VITAL SIGNS

 A THERMOMETER

VITAL SIGNS

Vital signs are observations that provide guide to the patient condition and progress. They Consist of temperature, pulse, respiration and blood pressure recorded at regular intervals or as and when requested.

Alteration in body function often are related to the body’s temperature, pulse and respiration. The mechanism governing the pulse rate, respiration rate and blood pressure are very sensitive to changes from the normal that is why they are referred to as vital signs or cardinal symptoms. When it is noted that the vital signs are deviated from the normal it automatically means that the patient needs constant observation.

TEMPERATURE

Temperature: is the measure of degree of hotness or coldness of substance or body. The instrument used for measurement is called thermometer which works on the principle that substances expand on heating and contract on cooling. The clinical thermometer is a glass instrument used to measure body temperature. It has two parts; the bulb and the stem. Mercury is in the bulb and being metal will expand when expose to heat and rise in the stem. The stem is marked in degree Celsius.

TYPES OF THERMOMETERS

Bath Thermometer

This is used to take the temperature of the patient’s bath water. It has been arranged so that it scopes out a small quantity of bath water out of the bath to maintain the mercury at its correct level until the nurse can read the temperature.

Lotion thermometer

This is use to take the temperature of lotions used in various nursing treatment. The range may vary considerably (6.6’c – 104’c.) This kind of thermometer will only read an accurate reading while held in the lotion.

Wall thermometer

This is use to register atmospheric temperature in the hospital rooms or wards sometimes alcohol colored with red dye is used instead of mercury.

Clinical thermometer

This is to take temperature of human body. It differs from others in that it is self-registry. There is a small constriction on the bulb just above the bulb part which the mercury will not run unless shaken. The range of clinical thermometer temperatures extends from 35’c-43.30c and the length of time taken to register may vary from 2 to 3 minutes. The optimum time is stated on the thermometer.

Electronic thermometer

The temperature is recorded rapidly and accurately and an accurate reading can be taken.

SITES FOR TAKING TEMPERATURE

1. the armpit/axilla
2. mouth / oral
3. rectum
4. groin

REQUIREMENT FOR TAKING TEMPERATURE

• Clinical thermometer
• Gallipot with clean cotton wool balls
• Gallipot containing water for rinsing the thermometer
• Receiver for used swab
• Temperature chart
• A watch with seconds hand or pulsometer
• Pen

Taking temperature in axilla / groin

Method For Taking Temperature

1. Explain procedure to patient 
2. Provide privacy if in the groin
3. Take temperature tray to the bed side of the patient
4. Make him comfortable either Iying or sitting up on bed
5. Take the thermometer, dry with cotton from the bulb to the stem
6. Shake the mercury until it falls below 35’c.
7. Dry axilla or groin by cleaning with swabs and discard.
8. Insert the thermometer in the axilla or groin making sure the bulb is in between skin fold
9. Leave the thermometer for 2 – 3 minutes or as indicated on it
10. Remove, wipe from the stem toward the bulb and check reading, Hold it at eye level and rotate in between the figures until the mercury line is clearly visible.
11. Record the reading on the temperature chart.
12. Thank patient
13. Leave patient comfortable
14. Dispose of used swab, clean thermometer appropriately.
15. Wash hands
16. Report any abnormalities
17. Do not take axilla or groin temperature within 30 minutes after bath                       

TAKING ORAL TEMPERATURE

Same requirement as above.

METHOD FOR TAKING ORAL TEMPERATURE

1. Explain procedure to the patient

NB: If he has just had hot drinks (beverage) wait for 3 minutes.

1. Rinse the thermometer in water and wipe.
2. Insert the bulb of the thermometer under patient’s tongue and advise him to close his lips tight but not to bite on the thermometer.
3. Leave the thermometer for 2 – 3 minutes or as indicated on it.
4. Remove thermometer, wipe from stem towards the bulb with a swab
5. Check the reading as described above
6. Record reading on the temperature chart
7. Leave patient comfortable
8. Discard tray as shown above
9. Wash hands
10. Thank patient 
11. Report any abnormality.

