Definition:
A system of care in which patients are placed in units on the
basis of their needs. It includes listening to, informing and
involving patients in their care.
Attributes:
These four attributes of patient-centered care are
the following:
"Whole-person" care.
Coordination and communication
Patient support and empowerment
Ready access
What is Patient Care?
Patient care refers to the prevention, treatment, and
management of illness and the preservation of physical
and mental well-being through services offered by health
professionals.
Patient care consists of services rendered by health
professionals (or non-professionals under their
supervision) for the benefit of patients.
A patient is a user of health care services whether he or
she is healthy or sick.
Vital sign:
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. Vital signs often vary by age
Vital signs:
There are four vital signs which are standard in most medical
settings:
Body temperature
Pulse rate (or heart rate)
Blood pressure
Respiratory rate
Temperature:
The degree or intensity of heat present in a
substance or object, especially as expressed
according to a comparative scale and shown
by a thermometer or perceived by touch.
Reason to measure
temperature:
The main reason for checking body temperature is to solicit
any signs of systemic infection or inflammation in the
presence of a fever or elevated significantly above the
individual's normal temperature.
Other causes of elevated temperature include hyperthermia.
A fever is the reaction to a disease-specific stimuli. The body
changes its normal temperature to support the body’s own
defense mechanisms. Fever is the most common form of
disease-related (pathological) increase in body temperature.
Temperature Recording:
Temperature is a relatively simple procedure. The first
factor to consider when taking a patient’s temperature is
the measurement site. Typically there are three specific
sites that are options for a patient, dependant upon their
age and physical condition.
Sites:
For standard stick-type thermometers, you
may choose from an
Oral
Axillary
Rectal measurement site.
ORAL:
Most popular choice of the three methods.
Oral measurements can provide accurate and reliable readings and a
good representation of core body temperature.
Recommended for patients 4 years and older who will not bite down on
the probe tip during measurement.
When taking temperature orally, a few key points to remember include
Drinking or eating very hot or cold food can affect measurement.
Physical activity can alter.
It is important that the patient keep their mouth closed during oral
measurements.
The ingress of cooler air from the environment can throw off readings.
ORAL:
AXILLARY:
The underarm must be dry prior to measurement.
You may need to wipe the patient’s underarm with a dry
towel prior to measurement.
After placing the probe tip in the armpit, bring the
patient’s arm down close against the body to trap body
heat.
The probe tip should be oriented in the same direction of
the body, with the tip towards the patient’s head.
AXILLARY:
Rectal:
Generally, water-soluble jelly or petroleum jelly should be
used as a lubricant when taking rectal temperatures. This
will allow for easier insertion of the probe and increase
patient comfort during the measurement. Lubricants are
generally placed over the probe cover.
The probe tip should be inserted no more than ½ inches or
1.3 cm into the rectum. You should never force the probe
tip in if resistance is encountered.
Average Temperature:
The normal human body temperature is often stated
as 36.5–37.5 °C (97.7–99.5 °F). In adults a review of
the literature has found a wider range of 33.2–38.2 °
C (91.8–100.8 °F) for normal temperatures,
depending on the gender and location measured.
Normal: 36.5–37.5 °C (97.7–99.5 °F)
Fever: >37.5 or 38.3 °C (99.5 or 100.9 °F)
Hypothermia: <35.0 °C (95.0 °F)
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.
PULSE RATE:
Pulse rate is counted by putting slight
pressure on any section of the body
where the artery is close to the skin
and where the pulsations can be felt.
The most convenient location is the
radial section of the wrist (radial
pulse).
Pulse Rate procedure:
Turn the hand with palm-side facing up
Place your index finger and middle finger just below the
thumb
Exert slight pressure with the index and second finger
against the wrist bone
Count the pulse for 30 seconds using a watch or clock and
multiply this number by 2
OTHER SITES FOR PULSE RATE:
Other locations include :
Side of the neck (carotid pulse)
Groin (femoral pulse)
Side of the feet (Posterior tibial artery
pulse).
PULSE:
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 60–100 beats per
minute, adolescents around 80–100 beats per minute, and
adults' pulse rate is anywhere between 50 and 80 beats
per minute
Reason for measuring Pulse:
Pulse is checked to:
See how well the heart is working. In an emergency situation, pulse
rate can help find out if the heart is pumping enough blood.
Help find the cause of symptoms, such as an irregular or rapid
heartbeat (palpitations), dizziness, fainting, chest pain, or shortness
of breath.
Check for blood flow after an injury or when a blood vessel may be
blocked.
Check on medicines or diseases that cause a slow heart rate.
Causes of high pulse rate :
Causes of tachycardia include: Heart-related
conditions such as high blood pressure
(hypertension) Poor blood supply to
the heart muscle due to coronary artery disease
(atherosclerosis), heart valve
disease, heart failure, heart muscle disease
(cardiomyopathy), tumours, or infections.
Causes of low heart rate :
Changes in the heart that are the result of aging.
Diseases that damage the heart's electrical system. These
include coronary artery disease, heart attack, and infections
such as endocarditis and myocarditis.
Conditions that can slow electrical impulses through the heart.
Examples include having a low thyroid level (hypothyroidism) or
an electrolyte imbalance, such as too much potassium in the
blood.
Some medicines for treating heart problems or high blood
pressure, such as beta-blockers, antiarrhythmics, and digoxin.
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. A
normal blood pressure would be 120 being the systolic over
80, the diastolic. Usually the blood pressure is read from the
left arm unless there is some damage to the arm. The
difference between the systolic and diastolic pressure is
called the pulse pressure
Blood 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.
