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ACADEMIC PAPER

VITAL SIGNS

Submitted to fulfill an assignment in Community Research Program (CRP)

Proposed by:

Khoriah Indrihutami 130110150049

Madeleine Priscilla 130110150074

Iffa Nadifa R. H 130110150163

Muthia Salsabila 130110150215

FACULTY OF MEDICINE

PADJADJARAN UNIVERSITY

SUMEDANG

2015

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APPROVAL PAGE

THE IMPORTANCE OF VITAL SIGN

Approved by :

This paper was submitted to fulfill the assignment of CRP subject of the academic

year 2015/2016.

Ratificated on :

Day :…………

Date :…….. September 2015

Known Lecturer of Subject,

Kurnia Wahyudi, dr., MSc. Budi Sujatmiko, dr.

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ABSTRACT

Vital sign are measurement of the body`s basic function. Vital signs

measrement can determinepatient’s health status, can identify the existence of

diseases, and also can be a marker of a chronic disease. Measurement of the vital

signs are prefer manually better than using an automatic machine, because when

using autimatic machine to measre the vital sign, it should be validating by manual

measurement. There are four main vital signs that routinely monitored by health care

providers, such as body temperature,pulse rate, respiration rate, and blood pressure.

Normal range for each vital sign vary with age, wight, gender, and overall health.

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TABLE OF CONTENTS

Abstract ....................................................................................................................... iii

Table of Content .......................................................................................................... iv

CHAPTER I Literature Review ................................................................................... 5

CHAPTER II Discussion ............................................................................................. 6

References...................................................................................................................26

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CHAPTER I

Literature Review

Vital signs are used to measure the body`s functions. These measurement

provides critical information “vital” about a patient`s state of health. Vital signs

include the measurement of body temperature, respiratory rate, pulse or heart rate,

and blood pressure. These measurement are taken to help assess the general health

of a person, give clues to possible diseases, and show progress toward recovery.

Normal range of the vital signs change with age, gender, physical activity,

emotional states, metabolism, fever, and medication. The vital signs measurement

prefer taken manually than using automatic machine. If there is vital sign that

measure by automatic machine, it must be validated with manual assessment.

When the vital signs are going to get assess, make sure the person is in the

relax situation, not sing effort or stressed and do the assessment in the quiet place.

Make sure the person is not smoking or drinking caffenated beverages 30 minutes

befor the measurement.

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CHAPTER II

Discussion

1. Pulse/Heart Rate

The pulse rate is a measurement of the heart rate, or the number of

times the heart beats per minute. Pulse rates are different from person to

person. Pulse rate can get low when at rest and increases when exercise

(because more oxygen-rich blood is needed by the body when you exercise).

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 males. Athletes, such as runners, who do a lot of cardiovascular

conditioning, may have heart rates lower than normal people near 40 beats

per minute and it is not a problem for them.

Age Group Pulse Rate (beats/min)

Average Pulse (beats/min)

Infant (birth to 1 yr) 120-160 140 Toddles (1-3 yr) 90-140 115

Preschool child (3-6 yr) 80-110 95 School-age child

(6-12 yr) 75-105 90

Adolescent (12-18 yr) 60-100 80 Adult (after 18th yr) 60-100 80 Adult (after 60th yr) 67-80 74 Well-trained athletes 40-60 50

Tabel 1.1 Normal Pulse Rate Range

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Pulse rate can be measured at any place where there is a large

artery (e.g. carotid, femoral, or simply by listening over the heart), it is

generally done by palpating the radial impulse.When the heart pushes blood

through the arteries, the arteries expand and contract by the flow of the blood.

Taking a pulse not only measures the heart rate, but also can indicate the

following:

1. Frequency: How many beats recorded per minute, no beats should be

missed. Normal beats are between 60 and 100 (for adult). A faster pulse

rate can indicate health problems like infection, dehydration, stress,

shock, anemia, or certain heart disorder.If the pulse rate above 100 beats

per minute its calles tachycardia. A lower pulse rate may also become a

sign of a heart condition. Some medications can slow pulse rate and if the

pulse rate lower than 60 beats per minute its called bradycardia if you

are not athlete and especially you have sign and symptoms such as

fainting, shortness of breath, or feel dizzy.

2. Regularity/rhythm: One beat between another should be constant

(regular). Irregular rhythms, however, are quite common. If the pulse is

irregular, it's a good idea to verify the rate by listening over the heart.

3. Quality : How strong the beats are, strong or weak.

4. Presence of pulse deficit : Difference rate between pulse rate in the

radial artery and when using stethoscope in the chest (heart).