CONTRAINDICATION FOR TAKING ORAL TEMPERATURE

1. Patient with dyspnoea
2. Local disease in the mouth e.g. stomatitis or oral thrush 
3. Nose padded with gauze
4. Fits or liable to have it
5. Unconsciousness 
6. Delirium 
7. Babies and small children
8. Psychiatric patient
9. When the patient has just smoked or chewed gum
10. When the patient is sneezing or coughing continuously,

TAKING RECTAL TEMPERATURE

This routine is mostly used in children or infants. A special rectal thermometer with a round bulb labelled “for rectal use only” is used. Vaseline is added to the requirement in the tray.

METHOD

1. Explain procedure to patient if applicable.
2. Let him empty his bowl if necessary
3. Provide privacy if necessary.
4. Wipe and shake the thermometer as described in axilla and oral route.
5. Lubricate the bulb at 2.2cm above it.
6. With the patient on his side fold back the bed linen and separate the buttocks so that the anal sphincter is visualized.
7. Insert the thermometer into the rectum for about 2cm and leave it in for 2-3 minutes
8. Hold it in place if patient is not co-operative.
9. Remove the thermometer and wipe it once from the stem to the bulb.
10. Read and shake the thermometer and record
11. Make patient comfortable
12. Discard tray as above and wash hands
13. Record any abnormality detected.

NB: Taking rectal temperature is contraindicated if patient have had:

1. Rectal surgery
2. Diseases of the rectum
3. Diarrhea.

DISINFECTION OF CLINICAL THERMOMETER

1. Use a clean soft tissue or cotton wool each time the thermometer must be wiped.
2. Hold the tissue at the end of the thermometer near the fingers.
3. Wipe down towards the bulb using twisting motion.
4. Clean it with soap or detergent solution again using twisting motion.
5. Rinse the thermometer under running cold water
6. Immerse thermometer in savlon or hibitane 1% for 20 minutes
7. Rinse the thermometer with water again after disinfection and before reuse.
8. Return the thermometer to the storage receptacle if not needed for immediate use.

NB: Cleaning: Thermometer for mass use is cleaned daily, if used individually it is cleaned weekly.

NAMES GIVEN TO DEGREE OF TEMPERATURE

1. Collapse: below 350c
2. Sub normal: 35 – 36°c
3. Normal: 36.2-37.2
4. Pyrexia: it is the rise of temperature above 37.2 degrees Celsius 
5. Low Pyrexia: 37.2 – 38.2 degree Celsius
6. Moderate: 38.3 – 39.4°c
7. Hyper Pyrexia: over 40 degree Celsius

CAUSES OF SUBNORMAL TEMPERATURE

1. Exposure to cold over a long period of time.
2. Less heat production in the body due to starvation 
3. Shock
4. Hemorrhage and dehydration.

CAUSES OF PYREXIA

1. Invasion of microorganism into the body due to other causes like toxic condition e.g., continuous pain experienced, a wound which is infected by the Clostridium tetani, septicemia etc
2. Exposure to severe external heat over a long period of time.
3. Direct interference with heat regulating center in the medullar oblongata e.g. tumor, head injury.

EFFECTS OF PYREXIA ON THE BODY

When the body is hot the heart pumps more blood to the kidney thus more urine is produced. The signs and symptoms which accompanies elevated temperature indicates its wide spread effect on the body in that every system is involved and it is known as febrile state or state of fever.

Respiratory system: There is increase rate of breathing

Circulatory: Increase pulse rate

Alimentary system: Anorexia (loss of appetite). Dry mouth and tongue, Nausea and vomiting.

Excretory system: diminished highly coloured urinary output.

Muscular system: General malaise, general aches and pains, feeling of weariness.

The nervous system: Headaches, restlessness and perhaps Insomnia and delirium.

TYPES OF FEVER

Fever is a raise in temperature above normal

CONSTANT FEVER

In this case there is continuous elevation or raise in temperature which does not vary more than

1.1 within 24 hours period.

