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TANDA-TANDA VITAL( VITAL SIGNS)

dr Putra hendra SpPDUNIBA

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Vital signVital signs arephysical signs thatindicate an individual

is alive , such as heartbeat, breathing rate,temperature, bloodpressures andrecently oxygensaturation

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TERMASUK:1. SUHU TUBUH2. NADI3. PERNAFASAN4. TEKANAN

DARAH5. (NYERI s!"ing

#is!$%t tan#a&tan#a 'ital ang)!&5*

Stat%s +si,l,gis-%ngsi t%$%s!s!,"ang #a/at

#i"!0!)si)an,l! in#i)at,"

TTV /!"%$a an TTVin#i)asi)an/!"%$.)!s! atan

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Vital sign Normal vital signs

berubah dipengaruhi

oleh - - umur - sex - berat badan - Aktivitas - kondisi

(sehat/sakit)

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SUHU TUBUH

SU!U "UBU! #$NUN%U&&AN&$!AN'A"AN"UBU! #ANUSIA

Panas tubuh Diprodu(si )

exercise danmetabolismema(anan

!ilang ) melalui (ulit,paru, dan produ(

sisa melalui prosesradiasi,(ondu(si,(onve(si,

evaporasi

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Suhu tubuh mencermin(an (eseimbangan antaraprodu(si panas dan (ehilangan panas, dan diu(urdalam unit panas yang disebut dera*at

Ada + macam suhu tubuh)Suhu inti *aringan dalam tubuh) rongga abdomendan rongga pelvis -elati. (onstan

+ Suhu permu(aan suhu (ulit, S/, dan lema( S/ nai( dan turun merespon thd ling(ungan

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FAKT R&FAKT R YANE PEN ARUHI PR DUKSI PANAS

B#- ) *umlah energi yang diguna(antubuh untu( mela(u(an a(tivitas utama

+ A&"IVI"AS 0"0") termasu( menggigil,mening(at(an metabolisme rate

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1 Stimulasi2respon $pineprin,norephinephrine, simpatis !ormon inidengan se(eti(a mening(at(anmetbolisme sel dibeberapa *aringantubuh

3 In.e(si ) mening(at(an *umlah

metabolisme tubuh

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Mekanisme perpindahan panas

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FAKT R YAN E PEN ARUHISUHU TUBUH

Circadian Rhythms perubahan fisiologis, seperti perubahan suhu dan TTV yang lain secarafluktuatif : pagi hari lebih rendah dibandingkan

sore hari, suhu tubuh berfluktuasi 4,+5 o 6 , o/selama periode +3*am

Usia suhu tuuh bayi dan ana(7ana( berubah

lebih cepat dalam merespon perubahanpanas dan dingin

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Hormonal perempuan cenderung lebihfluktuatif dibandingkan dengan laki-laki karena perubahan hormon

!tress respon tubuh terhadap stressfisik dan emosi akan meningkatkanproduksi epineprin dan nor epineprin

sehingga mengakibatkan peningkatanmetabolisme rate peningkatan suhutubuh

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SUHU TUBUH N R A Suhu Permu(aan ) 18,5 o 6 19,3 o / Suhu inti ) 18,3 o 6 15 o /

Suhu diu(ur dengan termometer""ermometer yang paling di(enal) #elsius (#) $eamur (rankine) ($)

%ahrenheit (%) &elvin (&) denganperbandingan antara satu dan lainn'a # $ (%- *) + , .

#ontoho

#+,/.(%- *) dan %+./ $ *

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PENGATURAN SUHUSuhu manusia di(endali(an

oleh H0123HA4AMU!

Anterior hilangnya panas

Vasodilatasi danbeng(a(

Posterior produ(si dan

menyimpan panas

#enyesuai(an dengan

sir(ulasi darah2. Piloerectile :mengatur

(onstri(si atau dilatasipori7pori (ulit;

3. Respon menggigil

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!ipotalamus meningat(an produ(si panas dengancara mening(at(an metabolisme melaluise(resi hormon thyroid, yaitu epinephrin dannorepinephrin medulla adrenalis

Dalam (eadaan normal, hipotalamus men*aga

suhu inti / oleh perubahan suhu permu(aantubuh dan darah

Suhu ? 3 @/, dan 13@/indi(asi (erusa(an di

pusat pengaturan

hipotalamus

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Pengaturan Suhu Tu uh !lehHIP"TALAMUS

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Axillary

Oral

Rectal

Tympanic

Vital Signs Temperature(cont.)