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Pulse can be measured by gently pressing index and middle finger

againts certain points on the body. As the heart forces blood through the

arteries, firmly pressing on the arteries, which are located close to the

surface of the skin at certain points of the body. For most people, it is

easiest to take the pulse at the wrist.

How to check your pulse :

a. Using the index and middle finger, press firmly but gently on the radial

artery (bellow the base of the thumb) until you feel the beats.

b. Begin counting the pulse, the easiest way to count the pulse is when

the clock's longer hand is on the 12.

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c. Count your pulse for 15 seconds and then multiply by four to calculate

beats per minute.

d. When the rhythm is irregular, count it for 60 seconds and the rate

should be evaluated by cardiac auscultation, because beats that occur

earlier than other may not be defected peripherally.

e. When counting concentrate on the beats of the pulse, do not watch the

clock continuously.

f. If unsure about your results, repeat the steps again, or ask another

person to count it for you.

Image 1.1,1.2, and 1.3: Location of the radial artery

 

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2. Temperature

Although you may choose to omit measuring the temperature in

ambulatory patients, it should be checked whenever you suspect an

abnormality. The average oral temperature, usually quoted at 37°C (98.6°F),

fluctuates considerably. In the early morning hours it may fall as low as

35.8°C (96.4°F), and in the late afternoon or evening it may rise as high as

37.3°C (99.1°F). Rectal temperatures are higher than oral temperatures by an

average of 0.4 to 0.5°C (0.7 to 0.9°F), but this difference is also quite

variable. (In contrast, axillary temperatures are lower than oral temperatures

by approximately 1 degree, but take 5 to 10 minutes to register and are

generally considered less accurate than other measurements.)

Picture 2.1 Taking Axillary Temperature

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Temperature

(˚C) 0 – 2 yrs 3 – 10 yrs 11 – 65 yrs >65 yrs

Oral - 35.5 – 37.5 36.5 – 37.5 35.5 – 36.6

Rectal 36 – 38 36.5 – 38 37 – 39 36 – 37

Axillary 34.5 – 37 36 – 36.5 35 – 36.5 35.5 – 36

Ear 36 – 38 36 – 36.5 35.5 – 37 35.5 – 37.5

Table 2.1 Normal Body Temperature Range

Most patients prefer oral to rectal temperatures. However, taking

oral temperatures is not recommended when patients are unconscious,

restless, or unable to close their mouths. Temperature readings may be

inaccurate and thermometers may be broken by unexpected movements of the

patient’s jaws.

For oral temperatures, you may choose either a glass or electronic

thermometer. When using a glass thermometer, shake the thermometer down

to 35°C (96°F) or below, insert it under the tongue, instruct the patient to

close both lips, and wait 3 to 5 minutes. Then read the thermometer, reinsert

it for a minute, and read it again. If the temperature is still rising, repeat this

procedure until the reading remains stable. Note that hot or cold liquids, and

even smoking, can alter the temperature reading. In these situations it is best

to delay measuring the temperature for 10 to 15 minutes.

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Picture 2.2 Taking Oral Temperature

If using an electronic thermometer, carefully place the disposable

cover over the probe and insert the thermometer under the tongue. Ask the

patient to close both lips, and then watch closely for the digital readout. An

accurate temperature recording usually takes about 10 seconds.

For a rectal temperature, ask the patient to lie on one side with the

hip flexed. Select a rectal thermometer with a stubby tip, lubricate it, and

insert it about 3 cm to 4 cm (11 ⁄ 2 inches) into the anal canal, in a direction

pointing to the umbilicus. Remove it after 3 minutes, then read. Alternatively,

use an electronic thermometer after lubricating the probe cover. Wait about

10 seconds for the digital temperature recording to appear.

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Picture 2.3 Taking Rectal Temperature

Taking the tympanic membrane temperature is an increasingly

common practice and is quick, safe, and reliable if performed properly. Make

sure the external auditory canal is free of cerumen. Position the probe in the

canal so that the infrared beam is aimed at the tympanic membrane (otherwise

the measurement will be invalid). Wait 2 to 3 seconds until the digital

temperature reading appears. This method measures core body temperature,

which is higher than the normal oral temperature by approximately 0.8°C.

