Vital signs
Vital signs | |
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anesthetic machine with integrated systems for monitoring of several vital parameters, including blood pressure and heart rate | |
Purpose | assess the general physical health of a person |
Vital signs (also known as vitals) are a group of the four to six most crucial
There are four primary vital signs:
), often notated as BT, BP, HR, and RR. However, depending on the clinical setting, the vital signs may include other measurements called the "fifth vital sign" or "sixth vital sign."Primary vital signs
There are four primary vital signs which are standard in most medical settings:[7]
The equipment needed is a thermometer, a sphygmomanometer, and a watch.[8] Although a pulse can be taken by hand, a stethoscope may be required for a clinician to take a patient's apical pulse.[9]
Temperature
Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions.
Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either a glass or electronic thermometer.[11] Note that rectal temperature measures approximately 0.5 °C higher than oral temperature, and axillary temperature approximately 0.5 °C less than oral temperature.[12] Aural and skin temperature measurements require special devices designed to measure temperature from these locations.[11]
While 37 °C (98.6 °F) is considered "normal" body temperature, there is some variance between individuals. Most have a normal body temperature set point that falls within the range of 36.0 °C to 37.5 °C (96.5–99.5 °F).[13]
The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever. Fever is considered temperature of 37.8 °C (100.0 °F) or above.[13] Other causes of elevated temperature include hyperthermia, which results from unregulated heat generation or abnormalities in the body's heat exchange mechanisms.[13]
Temperature depression (hypothermia) also needs to be evaluated. Hypothermia is classified as temperature below 35 °C (95 °F).[12]
It is also recommended to review the trend of the patient's temperature over time. A fever of 38 °C does not necessarily indicate an ominous sign if the patient's previous temperature has been higher.
Pulse
The pulse is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm).
Respiratory rate
Average respiratory rates vary between ages, but the normal reference range for people age 18 to 65 is 16–20 breaths per minute.[4] The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it is of limited value. Respiratory rate is a clear indicator of acidotic states, as the main function of respiration is removal of CO2 leaving bicarbonate base in circulation.
Blood pressure
Blood pressure is recorded as two readings: a higher
Other signs
In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record the patient's height, weight, and body mass index.[14] In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems.
The definition of vital signs may also vary with the setting of the assessment.
Fifth vital signs
The "fifth vital sign" may refer to a few different parameters.
- Pain is considered a standard fifth vital sign in some organizations, such as the U.S. Veterans Affairs.[16] Pain is measured on a 0–10 pain scale based on subjective patient reporting and may be unreliable.[17] Some studies show that recording pain routinely may not change management.[18][19][20]
- Menstrual cycle[21][22]
- Oxygen saturation (as measured by pulse oximetry)[23][24][25]
- Blood glucose level[26]
Sixth vital signs
There is no standard "sixth vital sign"; its use is more informal and discipline-dependent.
- End-tidal
- Functional status[29]
- Shortness of breath[30]
- Gait speed[31]
- Delirium[32]
Variations by age
Stage | Approximate age | Systolic | Diastolic | ||
---|---|---|---|---|---|
Range | Typical example | Range | Typical example | ||
Infants | 1 to 12 months | 75-100[33] | 85 | 50–70[33] | 60 |
Toddlers | 1 to 4 years | 80-110[33] | 95 | 50–80[33] | 65 |
Preschoolers | 3 to 5 years | 80-110[33] | 95 | 50–80[33] | 65 |
School age | 6 to 13 years | 85-120[33] | 100 | 55–80[33] | 65 |
Adolescents | 13 to 18 years | 95-140[33] | 115 | 60–90[33] | 75 |
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) |
Normal respiratory rate (breaths per minute) | ||
---|---|---|---|---|
Range[34] | Typical example | Range[35] | Typical example | |
Newborn | 100–160[36] | 130 | 30–50 | 40 |
0–5 months | 90–150 | 120 | 25–40 | 30 |
6–12 months | 80–140 | 110 | 20–30 | 25 |
1–3 years | 80–130 | 105 | 20–30 | 25 |
3–5 years | 80–120 | 100 | 20–30 | 25 |
6–10 years | 70–110 | 90 | 15–30 | 20 |
11–14 years | 60–105 | 80 | 12–20 | 16 |
15–20 years | 60–100 | 80 | 12–30[37] | 20 |
Monitoring
While monitoring has traditionally been done by nurses and doctors, a number of companies are developing devices that can be used by consumers themselves. These include Cherish Health, Scanadu and Azoi.
