VITAL SIGN

DR. KATHERINA
AIM?

Temperature Blood Pressure Pulse Rate Respiration

Rate
HOW TO BE A PROFESSIONAL DOCTOR?

GOOD INTERPERSONAL EXPLAIN THE AIM AND PROCEDURE

RELATIONSHIP

PROFESSIONAL
DOCTOR

INFORMED CONSENT HYGINE: WASH YOUR HAND

BLOOD PRESSURE
VITAL SIGN
FIND 5 MISTAKES
FIND 2 MISTAKES
 TYPE OF DEVICE?

Tensimeter digital
Sphygmomanometer air Sphygmomanometer Sphygmomanometer hybrid (oscillometric technique)
raksa aneroid
PART OF SPHYGMOMANOMETER
SIZE OF MANSET

Pasien Ukuran Manset

Dewasa (ukuran lengan atas)
22-26 cm 12x22 cm (dewasa kecil)
27-34 cm 16x30 cm (dewasa)
35-44 cm 16x36 cm (dewasa besar)
45-52 cm 16x42 (paha dewasa)
Anak-anak (usia)
Bayi baru lahir dan bayi prematur 4x8 cm
Bayi (hingga 1 tahun) 6x12 cm
Anak-anak 9x18 cm
PREPARATION:
MAKE SURE THERE ISNT ANY FACTOR THAT CAN
CAUSE SIGNIFICANT DEVIATION.

External factor
AVOID: Nicotine, exercise, alcohol, talking, background noise

Cuff size
Should be the right size

Body position
Relax, back and arm supported, legs uncrossed

Arm position
Middle of the cuff on the upper arm is at the level of right atrium (mid-point of sternum)
HOW TO MEASURE?

Cuff Placement and Stethoscope

Palpate brachial artery in antecubital fossa
Place the midline marker in brachial artery
Lower cuff should be 2-3 cm above the antecubital fossa
Inflation/Deflation System
1st inflation: PALPATOAR PRESSURE (inflate until radial pulse disappear)
2nd inflation: inflate 30mmHg higher than palpatoar pressure
Deflation rates 2-3 mmHg /second
IMPORTANT NOTES

1st examination: do it on 2 different arms

Detection coarctation of the aorta and upper extremity
arterial obstruction
PULSE RATE
HOW TO MEASURE?

Using 2&3 index finger

Examine: Frequency, Rhytme, Volume

Palpate in radial artery

Another choice: brachialis artery, carotid artery
Radial artery Brachial artery Carotid artery
NORMAL PULSE RATE

Kondisi normal

Usia Frekuensi

Neonatus (1-28 hari) 120-160 x/min

Bayi (1-12 bulan) 100-120x/min

Anak-anak (1-8 tahun) 80-100 x/min

Orang dewasa 60-100 x/min

RESPIRATORY RATE
RESPIRATORY PATTERN

INSPIRASI EKSPIRASI
Diafragma Kontraksi (tampak Relaksasi (melengkung ke
datar) atas)
Tulang iga bergerak keatas & bergerak kebawah &
(costae) keluar kedalam
Tulang dada Bergerak keluar Bergerak kedalam
Rongga dada membesar mengecil
Paru-paru Mengembang mengempis
NORMAL & ABNORMAL RESPIRATORY RATE
Kondisi normal
Usia Frekuensi
Neonatus (1-28 hari) 40 60 x/menit
Bayi (1-12 bulan) 25-50 x/menit
Anak-anak (1-8 tahun) 15-30 x/menit
Dewasa 12-20 x/menit
Kondisi abnormal
Takipnea >24x/menit
Bradipnea <10x/menit
Apneu -
HOW TO MEASURE?
IMPORTANT NOTES

Dont let the patient know were counting RR

Make sure the patients calm and relaxed

Count in 30 secs, x2. (pediatric: count in 1

minute)
TEMPERATURE
TYPE OF DEVICE?

Themometer axilla Themometer rectal Themometer digital

 Temporal artery temperature

Themometer tympanic Themometer temporal artery How to apply it

NORMAL TEMPERATURE?

Method Women Men

Oral 33.238.1 C (91.8100.6 F) 35.737.7 C (96.399.9 F)
Rectal 36.837.1 C (98.298.8 F) 36.737.5 C (98.199.5 F)
Tympanic 35.737.5 C (96.399.5 F) 35.537.5 C (95.999.5 F)

Sund-Levander M, Forsberg C, Wahren LK (2002).

COMPARISON

Axillary/Forehead (C) Oral (C) Rectal/Ear (C)

36.9-37.4 37.5-37.7 38-38.3
37.5-38.4 37.8-38.5 38.4-39.1
38.5-38.9 38.6-39.1 39.2-39.7
39-39.5 39.2-39.7 39.8-40.3
39.6-40 39.8-40.3 40.4-40.9
TEMPERATURE CLASSIFICATION

Temperature classification
Core (rectal, esophageal, etc.)
Hypothermia <35.0 C (95.0 F)
Normal 36.537.5 C (97.799.5 F)
Fever >37.5 or 38.3 C (99.5 or 100.9 F)
Hyperthermia >37.5 or 38.3 C (99.5 or 100.9 F)
Hyperpyrexia >40.0 or 41.5 C (104.0 or 106.7 F)
Note: The difference between fever and hyperthermia is the underlying mechanism.
Different sources have different cut-offs for fever, hyperthermia and hyperpyrexia.

Axelrod YK, Diringer MN (May 2008)

HOW TO MEASURE? (AXILLARY TEMPERATURE)

1. Clean the tip of thermometer

2. Wipe it until it reach 35C.

3. Place it under armpit (the tips fully covered)

4. Wait 5-10 min

5. Read it (eyes at the same level as the mercury)

6. Clean the tip of thermometer

THANK YOU !