Picture 2.4 Taking tympanic membrane temp

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Picture 2.5 (left) and 2.6 (right) Digital and mercury thermometer for axillary

and oral temperature measurement

 

Picture 2.7 (left) and 2.8 (right) Rectal thermometer and tympanic membrane Blood Pressure

 

 

 

 

 

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3. Blood Pressure

Blood pressure is usually expressed in terms of the systolic

pressure over diastolic pressure and measured in mmHg. Systole is the part

of cardiac cycle when ventricles contract, and diastole is the part of cardiac

cycle when the heart refills with blood. Blood pressure is exerted by

circulating blood upon the walls of blood vessels. Factors that affect the

measurement of blood pressure is how is the situation of the patient, the

activity they do, their age, and the disease state.

Blood pressure can be measured with three techniques, it’s office

blood pressure measurements, home blood pressure measurements, and

ambulatory blood pressure measurements. Home and ambulatory blood

pressure measurements are more accurate than the conventional office

Picture 3.1 Office Blood Pressure Monitoring Picture 3.2 Home Blood Pressure Monitoring

Picture 3.3 Ambulatory Blood Pressure Monitoring

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blood pressure measurements. Poor measurement technique, natural

physiologic fluctuations in blood pressure, anxiety while being measured,

and the presence of physician or nurse can alter the measurement of blood

pressure.

Ambulatory blood pressure monitoring is fully automated and

allows recording over an extended perios of time. There are automated

office blood pressure devices that sense the natural oscillations in the

arterial pressure waves and estimate the systolic and diastolic pressure.

They can take five or more readings and display both individual and

averaged measurements. These devices replace manual auscultatory

measurements in the office. With replacing manual office blood pressure

measurements to an automated device, we can eliminate observer error,

increase the number of readings, and produce measurements that are

comparable to ambulatory blood pressure as the current standard. The

patient must be seated in a quiet room for several minutes while being

measured with the automated office blood pressure device.

There are two types of hypertension based on manual office blood

pressure measurements. They are white coat hypertension and masked

hypertension. In white coat hypertension, the office blood pressure is high

but ambulatory blood pressure is normal, so cardiovascular risk is low. In

contrast, masked hypertension’s office blood pressure is normal but the

ambulatory blood pressure is high. It indicates a high risk of

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cardiovascular problem.

To measure blood pressure accurately, it’s essential to use an

accurate blood pressure device. There are three types blood pressure

device, they are aneroid sphygmomanometer, electronic

sphygmomanometer, and “hybrid” sphygmomanometer which combines

both electronic and ambulatory devices’ features. It is important to choose

a cuff that fits the patient’s arm, which is not too small and not too large,

because it affects the blood pressure’s reading.

Steps to ensure accurate blood pressure measurement :

1. In ideal situations, instruct the patient not to smoke or drink caffein

beverages 30 minutes before the blood pressure is measured.

2. Make sure the examining room is quiet and comfortable.

3. Ask the patient to sit quietly in the chair, and place their hand on the

table.

4. Make sure the arm selected is free from clothing.

Picture 3.4 (a) aneroid sphygmomanometer, (b) electronic sphymomanometer, (c) “hybrid” sphygmomanometer

(a)   (b)   (c)  

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5. Make sure the patient wear a cuff that fits him/her.

6. Palpate the brachial artery to confirm that it has pulse.

7. Position the arm so that the brachial artery, at the antecubital creases, is at heart level with the 4th interspace at its junction with the sternum.

How to measure the blood pressure :

1. Place the blood pressure cuff on the upper arm.

2. Center the inflatable bladder over the brachial artery. Lower border of

the cuff should be about 2.5 cm above the antenatal crease.

Picture 3.5 Palpate the brachial artery

Picture 3.6 Measuring Blood Pressure

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3. Estimate the systolic pressure by palpation. As you feel the radial

artery with the fingers of one hand, inflate the cuff until the radial

pulse diappears. Read the pressure on the manometer and add

30mmHg to it. This can prevent high cuff pressure, and the error

caused by auscultory gap.

4. Deflate the cuff properly and wait for 15-30 seconds. Place the

stethoscope over the brachial artery.

5. Inflate the cuff rapidly again, and deflate it slowly at a rate of about 2-

3mmHg per second. Note the level which you hear the sounds of at

least two consecutive beats.

6. The stethoscope perceives a noise and the value of blood pressure

measured at this moment is the maximal blood pressure, the sytolic

blood pressure.

7. Deflate the cuff slowly. The blood passes again. Continue to lower the

pressure slowly until the sounds become muffled and disappear. It

defines the minimal pressure, the diastolic blood pressure.

8. Read both the systole and diastole. Conclude the blood pressure of the

patient.