See also
- Biotelemetry
- Medical record
- Remote Patient Monitoring
References
- ^ "Vital Signs".
- ^ "Emergency Physicians Home". www.emergencyphysicians.org.
- ^ "Vital Signs Table - ProHealthSys". 3 July 2013.
- ^ ISBN 978-1-86016-471-2.
- National Institute for Health and Clinical Excellence. Clinical guideline 50: Acutely ill patients in hospital. London, 2007.
- ^ "Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient" (PDF). Royal College of Physicians of London. May 2013.
- ^ "Vital Signs". Cleveland Clinic. Retrieved 10 Sep 2020.
- ^ "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. 2022-06-14. Retrieved 2023-11-06.
- ^ "Apical Pulse: What It Is and How to Take It". Cleveland Clinic. Retrieved 2023-11-06.
- ^ "Vital Signs: How to Check My Vitals at Home". Cleveland Clinic. Retrieved 2023-11-06.
- ^ a b c d e f g h "Vital Signs (Body Temperature, Pulse Rate, Respiration Rate, Blood Pressure)". www.hopkinsmedicine.org. Retrieved 2019-08-30.
- ^ a b c d e f "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23.
- ^ OCLC 876336892.
- ^ "What should I include when I record vital signs of my patients for MU? - Providers & Professionals - HealthIT.gov". Archived from the original on 2018-03-25. Retrieved 2014-08-24.
- ^ Emergency Care, 11th edition, pp. 226–244.
- ^ "Pain as the 5Th Vital Sign Toolkit" (PDF).
- PMID 19429735.
- ^ Wellbery C (15 October 2006). "Tips From Other Journals - American Family Physician". American Family Physician. 74 (8): 1417–1418.
- PMID 16808744.
- ^ "The Fifth Vital Sign: Implementation of the Neonatal Infant Pain Scale" (PDF). Archived from the original (PDF) on 2012-05-26. Retrieved 2023-12-24.
- ^ American College of Obstetricians and Gynecologists. (2015). "Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Committee Opinion No. 651". Obstet Gynecol. 126: 143–6.
- ^ "Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign". Pediatrics. 118 (5). American Academy of Pediatrics, Committee on Adolescence, American College of Obstetricians and Gynecologists, Committee on Adolescent Health Care. 2006.
- PMID 9754497.
- PMID 9113944.
- PMID 3396392.
- ^ "Mining Vital Signs from Wearable Healthcare Device via Nonlinear Machine Learning". University of Hull. Archived from the original on 2016-08-17. Retrieved 2016-05-14.
- PMID 10979461.
- PMID 16374268.
- PMID 11722694.
- ^ "Nursing care of dyspnea: the 6th vital sign in individuals with chronic obstructive pulmonary disease (COPD)". National Guideline Clearinghouse. Archived from the original on 2009-01-17. Retrieved 2009-01-16.
- S2CID 31083716.
- PMID 18457806– via www.jamda.com.
- ^ a b c d e f g h i j PEDIATRIC AGE SPECIFIC Archived 2017-05-16 at the Wayback Machine, page 6. Revised 6/10. By Theresa Kirkpatrick and Kateri Tobias. UCLA Health System
- ^ Emergency Care, Page 214
- ^ Emergency Care, Page 215
- ^ Vorvick L. "Pulse". MedlinePlus. U.S. National Library of Medicine. Retrieved 23 January 2011.
- ^ "Normal Vital Signs: Normal Vital Signs, Normal Heart Rate, Normal Respiratory Rate". 2019-07-23.