Aneroid Sphygmomanometer:
Electronic Sphygmomanometer:
How to Prepare for the Test:
Before measuring blood pressure:
Rest for at least 5 minutes before blood pressure
is taken.
Do not take blood pressure when you're under
stress, have had caffeine or used a tobacco in the
past 30 minutes, or have exercised recently.
HOW TO PREPARE:
Take two or three readings at a sitting. Take the readings
1 minute apart. Remain in a seated position.
Measure blood pressure in the morning and at night for a
week.
HOW TO PERFORM:
Sit with the back supported, legs uncrossed, and feet on
the floor.
Arm should be supported so that upper arm is at heart
level. Roll up sleeve so that arm is bare.
Wrap the blood pressure cuff snugly around upper arm.
The lower edge of the cuff should be 1 inch above the
bend of patient’s elbow.
The cuff will be inflated quickly. This is done either by
pumping the squeeze bulb or pushing a button. Patient
will feel tightness around your arm.
Put on your stethoscope so that the ear pieces are angled
away from your head. Twist the head piece so that the
bell is engaged. This can be verified by gently tapping on
the end, which should produce a sound. With your left
hand, place the bell over the area of the brachial artery.
HOW TO PERFORM:
Next, the valve of the cuff is opened slightly, allowing the
pressure to slowly fall.
As the pressure falls, the reading when the sound of blood
pulsing is first heard is recorded. This is the systolic pressure.
As the air continues to be let out, the sounds will disappear.
The point at which the sound stops is recorded. This is the
diastolic pressure.
Inflating the cuff too slowly or not high enough may cause a
false reading. If you loosen the valve too much, you won't be
able to determine your blood pressure.
The procedure may be done two or more times.
HOW TO PERFORM:
WHY TO CHECK?
High blood pressure has no symptoms so you may not know if
you have this problem. High blood pressure is often
discovered during a visit to the doctor for another reason.
Finding high blood pressure early can help prevent heart
disease, stroke, eye problems, or chronic kidney disease.
All adults should have their blood pressure regularly
checked.
Get checked every 2 years if blood pressure was less than
120/80 mm Hg at the most recent reading.
People with high blood pressure, diabetes, heart disease,
kidney problems, or other conditions should have blood
pressure checked regularly.
NORMAL RESULTS:
Blood pressure readings are usually given as two numbers
(written as 120/80 mm Hg)
Normal blood pressure is when the top number (systolic
blood pressure) is 120 OR below most of the time, and the
bottom number (diastolic blood pressure) is below 80 most
of the time (written as 120/80 mm Hg).
If the blood pressure numbers are 120/80 or greater but
below 140/90, it is called pre-hypertension. If you have
pre-hypertension, you are more likely to develop high
blood pressure
ABNORMAL RESULTS:
High blood pressure (hypertension) is when the top number
(systolic blood pressure) is 140 or more most of the time or
the bottom number (diastolic blood pressure) is 90 or more
most of the time. (written as 140/90 mm Hg).
If the patient has diabetes, heart disease, or kidney
problems, or if he had a stroke, the doctor may want blood
pressure to be lower.
Most of the time, high blood pressure does not cause
symptoms ( SILENT KILLER)
NORMAL CONSIDERATIONS:
It is usually higher when you are at work.
It drops slightly when you are at home.
It is usually lowest when you are sleeping.
It is normal for your blood pressure to increase suddenly
when you wake up. In people with very high blood
pressure, this is when they are most at risk for a heart
attack and stroke.
B.P:
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 are called segmental blood
pressures and are used to evaluate blockage or arterial
occlusion in a limb (see Ankle brachial pressure index).
VALUES:
Pre-hypertension : Systolic BP 120-140 or diastolic BP
80-90.
Stage I hypertension: Systolic BP > 140-160 or diastolic BP
>90-100.
Stage II: Systolic BP > 160 or diastolic BP > 100.
Causes of High BP:
Smoking
Being overweight or obese
Lack of physical activity
Too much salt in the diet
Too much alcohol consumption (more than 1 to 2 drinks per day)
Stress
Older age
Genetics
Family history of high blood pressure
Chronic kidney disease
Adrenal and thyroid disorders
Sleep apnea
Causes of Low BP:
Pregnancy
Hormonal problems such as an
underactive thyroid(hypothyroidism), diabetes, or low blood
sugar (hypoglycemia)
Some over-the-counter medications
Some prescription medicines such as for high blood
pressure, depression or Parkinson’s disease
Heart failure
Heart arrhythmias (abnormal heart rhythms)
Widening, or dilation, of the blood vessels
Heat exhaustion or heat stroke
Liver disease
Respiration Rate:
Respiration rate is the measure of breaths a person take
per minute.
Measured when the patient is at rest involves counting
number of times chest rises.
Respiration rate increases in fever and other medical
conditions.
Normal respiration rate in resting adult is 12 to 16 breaths
per minute.
Causes of fast respiration:
Shallow, rapid breathing, tachypnea or hyperventilation has many
possible medical causes, including:
Asthma
Blood clot in an artery in the lung
Choking
Chronic obstructive pulmonary disease (COPD) and other chronic lung
diseases
Heart failure
Infection in the smallest air passages of the lungs in children
(bronchiolitis)
Pneumonia or other lung infection
Transient tachypnea of the newborn
Anxiety and panic
Other serious lung disease
Causes of Slow Heart Rate:
Causes of Bradypnea. There are several factors that can
contribute to bradypnea, such as pulmonary
obstructions, increased intracranial pressure, obesity,
alcohol consumption, and cardiogenic shock. However,
the most common factors that cause bradypnea are over
use of narcotics, brain disorders, and hypothyroidism
