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Vital Signs
Temperature
Pulse
Blood Pressure
Respiration
Pain (considered the 5th vital sign)
Vital Signs (VS) are the most important measurements
you will obtain when you evaluate or assess a clients
condition. A change in vital signs may indicate a
change
in health.

Vital Signs
Vital signs in pediatrics include
-

temperature
heart rate(pulse)
blood pressure
respiration
weight
height
head circumference.
Height, weight, and head circumference should be
plotted
on a growth curve graph.

Vital Signs
Frequency of vital signs
Vital signs are assessed at least every 4 hours
- in hospitalized patients with elevated
temperatures
- low or high blood pressures
- changes in pulse rate or rhythm
- respiratory difficulty as well as in patients who
are taking medications that effect cardiovascular
or respiratory function
- who had a surgery.

Normal Vital Signs in Childhood

Infant

Toddler

School-Age

Adolescent

Heart Rate

120-160

80-130

70-110

60-100

Respiratory
Rate

25-40

20-35

15-25

10-20

Systolic blood
pressure

60-90

70-100

90-110

95-130

Diastolic blood
pressure

30-55

45-65

50-70

60-80

Heart rate gradually decreases from about 150 beats per minute in newborns
to normal adult values of 60-100 by age 12. Heart rate goes up or down at
approximately 10% per degree Celsius and 5% per degree Fahrenheit.

Temperature
Temp or Fever ?
Temperature the measurement of heat in the body.
Fever- the measurement of heat in the body that is
above
normal for the individual.

Fever a defense mechanism

Indicator of disease in body

Pathogens release toxins
Toxins affect hypothalamus
Temperature is increased
Rest decreases metabolism and heat production by the
body

Temperature
Patterns of fever
SUSTAINED- remains above normal with little change
RELAPSING periods of febrile episodes interspersed
with
acceptable temp values
INTERMITTENTvaries from normal to above normal
to
below normal (may have a fairly predictable pattern)
REMITTENTfever spikes and falls w/o a return to
normal
temp values

Patterns of fever
A. Fever continues
B. Fever continues to
abrupt onset and
remission
C. Fever remittent
D. Intermittent fever
E. Undulant fever
F. Relapsing fever

Temperature
Body temperature reflects the balance between

the heat produced and the heat lost from the body,
and is measured in heat units called degrees. There
are two kinds of body temperature:

Core temperature is the temperature of the deep

tissues of the body such as abdominal cavity and
pelvic cavity; it remains relatively constant.
Surface temperature is the temperature of the
skin, the subcutaneous tissue, and fat. It rises and
falls in response to the environment. When the
amount of heat produced by the body equals the
amount of heat loss, the person is in heat balance.

Temperature

Normal core temperature : 37C (98.6F) + 0.8

diurnal variation = 0.6 - 1.1C
maximum temperature ~ 4 - 6 pm.
Oral - axilla temp < 1C
Rectal - oral temp < 1C (generally 0.4C (0.7F)
higher than oral readings)
Tympanic membrane ~ oral temperature (not
reliable for
< 3 year old children): underestimate core temp
by 0.5o C
Axillary temp underestimate core temp 1 o C
The standard definition of fever is a rectal
temperature of > 100.4F (38.0C).

Temperature

A number of factors affect the body's heat

production:
BMR(Basal Metabolic Rate) is the rate of energy
utilization in the body required to maintain essential
activities such as breathing.
Muscle activity; including shivering, increases the
metabolic rate.
Thyroxine output; increased thyroxine output increases
the rate of cellular metabolism throughout the body.
Epinephrine, norepinephrene, and sympathetic
stimulation/stress response. These hormones
immediately increases the rate of cellular metabolism in
many body tissues
Fever; fever increases the cellular metabolism rate and
thus increases the body's temperature further.

