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Vital Signs Table of Contents (ctrl+click on text to go directly to section) CLINICAL PROTOCOLS Temperature, Pulse & Respirations..................................................................................1 Blood Pressure ................................................................................................................ 2 Page 0 of 3 Core Clinical Service Guide Section: Vital Signs September 1, 2012 VITAL SIGNS When reviewing vital signs in each of the age groups, be alert
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  Vital Signs Table of Contents (ctrl+click on text to go directly to section) CLINICAL PROTOCOLS Temperature, Pulse & Respirations..................................................................................1Blood Pressure ................................................................................................................2 Page 0 of 3Core Clinical Service GuideSection: Vital SignsSeptember 1, 2012  VITAL SIGNS When reviewing vital signs in each of the age groups, be alert for signicant changes and compare with normal values for each of the signs. For best results, when taking vital signs of infants, respirations are counted rst before the infant is disturbed, the pulse next and the temperature last. When taking temperatures, the use of non-mercury thermometers is recommended. TEMPERATURE(Birth to Adult)NORMAL RESTING PULSE(Birth to Adult)RESPIRATIONS(Birth to Adult) (Birth to 10)  Temperature between .! #$$.! F is considered low-grade fever. %f the temperature is taken rectally, a temperature is not considered a fever until it is above #$$.& ã  Temperature between #$# #$' is considered a mild fever. ã  Temperature between #$' #$( is considered a moderate fever. ã  Temperature around #$& or above is considered a high fever, and delirium or convulsions may occur. (11 Year to Adult) ã  Temperature above #$$.&is considered a fever. ã %f temperature is taken rectally, it would register one degree higher and a reading of #$# would be considered a fever. ã  Temperature between #$# #$' is considered a mild fever. ã  Temperature between #$' #$( is considered a high fever, and delirium or convulsions may occur. Ma!a e#e!t )ssess the patient to determine if other signs or symptoms are present *i.e., +ushed face, hot, dry skin, low output and highly concentrated urine, disinterest in eating, constipation, diarrhea,or vomiting. lder children or adolescents may complain of sore throat, headaches, aching all over, nausea, constipation, ordiarrhea. etermine if elevated temperature could be post immuni/ation *see %mmuni/ation0ewborn--------#$$ #1$ 2 months # year$ #($' ( years----------!$ #'$& 3 years----------1$ ##$#$ years )dult---2$ #$$ Ma!a e#e!t  The apical heart rate is preferred in children. To count the rate, place stethoscope on the anterior chest at the fth intercostal space in a midclavicular position. 4ach 5lub-dub6 sound is one beat. 7ount the beats for one full minute. While counting the rate, note whether the rhythm is regular or irregular.8ulse rates may be checked at sites other than the apex, for example, the carotid, brachial, radial, femoral, and dorsalis pedis sites. 7ompare the distal and proximal pulses for strength. )lso record whether the pulse is normal, bounding *very strong, or thready *weak.When reviewing the resting heart or pulse rate in each of the age groups, if the rate is not within the normal limits9 ã :epeat to conrm. ã :eview history for appropriate age group to determine if patient is taking medication that may alter the heart rate or if the patient is active in sports orexercise programs *i.e., runner, ;ogger, football, basketball, tennis, etc.. ã %f heart or pulse rate is outside the normal range and there is no appropriate  The procedure for measuring a child<s respiratory rate is essentially the same as for an adult. =owever, keep in mind these points. ã >ince a child<s respiration rate is diaphragmatic, observe abdominal movement to count the respiration rate. ã )bdominal movement in a child will be irregular. ã 7ount for one full minute. Nor#al Re$iratio! Rate(Birth throu h Adult) 0ewborn---------($ 2$2 months--------'& (2# year------------'$ &$' ( years--------'$ ($& 2 years--------#2 ''2 #$ years------#2 '$## '$ years----#' '$ Ma!a e#e!t )ssess the patient to determine if other signs or symptoms of respiratory or cardiac distress are present.%f a child has any acute distress *retractions, cyanosis, whee/ing, irritability, refer immediately for a medical evaluation. Page 1 of 3Core Clinical Service GuideSection: Vital SignsSeptember 1, 2012  >ection, or related to underlying condition, being treated at the ?=. %f not, seek medical consultation and@or refer for medical evaluation.Fever in an infant ( months and younger is of greater signicance and medical consultation or referral should occur. rationale, refer for medical evaluation. Page 2 of 3Core Clinical Service GuideSection: Vital SignsSeptember 1, 2012  BLOO% PRESSURE REA%INGS IN &'IL%REN A%OLES&ENTS Alood pressure measurement for a child is basically the same as for an adult. The ie o* the +lood $reure ,u- i e.tre#el/ i#$orta!t . Whether manual or electronic eBuipment is being used, the si/e of the blood pressure cuC is determined by the si/e of the child<s arm or leg. Denerally, the width of the bladder cuC is two thirds of the lengthof the long bone of the extremity on which the blood pressure is taken. The length of the bladder cuC should be about three-fourths the circumference of the extremity and should not overlap. %f the bladder of the cuC is too small, the pressure will read extremely highE if it is too large, the pressure will be falsely low. A eNor#alSta e I Mild'/$erte!io!Sta e IIModerate'/$erte!io!Sta e IIISeere'/$erte!io!234 Year For results above normal, follow >tage %% guidelines>ystolic#$1 #####'iastolic2# 1$1# 536 /ear >ystolic### ##3##2 #'##'' #'#'iastolic2# 1$1# 111! !3!3 10317 Year >ystolic##' ##2##1 #'3#'2 #((#(( iastolic2& 1312 !#!' !! 12314 Year >ystolic##2 #'(#'& #(3#(2 #&(#&(iastolic23 1211 !3!2 !# 15318 Year >ystolic##! #'2#'1 #&##&' #&#&iastolic1$ 1!$ #' 11 Sour,e9 #odi:ed *ro# Natio!al 'eart; Lu!  Blood I!titute3Betheda< M%Sour,e9 #odi:ed *ro# the A#eri,a! A,ade#/ o* Pediatri, Ma!a e#e!t *or A+!or#al Blood Preure Readi! Sta e I (Mild '/$erte!io!) #.:epeat to conrm'.)ssess for obesity and anxiety(.:eview for underlying causes, including medications, underlying illnesses, pain, etc.&.=ealth education to include9a.Aasic nutritionb.4xercise for older children and adolescentsc.Gonitor weekly at ( diCerent times within # month to conrm baseline valuesE then monitor at routine visits. Sta e II a!d III (Moderate to Seere '/$erte!io!) #.:epeat to conrm'.=ealth and nutrition education(.:efer for medical evaluation Page 3 of 3Core Clinical Service GuideSection: Vital SignsSeptember 1, 2012
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