#easurementsDegrees ahrenheit

:@ ;Degrees /elsius :centigradeC @/;

Normal adult oraltemperature5 8@

19@/

TemperatureRoutes

Temporal

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PENGUKURAN SUHU

5" 2$A4"ermometer dileta((an didibaEah lidah

sublingual artery7 biasanya hasilpengu(uran 4,F 6 4,5 @/

diba6ah suhu inti

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K NTRA INDIKASIPENGUKURAN SUHU DI "RAL

&lien tida( (ooperati. + Bayi atau toodler 1 "ida( sadar 3 Dalam (eadaan menggigilF orang yang biasa berna.as dengan mulut8 Pembedahan pada mulut9 Pasien tida( bisa menutup mulut

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Unt%) !n6a in )!a)%"atan asil/!ng%)%"an /!"l% #i)a6i

Pengu(uran dila(u(an 14 menit setelah (lien )#engunyah permen2permen (aret

+ #ero(o(1 #a(an dan minum panas atau dingin

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#$ Re%tal Berbeda 4, @/ dengan

suhu inti

&ontraindikasi Diare Pembedahan rektal lotting disorders !emorrhoids

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&$ A%sila!asil pengu(uran 4,8@/ lebih rendah

dibanding(an suhu oralPaling sering dila(u(an mudah, nyaman

Contraindication of axillary temperature Pasien kurus

"nflamasi #okal daerah aksila Tidak sadar, shock $onstriksi pembuluh darah perifer

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37M1A317N8U&U$AN

#74#0U!

0ral 19@

-e(tal :setara; 19,F@

A(sila :setara; 18,3 @

E%ui'alen Pengu%uran suhu

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$ Telinga (Aural) -iset menun*u((an suhu ditelinga pada

membran timpani paling mende(ati suhu intitubuh

&esimpulan ini diddasar(an pada + .a(taanatomi)

#embran tympani hanya ber*ara( 1,5 cm darihipotalamus

+ Darah pada arteri (arotis internadan e(sterna,adalah pembuluh darah yang menyuplaihipotalamus dan membran tympani

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T /ani7 T !" , !t!"

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PENINGKATAN SUHU TU*UHPyrexia ) istilah yang diguna(an untu(menggambar(an suhu tubuhlebih tinggi dari set

point normal+ ever :demam; ) suhu tubuh ? 19,3@/, tanda

dan ge*ala)&ulit (emerahan'elisah,irratibilitas :le(as marah;"ida( na.su ma(anPandangan menurun dan sensiti. terhadap cahaya

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Banya( &eringatSa(it (epalaNadi dan -- mening(at

Disorientasi dan bingung :*i(a suhu terlalutinggi;&e*ang pada in.antdan ana(7ana(

1 !iperthermi ) suhu tubuh ? 34,8@/sangat beri(o ter*adi (erusa(an ota( bah(an(ematian (erusa(an pusat perna.asan

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Hypothermia; is a core body temperature belo%

the lo%er limit of normal& The three physiologicmechanisms of hypothermia are:

'xcessi(e heat loss

"nade)uate heat production to counteract heatloss "mpaired hypothalamic thermoregulation

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H /,t !" ia

!ypothermia isde.ined as a drop in

body temperaturebeloE F@

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The clinical signs of hypothermia:Decreased body temperature, pulse, and

respiration*e(ere shi(ering+eelings of cold and chillsPale, cool skin!ypotensionDecreased urinary output#ack of muscle coordination

DisorientationDro%siness progressing to coma+rostbite nose, fingers, toes-

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PEMERIKSAAN NADI

Nadi adalah sensasidenyutan seperti gelombangyang dapat dirasa(an2dipalpasi di arteri peri.er,ter*adi (arena gera(an ataualiran darah (eti(a

(onstra(si *antung

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Nadi adalah gelombang darah yangdibuat oleh (ontra(si ventri(el (iri

*antung Pada orang deEasa (ontra(si *antung

9: ; 5:: x/mnt saat istirahat #ardiac output C adalah volume

darah yang dipompa(an (edalamarteri oleh *antung dan G SVx!-

Nadi 1erifer< nadi yang berada *auh

dari *antung, ex) (a(i, radialis, leher Nadi apical C nadi central, lo(asinya

di apex *antung

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KE8EPATAN NADI ( PULSE RATE *

