicalsignsthatindicatethestatusofthebody'svital(life-sustaining)functions.Thesemeasurementsaretakentohelpassessthegeneralphysicalhealthofaperson,givecluestopossiblediseases,andshowprogresstowardrecovery.[1][2]Thenormalrangesforaperson'svitalsignsvarywithage,weight,gender,andoverallhealth.[3] Therearefourprimaryvitalsigns:bodytemperature,bloodpressure,pulse(heartrate),andbreathingrate(respiratoryrate),oftennotatedasBT,BP,HR,andRR.However,dependingontheclinicalsetting,thevitalsignsmayincludeothermeasurementscalledthe"fifthvitalsign"or"sixthvitalsign".VitalsignsarerecordedusingtheLOINCinternationallyacceptedstandardcodingsystem.[4][5] Earlywarningscoreshavebeenproposedthatcombinetheindividualvaluesofvitalsignsintoasinglescore.Thiswasdoneinrecognitionthatdeterioratingvitalsignsoftenprecedecardiacarrestand/oradmissiontotheintensivecareunit.Usedappropriately,arapidresponseteamcanassessandtreatadeterioratingpatientandpreventadverseoutcomes.[6][7][8] Contents 1Primaryvitalsigns 1.1Temperature 1.2Pulse 1.3Respiratoryrate 1.4Bloodpressure 2Othersigns 2.1Fifthvitalsigns 2.2Sixthvitalsigns 3Variationsbyage 4Monitoring 5Seealso 6References Primaryvitalsigns[edit] Therearefourprimaryvitalsignswhicharestandardinmostmedicalsettings:[9] Bodytemperature HeartrateorPulse Respiratoryrate Bloodpressure Theequipmentneededisathermometer,asphygmomanometer,andawatch.Althoughapulsecanbetakenbyhand,astethoscopemayberequiredforapatientwithaveryweakpulse. Temperature[edit] Temperaturerecordinggivesanindicationofcorebodytemperaturewhichisnormallytightlycontrolled(thermoregulation)asitaffectstherateofchemicalreactions.Bodytemperatureismaintainedthroughabalanceoftheheatproducedbythebodyandtheheatlostfromthebody. Oralglassthermometer Temperaturecanberecordedinordertoestablishabaselinefortheindividual'snormalbodytemperatureforthesiteandmeasuringconditions. Temperaturecanbemeasuredfromthemouth,rectum,axilla(armpit),ear,orskin.Oral,rectal,andaxillarytemperaturecanbemeasuredwitheitheraglassorelectronicthermometer.[10]Notethatrectaltemperaturemeasuresapproximately0.5 °Chigherthanoraltemperature,andaxillarytemperatureapproximately0.5 °Clessthanoraltemperature.[11]Auralandskintemperaturemeasurementsrequirespecialdevicesdesignedtomeasuretemperaturefromtheselocations.[10] While37 °C(98.6 °F)isconsidered"normal"bodytemperature,thereissomevariancebetweenindividuals.Mosthaveanormalbodytemperaturesetpointthatfallswithintherangeof36.0 °Cto37.5 °C(96.5–99.5 °F).[12] Themainreasonforcheckingbodytemperatureistosolicitanysignsofsystemicinfectionorinflammationinthepresenceofafever.Feverisconsideredtemperatureof37.8 °Corabove.[12]Othercausesofelevatedtemperatureincludehyperthermia,whichresultsfromunregulatedheatgenerationorabnormalitiesinthebody'sheatexchangemechanisms.[12] Temperaturedepression(hypothermia)alsoneedstobeevaluated.Hypothermiaisclassifiedastemperaturebelow35 °C(95 °F).[11] Itisalsorecommendedtoreviewthetrendofthepatient'stemperatureovertime.Afeverof38 °Cdoesnotnecessarilyindicateanominoussignifthepatient'sprevioustemperaturehasbeenhigher. Pulse[edit] Mainarticle:Pulse Anindividualtakingtheirownradialpulse. Thepulseistherateatwhichtheheartbeatswhilepumpingbloodthroughthearteries,recordedasbeatsperminute(bpm).[10]Itmayalsobecalled"heartrate".Inadditiontoprovidingtheheartrate,thepulseshouldalsobeevaluatedforstrengthandobviousrhythmabnormalities.