9. Take additional reading (1 or 2 readings) to minimize human error.

If the blood pressure is above the normal rate (approximately

120/80), it’s called hypotension. If the blood pressure is higher than the

normal rate, it’s called hypertension.

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Category Systolic (mmHg) Diastolic (mmHg)

Normal <120 <80

Prehypertension 120-139 80-89

Stage 1 Hypertension 140-159 90-99

Stage 2 Hypertension ≥160 ≥100

If Diabetes or Renal Disease <130 <80

Tabel 3.1 Blood Pressure Classification for Adults

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4. Respiratory Rate

Respiratory rate, pulmonary ventilation rate or ventilation rate, breathing

frequency (BF) is number of breaths per minute or, more formally, the number of

movements indicative of inspiration and expiration per unit time. In practice, the

respiratory rate is usually determined by counting the number of times the chest

rises or falls per minute. The aim of measuring respiratory rate is to determine

whether the respirations are

normal, abnormally fast (tachypnea), abnormally slow (bradypnea), or nonexistent

(apnea). 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.

Table 4.1 Normal Respiratory Rate

Common factors that influence respiration rate are as follows:

• Age

• Emotional status

• Air quality and altitude

• Exercise

• Internal temperature

• Disease (i.e, cardiopulmonary)

• O2 and CO2 level (i.e., pulmonary status)

• Effectiveness of breathing pattern

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How to measure respiratory rate :

Step 1

Stand or sit facing the person whose pulse rate and respiration rate you are to

measure.

Step 2

Select a site to measure the pulse. The two chief options are on the person’s wrist,

just below the thumb, or on the neck, on either side of the person’s windpipe.

Picture 4.1

Step 3

Press your index and middle finger gently to the area you selected to take the

pulse. You may have to move your fingers around slightly to locate the pulse.

Hold your position when you feel small, pulsating movements under your

fingertips. Holding your fingertips flat against the person's skin can help obtain a

more effective measurement.

Step 4

Use a stopwatch or wristwatch to count how many beats you feel the pulse move

against your fingers. If the pulse rhythm seems to be regular, count the number for

15 seconds and multiply this number by four to obtain the pulse in beats per

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minute. However, if the pulse rhythm seems to be uneven, count the number of

beats for a full minute to determine pulse rate.

Step 5

Count the number of breaths you see the person take within a 15-second time span

and multiply the number by four. This is the respiratory rate for the person. You

should not take your fingers off the person’s pulse because announcing you are

measuring respiration rate may cause the person to alter his breathing rate. By

counting the number of breaths taken along with measuring pulse, you can

determine both vital signs.

Picture 4.2

Step 6

Record the numbers you have obtained and re-check them as needed.

Picture 4.3

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The value of respiratory rate as an indicator of potential respiratory

dysfunction has been investigated butfindings suggest it is of limited value.One

study found that only 33% of people presenting to an emergency department with

anoxygensaturationbelow 90% had an increased respiratory rate. An evaluation of

respiratory rate for thedifferentiation of the severity of illness in babies under 6

months found it not to be very useful.Approximately half of the babies had a

respiratory rate above 50 breaths per minute, thereby questioningthe value of

having a "cut-off" at 50 breaths per minute as the indicator of serious respiratory

illness. Ithas also been reported that factors such ascrying,sleeping, agitation and

age have a significant influenceon the respiratory rate. As a result of these and

similar studies the value of respiratory rate as an indicator of serious illness is

limited.

Table 4.2 Lungs and breathing activity.

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Picture 4.4 Breathing patterns and body oxygenation

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REFERENCES

1. Goldberg, Charlie. A Practical Guide to Clinical Medicine. 2009. Cited : 27 September 2015. https://meded.ucsd.edu/clinicalmed/vital.htm#Pulse

2. Goldman L, Ausiello D. Cecil Textbook of Medicine 23rd Edition Philadelphia. 2007. Chapter 7.

3. Rochester, University. Vital Signs (Body Temperature, Pulse Rate,

Respiration Rate, Blood Pressure). 2015. Cited : 27 September 2015. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00866

4. Bates, Barbara. Guide to Physical Examination. 2008. Chapter 3.

5. Children’s. Seattle. Fever and Taking Your Child’s Temperature. 2013.

http://www.seattlechildrens.org/kids-health/parents/general-health/aches-pains-and-injuries/fever-and-taking-your-child-s-temperature/

6. Nall, Rachel. Demand Media How to Measure Someone's Pulse & Respiration. http://healthyliving.azcentral.com/measure-someones-pulse-respiration-8961.html