Temperature
Factors affecting body temperature:
Circadian Rhythms; predictable fluctuations in
measurement of body temperature and blood
pressure such as body temperature is usually lower in
the morning than in the evening.
Age; the body temperature of infants and children
changes more rapidly in response to both heat and
cold.
Hormones; women tend to have more fluctuations in
body temperature than men as a result of hormones
changes

Temperature
Factors affecting body temperature:
Stress; the body respond to both emotional and
physical stress as a threat increasing the
production of epinephrine and nor epinephrine as
a result the metabolic rate increases raising the
body temperature
Environmental temperature; we are
responding to a change in environment either by
wearing or less clothes.
Exercise, hard work or strenuous exercise
can increase body temperature.

Temperature
Fever
rectal temperature >= 38.0o C (100.4o F )

Pathophysiology: 3 causes
Raising of hypothalamic set point in CNS
Infection, collagen vascular disease, malignancies
lowered by antipyretic medication and removing
heat
Heat production exceeding heat loss
salicylate overdose, hyperthyroidism,
environmental heat
Defective heat loss
ectodermal dysplasia, heat stroke, poisoning with
certain drugs

Mechanism of fever production

Exgenous Pyrogens
Viruses Endotoxin
Bacteria Ag-Ab complexes
Fungi
Drugs
Antigen+
Sensitized
T-Cells

Phagocytic Leukocytes
Monocytes
Macrophages
Neutrophils

Interleukin-1

Interleukin-1

lymphocyte-activating
Interleukin-2
Proliferation of
Helper T-Cells

endogenous
T-Cell

Preoptic
Hypothalmic Nuc
Prostaglandins
Fever

Interleukin-1
Phospholipids
phospholipase A2

Arachidonic acid
Leukotr
lipogenase
Cyclo-oxygenase
Endoperoxides
Prostacyclins

Prostaglandins
(PGE-2)
Fever

Thromboxanes

Heat is produced by

Metabolism
Increased muscle activity
Vasoconstriction
External sources

Heat is lost by

Vasodilation
Convection
Radiation
Conduction
Evaporization

Mechanism of heat loss:

Radiation; the transfer of heat from the surface of one
object to the surface of another without contact
between the two objects, mostly in the form infrared
rays.
Conduction; is the transfer of heat from one molecule
to a molecule of lower temperature such as the body
transfers heat to an ice pack causing the ice to melt.
Vaporization; the conversion of a liquid to vapor such
as body fluid in the form of perspiration and insensible
loss is vaporized from the skin.
Convection is the dispersion of heat by air currents. The
body usually has a small amount of warm air adjacent
to it. This warm air rises and is replaced by cooler air.

Temperature
Fever
The signs and symptoms of fever: loss of appetite,
headache,
hot, dry skin, flushed face, thirst and general malaise. Young
children or other people with high fevers may experience
periods of delirium or seizures.

Nursing Interventions for Client's with fever:

Monitor vital signs
Assess skin color and temperature
Monitor WBC, HCT, and other laboratory reports for
indications of infection or dehydration

Temperature
Nursing Interventions for Client's with
fever:
Remove excess blanket when the client feels warm,
but provide extra warmth when the client feels chilled.
Measure intake and output
Provide adequate nutrition and fluid
Reduce physical activity to limit heat production.
Administer antipyretic
Provide oral hygiene to keep the mucous membrane
moist.
Provide a tepid sponge bath to increase heat loss
through conduction.
Provide dry clothing and bed linens.

Temperature
Fever: Treatment
Antipyretics:
lower the central set point
- inhibit cyclo-oxygenase enzyme, prevent
synthesis of prostaglandin
- do not interfere with immune response to
infection

Doses:
Acetaminophen: 15 mg/kg every 4 hours
Ibuprofen: 10 mg/kg every 6-8 hours

Temperature

adequate hydration
fever can cause excessive heat loss
better heat disipation with adequate intravascular
volume
careful not to overhydrate and cause hyponatremia
comfortable surroundings: temperature 72 o F (22o C)
not bundled in extra clothing or blankets
sponging with tepid water
temperature around 80o F (27o C)
ice baths or alcohol should be avoided: lead to
shivering
which may increase body temperature and is
uncomfortable