Pulse Rate :*umlah denyutan peri.eryang dirasa(an selama menit; dihitung dengan mene(an arteri peri.er

dengan mengguna(an u*ung *ari 3ach'cardia ) nadi ? 44 7 F4 x2mnt

*antung overwork o(sigenasi sel tida(

adeHuat 1alpitasi ) perasaan berdebar7debar,sering menyertai tachycardi

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+A,T"R ANGMEMPENGARUHI NADI

5" Usia C pening(atan usia, nadiberangsur7angsur menurun

*" =enis &elamin C pria sedi(it lebihrendah daripada Eanita :PG8478F x2mnt(eti(a istirahat, G975 x2mnt lebihcepat;

3. Circadian rhythm C rata7rata menurunpada pagi hari dan mening(at padasiamg dan sore hari

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3 Bentu( tubuhC tinggi, langsing biasanya denyut

*antung lebih pelan dan nadi lebih sedi(itdibanding(an orang gemu(F A(tivitas dan exercise; nadi a(an mening(at dengan

a(tivitas dan exercise dan menurun dengan istirahat

6. Stress dan emosiC rangsangan syara. simpatis danemosi seperti cemas, ta(ut, gembira mening(at(andenyut *antung dan nadiNyeri, adalah stressor yang dapat memacu nadi

lebih cepat

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9 !uhu 3ubuh C setiap pening(atan @ nadimening(at 4x2mnt, pening(atan @/ nadi

mening(at Fx2mnt Sebali(nya bila ter*adi penurunansuhu tubuh ma(a nadi a(an menurun

5 >olume darah C (ehilanngan darah yang berlebihana(an menyebab(an pening(atan nadi

obat-obatan C beberapa obat dapat menurun(an ataumening(at(an (ontra(si *antung 'olongandigitalisdan sedati.menurun(an !-, /a..eine,nicotine,cocaine, hormon tyroid, adrenalin

mening(at(an !-

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Penghitungan Na.i N!r/al

U!0A $7N3AN8N2$MA4 $A3A-$A3A

BBJ +4 6 84 34 6 + BJ 54 6 34 +4 6 + "! 54 6 14 4

1 6 8 "! 9F 6 +4 44

9 6 + "! 9F 6 4 F-$#A%A 84 6 44 54D$ ASA 84 6 44 54

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IRA A NADI

5" $78U47$< pola dan *ara( Ea(tudenyutan pada tiap denyutan terabasama2teratur N2$MA4

*" 0$$78U47$(arrh'thmia/d'srh'thmia)< pola dan

*ara( Ea(tu denyutan pada tiap

denyutan teraba tida( sama2tida(teratur

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Vital signs Pulse (cont.)

Regular Pulse Rhythm

ount for ./ seconds, then multiply by 0

a rate of .1 beats in ./

seconds e)uals a pulse rate of 2/ beats3minute-

Irregular Pulse Rhythm

ount for one full minute 4ay use stethoscope to listen for apical pulse and

count for a full minute

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ISI DEN UTAN Adalah (ualitas denyutan yang teraba yang

berhubungan dengan *ulah darah yangdipompa(an oleh *antung (eti(a ber(ontra(si

&ualitas definisi ?eskripsi4 "ida( ada nadi "ida( teraba, mes(ipun dite(an dengan

(uat

K Nadi sangat lemah:thready Pulse ;

Pulsasi susah dirasa(an, dengan te(ananringan tida( teraba

+K Nadi lemah Denyutan Jebih (uat dibanding Thready 1K Normal Dapt teraba dengan mudah,dengan

palpasi ringan denyutan tida( teraba

3K Denyutan (uat dan teraba dengan palpasisedang

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RESPIRATI"N RATE (RR)

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Adalah *umlah.re(uensi perna.anseseorang selama

satu menit re(uensi

perna.asan dihitung

setiap satu gera(aninhalasi dane(shalasi

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Respiration is controlled by

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Respiration is controlled bya- respiratory centers in the medulla oblongata

and the pons of the brainb- by chemo receptors located centrally in the

medulla and peripherally in the carotid and

aortic bodies&Extenal respiration 5the interchange of oxygen

and carbon dioxide bet%een the al(eoli of the

lungs and the pulmonary blood&Internal respiration 5 the interchange of these

same gases bet%een the circulating blood and

the cells of the body tissues&

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The respiratory rate is normally described in breaths per minute, normal in depth and ratecalled eupnea. Bradypnea 5 abnormally slo%

respirations& Tachypnea; abnormally fastrespirations& Apnea 5 the absence of

breathing&

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Res0irat!r1 Rate

Normal respirationrates at rest range.rom F to +4

breaths per minuteIn the cardio7pulmonary illness, itcan be a veryreliable mar(er o.disease activity

F

+4

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Vital Signs Respiration (cont.)