REMITTENT FEVER (UP)

There are variations of more 1.2 °C in 24 hours but the lowest temperature does not reach the normal (ie. 37.2 ‘C) with this period.

INTERMITTENT /SWINGING FEVER

This type may also be called hectic. The temperature swinging from nomal or subnormal to moderate or high pyrexia at intervals of one, two or three days. There is variation of 1.2 C between the high and the low temperature the lowest being normal or below normal. This is found in tuberculosis and malaria.

IRREGULAR FEVER

This type of Pyrexia does not come under any clearly defined group but may show signs and characteristics of some or all of them.

INVERSE FEVER

Here the highest temperature is recorded in the morning and the lowest in the evening. This is found to be normal state of affairs in night workers.

PYREXIA

In this case a typical febrile condition may be described. The only characteristics lacking is a rise in temperature. This has sometimes occurred in typhoid fever.

LYSIS

This is the name given to the gradual return to normal temperature. Takes 3, 4 or probably 5 days to do so. In the decline of the fever, there is a study improvement in the pulse and respiration rate and in the general condition of the patient.

CRISIS

The temperature falls sharply to normal within 24 hours and there is a corresponding improvement in the pulse, respiration and in the general condition of the patient.

FALSE / PSEUDO CRISIS

This may occur during the course of a disease before the true crisis. This is a decline of temperature which is not accompanied by a corresponding improvement in the pulse or respiration rate or in the general condition of the patient. The temperature rises again after a short period.

RIGOR

Sudden and severe shivering attack caused by disturbance of the heat regulating center in the brain (that is the medullar oblongata). It usually indicates the onset of a severe Febrile illness example malaria. If it occurs in the course of a febrile disease it will indicate the development of complication.

STAGES OF RIGOR

Rigor can be divided into 3 stages:

• cold stage

• Hot stage

• Sweating stage.

Cold stage

The patient feels cold and shivers violently. The skin is cold the temperature may reach 39.4- 40°C: The pulse is rapid and thready. The patient complains of feeling cold.

The superficial blood vessels are constricted and blood is diverted into the deeper internal organs. The patient should be given hot drink and covered with blanket. Close nearby louvers and windows.

Hot stage

This follows immediately after the cold stage. The skin is hot and dry. The patient complains of headache, thirst, soreness of the skin and is extremely restless. The temperature continues to rise and pulse is full and bounding. Cold drinks are given and blanket removed, cold compresses applied to the forehead, groin, armpit. Open nearby louvers and windows.

Sweat stage

The skin begins to act and the patient sweat profusely. The temperature falls the pulse improves and patient feels much better. Care must be taken to prevent chilling and possible collapsing of the patient during this state. The cold application must be discontinued to relief the patient’s discomfort. Face, neck and chest should be dried with towel at frequent intervals and clothing should be changed and the patient made comfortable. Throughout the rigor the temperature, pulse and respiration should be taken every 10 minutes. A special chart must be kept during the rigor period. and it should be indicated on the temperature chart.

TEPID SPONGING

Tepid sponging is sponging of a patient using tepid water (27-23) and it is done in order to reduce a high body temperature (is reducing a high body temperature by sponging a patient using tepid water of 27- 23) Another book says it is a form of treatment given to patient with febrile condition and it reduces temperature by 1.1 degrees Celsius.

REQUIREMENT FOR TEPID SPONGING

A trolley with the following

Top shelf

A bowl for the tepid water

Bath thermometer if any

Six pieces of cloth or flannel

Temperature tray.

• Lower shelf

Two jars: one for hot water, one for cold water.

Two light bath towels

Bed linen or cloth

Others are linen bin, talcum powder.