Temperature
Differential diagnosis of acute fever

Upper Respiratory Tract Disease

Viral respiratory tract disease
Otitis media
Sinusitis
Lower Respiratory Tract Disease
Bronchiolitis
Pneumonia
Gastrointestinal Disorders
Bacterial gastroenteritis
Viral gastroenteritis

Temperature
Musculoskeletal Infections
Cellulitis
Septic arthritis
Osteomyelitis
Urinary Tract Infections
Bacteremia
Meningitis

Temperature
Hypothermia
a core body temperature below the lower limit of
normal. The
three physiologic mechanisms of hypothermia are:
Excessive heat loss
Inadequate heat production to counteract heat
loss
Impaired hypothalamic thermoregulation

Temperature
The clinical signs of hypothermia:
Decreased body temperature, pulse, and
respiration
Severe shivering
Feelings of cold and chills
Pale, cool skin
Hypotension
Decreased urinary output
Lack of muscle coordination
Disorientation
Drowsiness progressing to coma
Frostbite(nose, fingers, toes)

Temperature
Nursing Interventions for Client's with
hypothermia
Provide a warm environment
Provide dry clothing
Apply warm blanket
Keep limbs close to body
Cover the client's scalp with a cap
Supply warm oral or intravenous fluids
Apply warming pads

Temperature
Temperature Sites

Oral within the mouth or under the tongue.

Axillary in the armpit.
Tympanic in the ear canal.
Rectal through the anus, in the rectum.
Other sites include on the skin or in the blood.

Temperature
Assessing Body Temperature

The four most common sites for measuring body

temperature are oral, rectal, axillary, and the
tympanic membrane and the skin.

Orally: It reflects changing body temperature more

quickly than the rectal method. Oral
thermometers may have long, short, or rounded
tips

Temperature
Contra indication of oral temperature:
Breathing is difficult or rapid

Can't close mouth for any reason

Breathing through mouth
Mouth is inflamed
Confused or comatose
Infant or young children
Oral surgery/ broken jaw
Unconscious/agitated people

Temperature
Rectally; are considered to be very accurate.
Contra indication of rectal temperature
Diarrhea
Rectal surgery
Clotting disorders
Hemorrhoids "pile"

Temperature
Axillary; is the preferred site for measuring
temperature
newborn because it is accessible and offers no possibility
rectal
perforation.

Contraindication of axillary temperature

Thin patient
Local inflammation
Unconsciousness, shocked patients
Constricted peripheral blood vessels.

Temperature
Tympanic membrane; nearby tissue in the
ear canal
because the membrane has an abundant arterial
blood supply.

Temperature
Temporal artery thermometer

are most

useful for infants

and children where a more invasive measurement is
not
necessary.

Temperature scales

Temperature

The body temperature is measure in degreed on

two scales: Celsius (centigrade) and Fahrenheit.
C= (Fahrenheit temperature 32) * 5/9
F = (Celsius temperature * 9/5) +32

Temperature
Types of
Thermometers
Electronic
Thermometers

Measure
temperature
through a probe at
the end of the
device.
Hold as close as
possible to the
area where you
wish to measure
the temperature.

Temperature
Types of Thermometers (cont.)
Glass Thermometers

Mercury rises in a glass tube until its

level matches the temperature.
Bulb shapes

Long tip for oral use.

Security tip for oral and rectal use.
Rounded tip for rectal

Temperature
Types of Thermometers (cont.)
Thermometer Handles

Blue oral and axillary.

Red rectal.

Use disposable plastic covers to prevent

contamination.

Temperature
Reading a thermometer

Heart Rates(Pulse)
Age Normal Range (Resting)

Premature
0-3 months
3-6 months
6-12 months
1-3 years
110
3-6 years
110
6-12 years
Over age 12

120-170
100-150
90-120
80-120
706560-95
55-85

Pulse
A wave of blood flow
created
by a contraction of the
heart.