[10]Thepulseiscommonlytakenatthewrist(radialartery).Alternativesitesincludetheelbow(brachialartery),theneck(carotidartery),behindtheknee(poplitealartery),orinthefoot(dorsalispedisorposteriortibialarteries).[10]Thepulseistakenwiththeindexfingerandmiddlefingerbypushingwithfirmyetgentlepressureatthelocationsdescribedabove,andcountingthebeatsfeltper60seconds(orper30secondsandmultiplyingbytwo).[10]Thepulseratecanalsobemeasuredbylisteningdirectlytotheheartbeatusingastethoscope.Thepulsemayvaryduetoexercise,fitnesslevel,disease,emotions,andmedications.[10]Thepulsealsovarieswithage.Anewborncanhaveaheartrateof100–⁠160bpm,aninfant(0–⁠5monthsold)aheartrateof90–⁠150bpm,andatoddler(6–⁠12monthsold)aheartrateof80–140bpm.[11]Achildaged1–⁠3yearsoldcanhaveaheartrateof80–⁠130bpm,achildaged3–⁠5yearsoldaheartrateof80–⁠120bpm,anolderchild(ageof6–10)aheartrateof70–⁠110bpm,andanadolescent(age11–⁠14)aheartrateof60–105bpm.[11]Anadult(age15+)canhaveaheartrateof60–100bpm.[13] Respiratoryrate[edit] Mainarticle:Respiratoryrate Averagerespiratoryratesvarybetweenages,butthenormalreferencerangeforpeopleage18to65is16–20breathsperminute.[6]Thevalueofrespiratoryrateasanindicatorofpotentialrespiratorydysfunctionhasbeeninvestigatedbutfindingssuggestitisoflimitedvalue.Respiratoryrateisaclearindicatorofacidoticstates,asthemainfunctionofrespirationisremovalofCO2leavingbicarbonatebaseincirculation. Bloodpressure[edit] Mainarticle:Bloodpressure§ Measurement Thissectiondoesnotciteanysources.Pleasehelpimprovethissectionbyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.(September2017)(Learnhowandwhentoremovethistemplatemessage) Manualsphygmomanometerandstethoscopeusedtotakebloodpressureinclinic. Bloodpressureisrecordedastworeadings:ahighersystolicpressure,whichoccursduringthemaximalcontractionoftheheart,andthelowerdiastolicorrestingpressure.[10]Inadults,anormalbloodpressureis120/80,with120beingthesystolicand80beingthediastolicreading.[11]Usually,thebloodpressureisreadfromtheleftarmunlessthereissomedamagetothearm.Thedifferencebetweenthesystolicanddiastolicpressureiscalledthepulsepressure.Themeasurementofthesepressuresisnowusuallydonewithananeroidorelectronicsphygmomanometer.Theclassicmeasurementdeviceisamercurysphygmomanometer,usingacolumnofmercurymeasuredoffinmillimeters.IntheUnitedStatesandUK,thecommonformismillimetersofmercury,whileelsewhereSIunitsofpressureareused.Thereisnonatural'normal'valueforbloodpressure,butratherarangeofvaluesthatonincreasingareassociatedwithincreasedrisks.Theguidelineacceptablereadingalsotakesintoaccountotherco-factorsfordisease.Therefore,elevatedbloodpressure(hypertension)isvariouslydefinedwhenthesystolicnumberispersistentlyover140–160mmHg.Lowbloodpressureishypotension.Bloodpressuresarealsotakenatotherportionsoftheextremities.Thesepressuresarecalledsegmentalbloodpressuresandareusedtoevaluateblockageorarterialocclusioninalimb(seeAnklebrachialpressureindex). Othersigns[edit] IntheU.S.,inadditiontotheabovefour,manyprovidersarerequiredorencouragedbygovernmenttechnology-in-medicinelawstorecordthepatient'sheight,weight,andbodymassindex.[14]Incontrasttothetraditionalvitalsigns,thesemeasurementsarenotusefulforassessingacutechangesinstatebecauseoftherateatwhichtheychange;however,theyareusefulforassessingtheimpactofprolongedillnessorchronichealthproblems. Thedefinitionofvitalsignsmayalsovarywiththesettingoftheassessment.Emergencymedicaltechnicians(EMTs),inparticular,aretaughttomeasurethevitalsignsofrespiration,pulse,skin,pupils,andbloodpressureas"the5vitalsigns"inanon-hospitalsetting.