METHOD FOR TEPID SPONGING

1. Explain procedure to the patient
2. Screen the bed. Sponging must be performed without hurry and with careful attention to patient reacting to it. If it is to be effective, sponging must be carried out with the least possible exertion on the part of the patient.
3. Bring trolley to the bed side
4. Wash hands
5. Take patient’s temperature, pulse and respiration
6. Strip the ends of bed.
7. Insert bath towels under patient.
8. Fill the basin with tepid water temperature 28°C (Test it with bath thermometer if available or with your elbow.)
9. Undress the patient
10. Wash and dry face to refresh him
11. Leave a flannel wrung out of cold water on the patient’s forehead
12. Place the six pieces of cloth into the basin or tepid water.
13. Place a wet flannel in each axilla and groin.
14. Change these five wet cloths frequently to keep them tepid.
15. Sponge the body as in order of bed bath leaving small drops of water on the skin. Do not dry the skin.
16. Turn the patient onto his side and continue to sponge as in order of bed bath leave small drops of water on the skin
17. change the water as often necessary
18. The whole procedure should take 15- 20 minutes.
19. Dry the patient gently at the end of the procedure.
20. Dress patient
21. Recheck the patient’s temperature and chart.
22. It should have fallen by 1.1°c
23. Remake the bed with clean linen
24. Leave the patient covered with thin sheet
25. Clear away trolley
26. Wash and dry hands
27. Give patient cold drinks
28. Open windows
29. Thank your patient.

PULSE

It is the wave of expansion felt in an artery whenever superficial artery passes over a bone. The wave of expansion corresponds to left ventricular contraction. Normal pulse rate in adult’s ranges between 60 and 80 beats per minutes with an average of 72 beat per minute (bpm). It is faster in children and slower in old age. It increases with activities, slow down at rest and in starvation.

Sites in the body where pulse can be felt

1. Temporal Artery: that is in front of the ear.
2. Facial artery: is found 2.5 cm in front of the artery of the jaw.
3. Carotid artery: It is found in the neck
4. Radial artery: It passes on the thumb side of the wrist
5. Femoral artery: This is in the groin.
6. Posterior Tibia artery: It is found just below the internal melleolus.
7. Fontanelle Artery: In infants is very much felt when the child is dehydrated.
8. Over the apex of the heart (Apex pulse) using a stethoscope. Locate apical beat 8.8cm to the midline in the 5th intercostal space. For simultaneous checking of radial pulse: 2 nurses synchronize their watches. Start counting together and stop at the same time.

NORMAL PULSE RATE

1. New born: 130 b.p.m

2. 12 months old: 110– 120 b.p.m

3. 2-5 years: about 100- b.p.m

4. 5-10 years: about 90 b.p.m

5. Adults: 60-80 b.p.m

6. Old Age turns to become slower

FACTORS THAT BRINGS VARIATION IN NORMAL PULSE

1. Position of the patient: when the patient is standing up and moving about the pulse is more rapid than when he is lying down or relaxing.
2. Sex of the patient: The pulse turns to be more rapid in women than in men. The difference is 5 b.p.m.
3. Age of patient: the ratio between the age group is greatly varied e.g. in infant and young children the pulse is more rapid than in adult.

CHARACTERISTICS OF A NORMAL PULSE

RATE: How fast or slow the pulse or heart beat is.

RHYTHM: That is the regularity with which the heat beat occur. The length between each beat should be the same.

VOLUME OR STRENGTH: It should require moderate pressure to obliterate the blood vessel i.e. how forceful the blood is been pushed out through the blood vessels.

TENSION: It is how soft or hard it feels under the nurses figures.

ABNORMAL VARIATION IN PULSE RATE

1. TACHYCARDIA: Denote a rapid heart rate that is more than 100 b.p.m. It is normal in infants, and young children and in adults, it is usual with exercise and anxiety. It also accompanies fever, shock. hemorrhage, thyrotoxicosis and heart failure. Having recorded the patient pulse rate on the graph, the nurse should look at the trend of the recording on the graph steady or gradual increase or decrease, sudden increase or decrease. Any change in pulse should be recorded at once.

1. BRADYCARDIA: This is the term for slow pulse that is less than 60. This is a normal rate in athletes but is also associated with excess vagal stimulation e.g. Due to raised intracranial pressure.