A.

E.

B.

F.

Pulse Sites
A. Temporal
B. Femoral
C. Popliteal
D. Posterior tibial
E. Carotid
F. Brachial
G. Radial
H. Dorsalis pedis

C.

D.

G.

H.

Pulse
Pulse sites

Radial pulse located

inside the wrist, near
the thumb.
Brachial pulse found
in the antecubital space
of the arm (the bend of
the elbow) in adults.
Apical pulse
auscultated with a
stethoscope on the
chest wall. The pulse is
found at the apex of the
heart.

Pulse
Pulse Sites
Temporal; passes over the temporal bone of the head.
The site is superior and lateral to the eye.
Carotid; at the side of the neck between the trachea and
the sternocleiodomastoid muscle.
Apical; at the apex of the hearty. About 8cm to the left of
the sternum and at the fourth and sixth intercostals space.
Brachial; at the inner aspect of the biceps muscle of the
arm
Radial; on the thumb side of the inner aspect of the wrist
Femoral; alongside the inguinal ligaments
Popliteal; behind the knee
Posterior tibial; on the medial surface of the ankle
Pedal dorsalis pedis; over the bones of the feet

Memeriksa denyut arteri radialis

Palpasi arteri radialis dan arteri femoralis

bersamaan.
Denyut femoralis yang lebih lambat menunjukkan
adanya aortic coarctation

Pulse

Factors affecting pulse:

Age; as age increases, the pulse rate gradually
decreases.
Gender, males pulse rate is slightly lower than
the females.
Exercise; the pulse rate normally increase with
activity
Fever; the pulse rate increases in response to the
lowered blood pressure that results from
peripheral vasodilatation associated with
elevated temperature and because of the
increased metabolic rate.

Pulse
Factors affecting pulse:
Medications; some medications decrease the pulse
rate, and others increase it such as digitalis decrease
the heart rate.
Hypovolemia; loss of blood from the vascular system
normally increase pulse rate. Stress; in response to
stress, sympathetic nervous system stimulation
increases the overall activity of the heart.
Position change; when the person is sitting or
standing, blood usually pools in dependent vessels of
the venous system.
Pathology; certain diseases such as some heart
conditions or those with impair oxygenation can alter
the resting pulse rate.

Pulse
Characteristics of the Pulse
- Pulse Rate
Assessed as beats per minute, or BPM.
Counted for 15, 20, 30, or 60 seconds.
Tachycardia a pulse rate faster than normal.
Bradycardia a pulse rate slower than normal.
An elevated heart rate is seen in infections, hypovolemia,
hyperthyroidism, and anxiety.
A rule of thumb is that the heart rate increases by
10/minute for each 1 degree of temperature Centigrade.
Bradycardia is seen in hypertension, increased
intracranial pressure, certain intoxications, or other
hypometabloic states.
It is best to examine an infants heart first during the
exam.

Pulse
Rhythm

- Pulse Rhythm

the pattern of the

heartbeats.
A client with an
irregular heartbeat
(arrhythmia or
dysrhythmia) must
be measured a full
minute to determine
the average rate.
When documenting
pulse rhythm, record
as regular or
irregular.

Regular
Irregular

Pulse

Pulse volume, or strength of the pulse,

can be measured with the following scale:

0 absent, unable to detect.
1 thready or weak, difficult to palpate, and easily
obliterated by light pressure from fingertips.
2 strong or normal, easily found and obliterated
by strong pressure from fingertips.
3 bounding or full, difficult to obliterate with
fingertips.
A thready or weak pulse may indicate decreased
circulation. A bounding pulse may indicate high
blood pressure.

Pulse
Bilateral Presence pulses should be found
within the same areas on both sides of the body
and have the same rate, rhythm, and volume.