(2 !"#$

(2#!%#$(&'!2"$ (& !2"$

(&2!2#$(&2!2"$

6OT': Ranges reflect reaths per minute

6ormal Respiratory Rates

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irculatoryPulse

RespiratoryRespirations

Pulse and respirations are related because the heart and lungs%ork together& 6ormally, an increase or decrease in one causes thesame effect on the other&

Pulse and Respiration

-atio o. pulse to respirations is 3)

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Factors affecting Respirations

+actors increase the rate:L 'xerciseL "ncrease metabolismL *tressL "ncreased en(ironmental temperatureL #o%ered oxygen concentration

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+actors decrease respiration rate:

Decreased en(ironmental temperature ertain medications such as narcotics "ncreased intra cranial pressure

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Respiration depth 5 is generally described as normal,deep, or shallo%& Deep respirations 5 large (olumeof air is inhaled and exhaled, inflated most of thelungs&

Shallow breathing in(ol(e the exchange of a small

(olume of air and often the minimal use of a lungtissueHyper)entilation 5 refers to (ery deep, rapid

respiration&Hypo)entilation 5 refers to (ery shallo% respirations

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*L""D PRESSURE

P 0 ti! 2!

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Pre0arati!n 2!r/easure/ent Patient should

abstain .rom eating,drin(ing, smo(ing

and ta(ing drugs thata..ect the bloodpressure one hourbe.ore

measurement

$ ll

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R! ! $!" t ! -,ll,9ing -,"a77%"a7 ,- ,%" "!a#ings Instruct your patients

to avoid co..ee ,smo(ing or any other

unprescribed drugEithsympathomimeticactivity on the day o.

the measurement

Pre0arati!n 2!r

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Pre0arati!n 2!r/easure/ent

Because a .ullbladder a..ects the

blood pressure itshould have beenemptied

Pre0arati!n 2!r

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Pre0arati!n 2!r/easure/ent Pain.ul procedures

and exercise shouldnot have occurred

Eithin one hour Patient should havebeen sitting Huietly.or about F minutes

Pre0arati!n 2!r

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Pre0arati!n 2!r/easure/ent BP ta(e in Huiet room

and com.ortabletemperature, must

record roomtemperature and timeo. day

Vi l Si

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Vital Signs Blood Pressure(cont.)

$HuipmentSphygmomanometer L In.latable cu..

L Pressure bulb or other

device .or in.lating cu..

L #anometer

"ypes o.

sphygmomanomete

rs

L Aneroid

L $lectronicL #ercury

! g%)%" T!) D "

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!ng%)%" T!)anan Da"a

Jing(ungan tenang Istirahat :min 14

menit; + *am sebelumnya)

(opi, ma(an,mero(o(,de(ongestan :7;

BAB M BA&sebelumnya

Bicara M gera( :7; Dudu( (a(i tida(disilang

Dudu( bersandar #anset setinggi

*antung, 1 cm di ataslipatan si(u

Jengan besandar

!ebelum!e6aktu

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P!siti!n !2 the Patient Sitting position Arm and bac( are

supported

eet should beresting .irmly on the.loor

eet not dangling

In "#!" t !as%"! t ! Bl #

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In ,"#!" t, !as%"! t ! Bl,,#P"!ss%"! (!:%i/ !nt* Pediatric /u.. si e

#inimum /u.. idth)+21 length o. upperarm #inimum /u.. length)Bladder nearlyencircles arm

In "#!" t !as%"! t ! Bl #

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In ,"#!" t, !as%"! t ! Bl,,#P"!ss%"! (!:%i/ !nt* Adult /u.. si e

Indications .or largecu.. or thigh cu..L Upper arm

circum.erence ?13 cm Indications .or .orearmcu.. :Eith radialpalpation;

L Upper armcircum.erence ?F4 cm

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;N8 < BP 8at!g,"i=ati,nBP /lass SBP, mm !g DBP, mm !g

normal +4 54

prehypertension + 7 1 54 7 5

Stage I 34 7 F 4 7

Stage II O 84 O 44

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