ABNORMAL CHANGES IN THE PULSE RHYTHM

1. DICROTIC PULSE:

It is a type of pulse which is immediately followed by a weaker pulse? This is due to the fact that the muscle layer of the walls of the blood vessel has lost its tone. The second echo-like beat is caused by the blood rebounding off the closed aorta.

1. EXTRASYSTOLES /ECTOPIC BEAT:

May appear isolated irregularities in an otherwise regular pulse. This extra beats of the ventricles follows quickly upon the previous beat as followed by compensatory pause.

1. INTERMITTENT PULSE:

It is a pulsation which may be mixed and it may occur at regular or irregular interval. The reason being that the heart beat is not strong enough to emit a wave along the radial artery. It can be caused by excessive smoking and drinking of coffee or tea.

1. ATRIA AURICULAR FIBRILLATION:

It produces a totally irregular pulse and is often associated with thyrotoxicosis, coronary artery disease and mitral stenosis. In atrial auricular fibrillation of the heart the pulse rate is rapid, the number of pulsations felt in peripheral artery will be fewer or less than the number of beats felt at the apex. That is pulse rate may not reflect the heart rate. The discrepancy between apical and radial recording is called pulse deficit. The pulse deficit is estimated by simultaneous recording by two people of heart rate and pulse rate. The rate of an irregular pulse must be counted for not less than a minute.

1. SINUS ARTHYMIAS

The rate turns to be rapid with inspiration and slower with expiration. It is common in children but then it is of little significance.

HOW TO COUNT THE HEART BEAT AT APEX

Occasionally the patient radial pulse may be difficult to count. A stethoscope is put over the apex of the heart. The impulse of the heart against the chest wall can be heard in the space between 5″ and 6″ ribs and about 3 inches to left of the medial line. For many patient having cardiac conditions or receiving medication to improve heart action, the physician may request that the heart beat should be taken at the apex of the heart and the radial pulse simultaneously. This is referred to as apical radial pulse. Two nurses are required. One listens over the apex of the heart with stethoscope. The other counts at the wrist. They use one watch place between them. After listening and feeling, be sure that they get the best possible count they decide on the time to counting.

ABNORMAL VARIATIONS IN THE VOLUME OF THE PULSE

Thready pulse: When the pulse is weak and rapid and the flow of blood can easily be stopped by pressure.

Running Pulse: It is a rapid pulse with very poor volume. It is a sign of extreme prostration.

Corrigan’s Pulse / water Hammer pulse: It is found in patient with aortic valve incompetence. Here the first half of the heart beat is normal but after reaching the peak it suddenly collapses under the fingers.

TAKING AND RECORDING PULSE

Requirement

A watch with a second hand or a pulsometer, temperature chart and pen

STEPS FOR TAKING RADIAL PULSE

It is usually taken while taking the temperature but may be taken separately.

1. Explain procedure to the patient
2. Patient must be at rest and comfortable.
3. Place first 3 figures of one hand on the arterial aspect of the patient forehead just above the base of the thumb.
4. Feel the pulsation of the radial artery: get used to feel of the pulse before counting.
5. Note rhythm, rate, volume and state of arterial wall.
6. Using the watch or pulsometer count for a full minute.
7. Record on temperature, pulse and respiration chart
8. make patient comfortable
9. Wash hands
10. Report any abnormalities detected.

RESPIRATION

Respiration is the process by which exchange of gases takes place in lungs between air and the circulating blood.

Respiration cycle is made up of inspiration (breathing in), expiration (breathing out) and pulse. Normal range is 16 – 20 and the average is 18 cycles per minute in the adult. Respiration is faster in babies and small children. The steady rise and fall of the chest wall is the apparent sign of respiration is what the nurse counts and records. Respiration is the process whereby oxygen and carbon dioxide are exchanged. Normal respiration should rhythmical, quiet, regular and comfortable being neither too deep nor too shallow.