Blood pressure
Blood pressure (BP) is the pressure or
tension exerted on the arterial walls as blood
pulsates through them.

Systolic blood pressure (SBP)

pressure exerted on the arteries during the
contraction phase of the heartbeat.

Diastolic blood pressure (DBP) the

resting pressure on the arteries as the heart
relaxes between contractions.

Blood pressure
Expected Blood Pressure Values

Expected SBP 100 to 140 mm Hg.

Expected DBP 60 to 90 mm Hg.
Hypotension when the blood pressure drops
below expected levels.
Hypertension high blood pressure.
Prehypertension classified by the American
Heart Association as SBP 120 to 139 mm Hg or
DBP 80 to 89 mm Hg.

Blood pressure
Sites for Blood Pressure Assessment

Brachial taken on the upper arm; most common

site.
Radial taken on the lower arm; possible site for
infants or clients who have very large upper arms.
Popliteal taken on the thigh.
Dorsalis pedis and posterior tibial taken on
the lower leg.

Equipment for Measuring Blood Pressure

Blood pressure is measured using a

sphygmomanometer, also called a BP cuff, or
cuff.

Blood pressure
Equipment for Measuring
Blood Pressure

Types of
Sphygmomanometers
Mercury has a calibrated
glass tube containing
mercury.
Aneroid has a calibrated
dial with a needle that
points to numbers on the
face of the dial.
Electronic uses a digital
display and usually includes
the pulse rate.

Mengukur tekanan darah

menggunakan sphygmomanometer dan stetoskop.
Cuff sphygmomanometer
dipasang pada lengan atas
yang bebas dari pakaian.
Letak lengan atas sejajar
dengan letak jantung.

Blood Pressure
Blood pressure must be measured with a cuff wide
enough to cover at least 1/2 to 2/3 of the extremity
and its bladder should encircle the entire extremity.
A narrow cuff elevates the pressure, while a wide
cuff lowers it.
Systolic hypertension is seen with anxiety, renal
disease, coarctation of the aorta, essential
hypertension, and certain endocrine abnormalities.
Diastolic hypertension occurs with endocrine
abnormalities and coarctation of the aorta.
Hypotension occurs in hypovolemia and other
forms of shock.

Blood Pressure
Blood pressure is referred to the force of the blood
against arterial walls. Maximum blood pressure is
exerted on the walls of arteries when the left
ventricles of the heart pushes blood through the
aortic valve into the aortas during contraction, the
highest pressure thus called systolic pressure.
Diastolic pressure is the pressure when the
ventricles are at rest. Diastolic pressure, then,
is the lower pressure present at all times within
the arteries. The differences between the two
called the pulse pressure

Blood
Pressure
Determination of blood pressure
Pumping action of the heart; when the pumping
action of the heart is weak, less blood is pumped
into arteries "lower cardiac output", and the blood
pressure decreases.
Peripheral vascular resistance; peripheral vascular
can increase blood pressure. The diastolic pressure
especially is affected. Some factors that create
resistance in the arterial system are the capacity of
the arterioles, the compliance of the arteries, and
the viscosity of the blood

Blood Pressure

Blood volume; when the blood volume decreases

as a result of hemorrhage, the blood pressure
decreases because of the decreased fluid in the
arteries.
Blood viscosity; blood pressure is higher when the
blood is highly viscous "thick" that is, when the
proportion of RBC to the blood plasma is high.

Blood Pressure
Factors affecting Blood Pressure
Age; the pressure rises with age, reaching a peak at
the onset of puberty, and then tend to decline.
Exercise; physical activity increases the cardiac
output and hence in blood pressure; thus 20-30
minutes of rest following exercise is indicated before
the resting blood pressure can reliably assessed.
Stress; stimulation of the nervous system increases
cardiac output and vasoconstriction of the arterioles,
however severe pain can decrease blood pressure
greatly by inhibiting the vasomotor center and
provide vasodilatation
Race (African American males over 35 years have
higher BP than European American males)

Blood Pressure
Gender; after puberty, female usually have lower
blood pressure than males at the same age. After
menopause the female has higher blood pressure
than males
Medications
Obesity; predispose to high blood pressure
Diurnal variations; pressure is usually lowest early
in the morning when metabolic rate is low.
Disease process; any condition affecting the
cardiac output, blood volume, blood viscosity, and
compliance of the arteries has a direct effect on the
blood pressure.