[15] Fifthvitalsigns[edit] The"fifthvitalsign"mayrefertoafewdifferentparameters. Painisconsideredastandardfifthvitalsigninsomeorganizations,suchastheU.S.VeteransAffairs.[16]Painismeasuredona0–⁠10painscalebasedonsubjectivepatientreportingandmaybeunreliable.[17]Somestudiesshowthatrecordingpainroutinelymaynotchangemanagement.[18][19][20] Menstrualcycle[21][22] Oxygensaturation(asmeasuredbypulseoximetry)[23][24][25] Bloodglucoselevel[26] Sixthvitalsigns[edit] Thereisnostandard"sixthvitalsign";itsuseismoreinformalanddiscipline-dependent. End-tidalCO2[27][28] Functionalstatus[29] Shortnessofbreath[30] Gaitspeed[31] Delirium[32] Variationsbyage[edit] Referencerangesforbloodpressure Stage Approximateage Systolic Diastolic Range Typicalexample Range Typicalexample Infants 1to12months 75-100[33] 85 50–70[33] 60 Toddlers 1to4years 80-110[33] 95 50–80[33] 65 Preschoolers 3to5years 80-110[33] 95 50–80[33] 65 Schoolage 6to13years 85-120[33] 100 55–80[33] 65 Adolescents 13to18years 95-140[33] 115 60–90[33] 75 Childrenandinfantshaverespiratoryandheartratesthatarefasterthanthoseofadultsasshowninthefollowingtable : Age Normalheartrate(beatsperminute) Normalrespiratoryrate(breathsperminute) Range[34] Typicalexample Range[35] Typicalexample Newborn 100–160[36] 130 30–50 40 0–5months 90–150 120 25–40 30 6–12months 80–140 110 20–30 25 1–3years 80–130 105 20–30 25 3–5years 80–120 100 20–30 25 6–10years 70–110 90 15–30 20 11–14years 60–105 80 12–20 16 15–20years 60–100 80 12–30[37] 20 Monitoring[edit] Monitoringofvitalparametersmostcommonlyincludesatleastbloodpressureandheartrate,andpreferablyalsopulseoximetryandrespiratoryrate.Multimodalmonitorsthatsimultaneouslymeasureanddisplaytherelevantvitalparametersarecommonlyintegratedintothebedsidemonitorsinintensivecareunits,andtheanestheticmachinesinoperatingrooms.Theseallowforcontinuousmonitoringofapatient,withmedicalstaffbeingcontinuouslyinformedofthechangesinthegeneralconditionofapatient. Whilemonitoringhastraditionallybeendonebynursesanddoctors,anumberofcompaniesaredevelopingdevicesthatcanbeusedbyconsumersthemselves.TheseincludeCherishHealth,ScanaduandAzoi. Seealso[edit] Biotelemetry Medicalrecord RemotePatientMonitoring References[edit] ^"VitalSigns". ^"EmergencyPhysiciansHome".www.emergencyphysicians.org. ^"VitalSignsTable-ProHealthSys".3July2013. ^"Home".LOINC. ^"LOINC-ALinguaFrancaCriticalforElectronicMedicalRecordsandHealthInformationExchange". ^abNationalEarlyWarningScoreDevelopmentandImplementationGroup(NEWSDIG)(2012).NationalEarlyWarningScore(NEWS):standardisingtheassessmentofacute-illnessseverityintheNHS.London:RoyalCollegeofPhysicians.ISBN 978-1-86016-471-2. ^NationalInstituteforHealthandClinicalExcellence.Clinicalguideline50:Acutelyillpatientsinhospital.London,2007. ^"Acutecaretoolkit6:themedicalpatientatrisk:recognitionandcareoftheseriouslyillordeterioratingmedicalpatient"(PDF).RoyalCollegeofPhysiciansofLondon.May2013. ^"VitalSigns".ClevelandClinic.Retrieved10Sep2020. ^abcdefgh"VitalSigns(BodyTemperature,PulseRate,RespirationRate,BloodPressure)".www.hopkinsmedicine.org.Retrieved2019-08-30. ^abcde"NormalVitalSigns:NormalVitalSigns,NormalHeartRate,NormalRespiratoryRate".2019-07-23.{{citejournal}}:Citejournalrequires|journal=(help) ^abcLeBlond,RichardF.;Brown,DonaldD.;Suneja,Manish;Szot,JosephF.(2014-09-05).DeGowin'sdiagnosticexamination(10th ed.).NewYork:McGraw-HillEducation.ISBN 9780071814478.OCLC 876336892. ^"NormalVitalSigns:NormalVitalSigns,NormalHeartRate,NormalRespiratoryRate".2019-07-23.