THE RATE OF RESPIRATION

This varies with age and sex. It is usually expressed as so many breaths / minutes, It is more slightly rapid in women than in men.

New born infants… 30-35 breath /minute

12 months old…25-30 breath / minute           

2-5 years…20- 25 breath / minute  

Adult…14-18 breath /minute.

THE NORMAL RESPIRATION

Breathing is an automatic and noiseless, regular, even and without effort being neither too deep nor too shallow. Between each respiration there is normally a short resting period, Men breathe with their diaphragm than women who make use of their intercostal muscle. Normal increase in rate occurs during and for some time after taken exercise, in state of excitement and in motion where there is sudden chilling of the body and in increased atmospheric pressure such as at higher level. Normal decrease in rate occurs during rest, sleep and fatigue.

HOW TO TAKE RESPIRATION OF A PATIENT

REQUIREMENT

A watch with second hand and pulsometer, pen and TPR chart (Temperature Pulse and Respiration).

METHOD

1. After checking pulse with the hand still on patient’s wrist observe patient respiration without his awareness.

2. Note rise and fall of patient chest during inspiration and expiration. The rise and fall counts as one cycle.

3. Using the watch count for the respiration for a minute to obtain the respiration rate.

4. Note also the depth, the rhythm, any difficulty in breathing. Position in which he breaths better and his colour. Record respiration on T P R chart. Make patient comfortable

5. Report abnormalities.

ABNORMALITIES OF RESPIRATION

When the respiration is more rapid than normal, they are usually shallow and when slower than normal they are usually deeper.

SIGHING RESPIRATION:

This is known as air hunger. Long deep inspiration indicating the need for more oxygen. Occurs in cases of severe anemia severe hemorrhage and also be seen in cases of diabetic coma and uremia.

SLOW RESPIRATION;

This is present in coma due to cerebral cause or large doses of drugs. Excessively slow rhythm are characteristics of poison by opium and others.

SHALLOW RESPIRATION:

This type of breathing is seen in diseases of the lungs such as pneumonia and conditions where respiratory movement are painful such as in fractured ribs.

STERTOROUS BREATHING:

Noisy snoring inspiration accompanied by coughing of the checks. This occurs in deep unconscious patient and may be due to the tongue slipping back and blocking the air way and is found in patient suffering from cerebral haemorrhage.

STRIDOR RESPIRATION:

Noisy inspiration. The noise may be harsh and grunting or whistle sound. This occurs in patient with obstruction of the upper airway.

WHEEZING RESPIRATION:

This is the term which describes the sound made during respiration. When there is obstruction in the lower air way as a result of air passing through fluid in the air passages. It is noticed in patient suffering from asthma and bronchitis.

WHOOPING RESPIRATION:

It is the long down up noisy inspiration which occurs after an attack of coughing as in whooping cough.

APNOEA:

This term denote cessation of respiration for a period or in other words a period when breathing has stopped.

HYPEPNOEA

This is force breathing in which the respiration are rapid and deep.

DYSPNOEA:

This is a condition in which breathing is laboured and difficult which may or may not be accompanied by pain. The difficulty may be inspiration or expiration or both. This is a characteristics of some lung and heart diseases.

ORTHOPNOEA:

In this case the patients have difficulty in breathing unless sitting up right. It is associated with advance heart disease. In many cases it is helpful to put a patient bed table up to the patient and allowed the patient to lean forward.

CHEYNE STROKES RESPIRATION:

It is observed in normal individual in very high altitude and also patient suffering a disease affecting the circulation of blood, heart diseases and cerebral condition. A pause is followed by shallow respiration which gradually increases in rate and depth until reaching a maximum; they increase again during the period of time. The cycle is then repeated. After several cycles, the breathing may become normal again and this is a serious sign.

BLOOD PRESSURE

Blood pressure is the force of blood pushing against the walls of the blood vessel. Or blood pressure is the pressure exerted by the blood and the walls of the vessel. The term blood pressure usually refers to the pressure of blood on the walls of the artery; arterial blood pressure is the accurate term. There is always a certain amount of blood in the artery. The blood goes first into the artery and circulates through the whole body.