Blood Pressure
Hypertension: an abnormally high blood
pressure, over
140 mm Hg systolic and 90 mm Hg diastolic.

Factors associated with hypertension

Thickening of the arterial walls, which reduces the
size of the arterial lumen
Elasticity of the arteries
Lifestyle as cigarette smoking
Obesity
Lack of physical exercise
High blood cholesterol level
Continued exposure to stress

Blood Pressure
Hypotension: blood pressure below normal that is

systolic
reading between 85-110mm Hg. It occurs as a result of
peripheral vasodilatation in which blood leaves the central
body organs especially the brain and moves to the
periphery

Factors associated with hypotension

Analgesics
Bleeding
Severe burn
Dehydration.

Blood Pressure
It is important to monitor hypotensive clients carefully
to
prevent falls. When assessing the orthostatic hypotension:
Place the client in a supine position for 2-3 minutes
Record the client's pulse and blood pressure
Assist the client to slowly sit or stand. Support the
client in case of faintness
After one minute in the upright position, check the
pulse and blood pressure in the same site as
previously
Record the results, a rise in pulse of 40 beats per
minute or a drop in blood pressure of 30mm Hg
indicates abnormal vital signs.

Blood Pressure
Equipments used to assess pulse and
blood pressure
Stethoscope; is used to auscultated and assess
body sounds including the apical pulse and the
blood pressure
Sphygmomanometer; is used to assess blood
pressure consist of cuff, good selection of the cuff
in order to obtain accurate blood pressure.

Blood pressure
Blood pressure sites
Assessing the blood pressure on a clients thigh is indicated
in these situations:
The blood pressure can not be measured on either arm
due to burn or other trauma
The blood pressure on one thigh is to be compared with
the blood pressure in the other thigh
Blood pressure is not measured on a particular clients limb
in the following situations:
1) Avoid having blood [pressure in injured or an area with
cast
2) The client has had removal of axilla lymph node on that
site
3) The client has intravenous line in that limb
4) The client has an arteriovenous fistula for dialysis in that
limb

Respiration
Respiration (R) is the act of breathing.
Respiratory Rate (RR)

Observe the clients chest movement upward

and outward for a complete minute.
Children under 7 years of age use abdominal
breathing.
Auscultation with a stethoscope may be
necessary on clients who are aware that you
are counting their respiratory rate.

Respiration
Respiration is controlled by (a) respiratory
centers in the medulla oblongata and the pons of
the brain and (b) by chemo receptors located
centrally in the medulla and peripherally in the
carotid and aortic bodies.

External respiration; the interchange of

oxygen and carbon dioxide between the alveoli of
the lungs and the pulmonary blood. Internal
respiration; the interchange of these same
gases between the circulating blood and the cells
of the body tissues.

Respiration
Factors affecting Respirations
Factors increase the rate:
Exercise
Increase metabolism
Stress
Increased environmental temperature
Lowered oxygen concentration
Factors decrease respiration rate:
Decreased environmental temperature
Certain medications such as narcotics
Increased intra cranial pressure

Respiration
Respiration depth; is generally described as normal,

deep, or shallow. Deep respirations; large volume of

air is inhaled and exhaled, inflated most of the lungs.
Shallow breathing involve the exchange of a small
volume of air and often the minimal use of a lung tissue
Hyperventilation; refers to very deep, rapid
respiration.
Hypoventilation; refers to very shallow respirations

Respiratory rhythm refers to the regularity of the

expirations and the inspirations .An respiratory rhythm
can be described as regular or irregular.