{{citejournal}}:Citejournalrequires|journal=(help)[verificationneeded] ^"WhatshouldIincludewhenIrecordvitalsignsofmypatientsforMU?-Providers&Professionals-HealthIT.gov". ^EmergencyCare,11thedition,pp.226–244. ^http://www.va.gov/painmanagement/docs/toolkit.pdf[bareURLPDF] ^Lorenz,KarlA.;Sherbourne,CathyD.;Shugarman,LisaR.;Rubenstein,LisaV.;Wen,Li;Cohen,Angela;Goebel,JoyR.;Hagenmeier,Emily;Simon,Barbara;Lanto,Andy;Asch,StevenM.(1May2009)."HowReliableisPainastheFifthVitalSign?".JAmBoardFamMed.22(3):291–298.doi:10.3122/jabfm.2009.03.080162.PMID 19429735. ^Wellbery,Caroline(15October2006)."TipsFromOtherJournals-AmericanFamilyPhysician".AmericanFamilyPhysician.74(8):1417–1418. ^MularskiRA,White-ChuF,OverbayD,MillerL,AschSM,GanziniL(2006)."Measuringpainasthe5thvitalsigndoesnotimprovequalityofpainmanagement".JGenInternMed.21(6):607–12.doi:10.1111/j.1525-1497.2006.00415.x.PMC 1924634.PMID 16808744. ^http://www.pain-initiative-un.org/doc-center/en/docs/The%20Fifth%20Vital%20Sign%20Implementation.pdf[bareURLPDF] ^AmericanCollegeofObstetriciansandGynecologists.(2015)."Menstruationingirlsandadolescents:usingthemenstrualcycleasavitalsign.CommitteeOpinionNo.651".ObstetGynecol.126:143–6. ^AmericanAcademyofPediatrics,CommitteeonAdolescence,AmericanCollegeofObstetriciansandGynecologists,CommitteeonAdolescentHealthCare.(2006)."MenstruationinGirlsandAdolescents:UsingtheMenstrualCycleasaVitalSign".Pediatrics.118(5).{{citejournal}}:CS1maint:multiplenames:authorslist(link) ^MowerW,MyersG,NicklinE,KearinK,BaraffL,SachsC(1998)."Pulseoximetryasafifthvitalsigninemergencygeriatricassessment".AcadEmergMed.5(9):858–65.doi:10.1111/j.1553-2712.1998.tb02813.x.PMID 9754497. ^MowerW,SachsC,NicklinE,BaraffL(1997)."Pulseoximetryasafifthpediatricvitalsign".Pediatrics.99(5):681–6.CiteSeerX 10.1.1.575.2200.doi:10.1542/peds.99.5.681.PMID 9113944. ^NeffT(1988)."Routineoximetry.Afifthvitalsign?".Chest.94(2):227.doi:10.1378/chest.94.2.227a.PMID 3396392. ^"MiningVitalSignsfromWearableHealthcareDeviceviaNonlinearMachineLearning".UniversityofHull.Retrieved2016-05-14. ^VardiA,LevinI,ParetG,BarzilayZ(2000)."Thesixthvitalsign:end-tidalCO2inpediatrictraumapatientsduringtransport".Harefuah.139(3–4):85–7,168.PMID 10979461. ^HolcombJB,SalinasJ,McManusJM,MillerCC,CookeWH,ConvertinoVA(2005)."Manualvitalsignsreliablypredictneedforlife-savinginterventionsintraumapatients".JTrauma.59(4):821–8,discussion828–9.doi:10.1097/01.ta.0000188125.44129.7c.PMID 16374268. ^BiermanA(2001)."FunctionalStatus:TheSixthVitalSign".JGenInternMed.16(11):785–6.doi:10.1111/j.1525-1497.2001.10918.x.PMC 1495293.PMID 11722694. ^"Nursingcareofdyspnea:the6thvitalsigninindividualswithchronicobstructivepulmonarydisease(COPD)".NationalGuidelineClearinghouse.Archivedfromtheoriginalon2009-01-17.Retrieved2009-01-16. ^StudenskiS,PereraS,WallaceD,et al.(2003)."Physicalperformancemeasuresintheclinicalsetting"(PDF).JAmGeriatrSoc.51(9):314–322.doi:10.1046/j.1532-5415.2003.51104.x.PMID 12588574.S2CID 31083716. ^Bellelli,Giuseppe;Trabucchi,Marco(May1,2008)."DeliriumastheSixthVitalSign".JournaloftheAmericanMedicalDirectorsAssociation.9(4):279,authorreply279–80.doi:10.1016/j.jamda.2007.08.014.PMID 18457806–viawww.jamda.com. ^abcdefghijPEDIATRICAGESPECIFIC,page6.Revised6/10.ByTheresaKirkpatrickandKateriTobias.UCLAHealthSystem ^EmergencyCare,Page214 ^EmergencyCare,Page215 ^Vorvick,Linda."Pulse".MedlinePlus.U.S.NationalLibraryofMedicine.Retrieved23January2011. 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