FACTORS MAINTAINING BLOOD PRESSURE

1. The pumping force of the heart: That is the heart itself must be strong.
2. The quality of the circulating blood.
3. The viscosity of the blood: it is derived from plasma protein and number of red blood cells. This deals with hemoglobin level.
4. Elasticity of the blood vessel wall
5. Peripheral resistance this is the resistance offered to the blood passing through the vessel.
6. The resistance of blood flow in the arterioles. If the plane muscles in the walls of these vessel contract then the caliber of the vessels decreases and the resistance of blood flow increase and so does the arterial blood pressure.
7. The state of the arterial wall, of their normal distensible state associated with the elastic fiber is lost then there’s an arterial blood pressure.

NB:

The force of the ventricular contraction, the quantity of blood return to the heart and the heart rate together determine the cardiac output in terms of amount per minute. Blood pressure is measured in millimeter of mercury (mmHg) and the normal arterial systolic pressure of a healthy adult at rest is sufficient to support a column of mercury (Hg) 120mm in height. The normal arterial systolic BP is 120mmHg while average diastolic BP of an adult at rest is 80mmHg. BP turns to rise with age. So average arterial systolic pressure is 30-40 mmHg at birth, while in elderly it may rise to 140-150mmHg. Since cardiac output increases with exercise so does the BP. Emotion such as anxiety cause an increase in BP.

Hypertension is a name given to the condition where the BP of the individual at rest is increased above normal. An increase in diastolic pressure.

150 – Systolic mmHg

100 – Diastolic.

This may due to:

1. prolong constrictions
2. Loss of elasticity of the arterial wall.
3. An increase viscosity of the blood as in very severe polycythemia.
4. Hypertension may be associated with renal diseases. It is postulated that the rise in blood pressure is mediated by a hormone called Rennin released from a tissue near glomerular of the nephron if the glomerular blood pressure falls; Rennin increases the amount of circulating angiogenesis which causes an increase in blood pressure.
5. Prolong increase in quantity of certain hormone which raises blood pressure e.g. Adrenaline and non-adrenalin

Hypertension for shock:

It refers to a condition in which the B P. is lower than normal. It may be associated with

1. Hemorrhage
2. Burns
3. Severe dehydration
4. Vagal inhibition resulting in reduction of cardiac output due to sudden failure of the heart muscle.
5. Adrenocortical insufficiency may increase the effect of loss of circulation fluid
6. In injured individuals who have been receiving corticosteroids

HOW TO RECORD BLOOD PRESSURE

Blood pressure is estimated by using sphygmomanometer which consists of a glass manometer containing mercury and calibrated in millimeters. An inflatable rubber cuff attaches by a piece tubing to the manometer, it is enclosed in a cotton bar and when applied around the limb or inflated act as a tourniquet constricting the blood vessels of the limb to which it is applied. When the pressure of the inflatable bulb just exceed the systolic blood pressure and pulsation in the artery disappears, on its return a tapping sound can be detected by listening over the vessel wall through stethoscope. The height of the mercury in the manometer at the point of the first sound gives the arterial systolic blood pressure in mmHg. As the air is left out of the bulb the sounds change in character and then disappear. Either the point at which the sound change or at which they disappear may be taken as the diastolic pressure according to the convention in the hospital. All persons recording the blood pressure of a particular patient should use the same criteria to determine the diastolic blood pressure.

NB: Do not allow the patient to see the mercury whiles the blood pressure is been recorded else it may cause anxiety which could increase his blood pressure.

METHOD

BLOOD PRESSURE: When you take the patient blood pressure the ward must be quiet the patient should be at rest preferably in bed. Make sure he has no tight clothing around the arm.

1. Explain the procedure to the patient
2. Place the manometer level with the patient arm for accurate reading.
3. Apply the sphygmomanometer cuff evenly and firmly to the patient upper arm above his elbow. The end is tacked in.