Cheyne-stokes breathing, from very deep to very

shallow breathing and temporary apnea.

Respiration
Kussmaul .. Increased rate and depth of respiration above
20bpm

Respiratory quality, usually breathing does not require

noticeable
effort. Dyspnea, difficult and labored breathing. Orthopnea,
ability to
breath only in upright sitting or standing positions.

Breath sounds
- Stridor, harsh sound heard during inspiration with laryngeal
obstruction
- Stertor, snoring respiration usually due to a partial
obstruction of the upper airway.
- Wheeze, continuous, high pitched musical sound occurring on
expiration when air moves through narrowed or partially
obstructed air way.

Respiration
Secretions and coughing
- Hemoptysis, the presence of blood in the sputum
- Productive cough, a cough accompanied by
expectorated secretions
- Nonproductive cough, a dry, harsh cough
without secretions

Respiration
Characteristics of Respiration
Rate of Respiration the number of breaths

per minute.
Normal range is 12 to 20 breaths per minute for an
adult.
Rate will vary with age and size of client.
An increased respiratory rate is called
hyperventilation.
A decrease in respiratory rate and depth is called
hypoventilation.
Rhythm of Respiration should be regular.

Quality of Respiration

Can be shallow or deep.

Respiration
Respiratory Rate

Newborn
6 - 12 months
1 - 2 years
2 - 4 years
4 - 10 years
10 - 14 years
15 +

30 - 75
22 - 31
17 - 23
16 - 25
13 - 23
13 - 19
same as adult

Respiration
Tachypnea is seen with increased activity,
hypermetabolic states, fever, or respiratory
distress.
A decreased respiratory rate is seen with
conditions affecting the central nervous system,
including medications/toxins, congenital
malformations, and other lesions.
A variable respiratory rate, known as periodic
breathing, is commonly seen in neonates but
more than a 20 second pause is always abnormal.
Cheyne-Stokes breathing is seen with brainstem
abnormalities.

Oxygen
Saturation
A pulse oximeter: is a non invasive device that
measures a
client's arterial blood oxygen saturation by means of a sensor
attached to the client's finger, toe, nose, earlobe, or forehead.
The pulse oximeter can detect hypoxemia before clinical signs
and symptoms such as dusky skin color and dusky nailbed
color.

Factors affecting oxygen saturation reading

Hemoglobin; if the hemoglobin is fully saturated with
oxygen, the saturation will appear normal even if the total
hemoglobin level is low
Circulation
Activity; shivering or excessive movement of the sensor site
may interfere with accurate reading.
Carbon monoxide poisoning.

Weight
Decrease in weight percentile may be due to
- decreased intake (malnutrition, central nervous system
abnormality)
- malabsorption (cystic fibrosis, IBD, celiac disease,
parasitic
infestation), or
- increased metabolic rate (hyperthyroidism, congestive
heart failure).
Increase in weight is most commonly exogenous ,but
may also be associated with certain genetic syndromes
(Prader- willi).

Height
A childs length (lying flat on a table) is measured
until 2 to 3 years of age; after that it is measured
as height (standing).
Decrease height may be familial, or may be seen
in conditions affecting weight or independent of
weight (Turner syndrome).
Increase height may be familiar or associated
with certain genetic and endocrine abnormalities
(Cerebral gigantism).

Head Circumference
Head circumference is routinely measured until 2
to 3 years of age.
Microcephaly may be part of a syndrome (Rett
syndrome), congenital infection (CMV), or the
result of abnormal brain growth (schizencephaly).
Macrocephaly may be familiar or may represent a
pathologic state (Hydrocephalus, Canavaan
disease, AV malformation).

General appearance
Does patient appear ill ? To what degree ?
State of consciousness, or mental status
General nutrition status
Position or posture
Note characteristics that strike you on first
observing the
patient (e.g. severe respiratory distress,
moderate jaundice,
unusual face, inspiratory stridor)