Module IV

Vital Signs, Lifestyle/Hypo Kinetic Diseases And Its

Management

Vital signs
Vital signs are a group of the 4 to 6 most important signs that indicate the
status of the body’s vital (life sustaining) functions. These measurements are
taken to help assess the general physical health of a person, give clues to possible
diseases, and show progress toward recovery. The normal ranges for a person’s
vital signs vary with age, weight, gender, and overall health. There are four
primary vital signs: Pulse rate, Respiratory rate, Blood pressure, Body
temperature.

Pulse rate: The pulse is the rate at which the heart beats while pumping blood
through the arteries, recorded as beats per minute (bpm).It may also be called
"heart rate". The pulse is commonly taken at the wrist (radial
artery).Alternative sites include the elbow (brachial artery), the neck (carotid
artery), behind the knee (popliteal artery),or in the foot (dorsalispedis or
posterior tibial arteries).The pulse rate can also be measured by listening
directly to the heart beat using a stethoscope. The pulse varies with age:a new
born or infant can have a heart rate of 130–150bpm, a kid of 100–120bpm, an
older child of 60–100bpm,an adolescent of 80–100bpm,and an adult of
50–80bpm.

Respiratory rate: The respiratiory rate is the number of breaths a person takes
per minute. The rate is usually measured when a person is at rest and simply
involves counting the number of breaths for one minute by counting how many
times the chest rises. Respiration rates may increase with fever, illness, and other
medical conditions. When checking respiration, it is important to also note
whether a person has any difficulty breathing.
Normal respiration rates for an adult person at rest range from 12 to 16 breaths
per minute.. The value of respiratory rate as an indicator of potential respiratory
dysfunction has been investigated but findings suggest it is of limited
value.Respiratory rate is a clear indicator of acidotic states, as the main function
of respiration is removal of CO2 leaving bicarbonate base in circulation.

Blood pressure; Blood pressure is the force of the blood pushing against the
artery walls during contraction and relaxation of the heart. Each time the heart
beats, it pumps blood into the arteries, resulting in the highest blood pressure as
the heart contracts. When the heart relaxes, the blood pressure falls.Two numbers
are recorded when measuring blood pressure. The higher number, or systolic
pressure, refers to the pressure inside the artery when the heart contracts and
pumps blood through the body. The lower number, or diastolic pressure, refers
to the pressure inside the artery when the heart is at rest and is filling with blood.
Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters
of mercury).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. The classic measurement device is a
mercury sphygmomanometer.

Body Temperature: The normal body temperature of a person varies depending

on gender, recent activity, food and fluid consumption, time of day, and, in women,
the stage of the menstrual cycle. Normal body temperature can range from 97.8
degrees F (or Fahrenheit, equivalent to 36.5 degrees C, or Celsius) to 99 degrees F
(37.2 degrees C) for a healthy adult. Temperature recording gives an indication of
core body temperature which is normally tightly controlled (thermoregulation) as
it affects the rate of chemical reactions.

DISEASES
1. Diabetes

What is diabetes?

Diabetes happens when your body isn't able to take up sugar (glucose) into its cells and use it
for energy. This results in a build-up of extra sugar in your bloodstream.

Poorly controlled diabetes can lead to serious consequences, causing damage to a wide range
of your body's organs and tissues – including your heart, kidneys, eyes and nerves.

Why is my blood glucose level high? How does this happen?

The process of digestion includes breaking down the food you eat into various different nutrient
sources. When you eat carbohydrates (for example, bread, rice, pasta), your body breaks this
down into sugar (glucose). When glucose is in your bloodstream, it needs help – a "key" – to
get into its final destination where it's used, which is inside your body's cells (cells make up
your body's tissues and organs). This help or "key" is insulin.

Insulin is a hormone made by your pancreas, an organ located behind your stomach. Your
pancreas releases insulin into your bloodstream. Insulin acts as the “key” that unlocks the cell
wall “door,” which allows glucose to enter your body’s cells. Glucose provides the “fuel” or
energy tissues and organs need to properly function.

If you have diabetes:

• Your pancreas doesn’t make any insulin or enough insulin.

Or

• Your pancreas makes insulin but your body’s cells don’t respond to it and can’t use it
as it normally should.
 If glucose can’t get into your body’s cells, it stays in your bloodstream and your blood
glucose level rises.

What are the symptoms of diabetes?

Symptoms of diabetes include:

• Increased thirst.

• Weak, tired feeling.

• Blurred vision.

• Numbness or tingling in the hands or feet.

• Slow-healing sores or cuts.

• Unplanned weight loss.

• Frequent urination.

• Frequent unexplained infections.

• Dry mouth.

• Other symptoms

In women: Dry and itchy skin, and frequent yeast infections or urinary tract infections. In

men: Decreased sex drive, erectile dysfunction, decreased muscle strength.

What are the different types of diabetes?

The types of diabetes are:

• Type 1 diabetes: This type is an autoimmune disease, meaning your body attacks itself.
In this case, the insulin-producing cells in your pancreas are destroyed. Up to 10% of people
who have diabetes have type 1. It’s usually diagnosed in children and young adults (but can
develop at any age). It was once better known as “juvenile” diabetes. People with type 1
diabetes need to take insulin every day. This is why it is also called insulin-dependent diabetes.

• Type 2 diabetes: With this type, your body either doesn’t make enough insulin or your
body’s cells don’t respond normally to the insulin. This is the most common type of diabetes.
Up to 95% of people with diabetes have type 2. It usually occurs in middle-aged and older
people. Other common names for type 2 include adult-onset diabetes and insulin-resistant
diabetes.
 Who gets diabetes? What are the risk factors?

Factors that increase your risk differ depending on the type of diabetes you ultimately
develop.

Risk factors for type 1 diabetes include:

• Having a family history (parent or sibling) of type 1 diabetes.

Injury to the pancreas (such as by infection, tumor, surgery or accident).
• Presence of autoantibodies (antibodies that mistakenly attack your own body’s tissues
or organs).

• Physical stress (such as surgery or illness).

• Exposure to illnesses caused by viruses.

Risk factors for type 2 diabetes include:

• Family history (parent or sibling) of prediabetes or type 2 diabetes.

• Being overweight.

• Having high blood pressure.

• Having low HDL cholesterol (the “good” cholesterol) and high triglyceride level.

• Being physically inactive.

• Being age 45 or older.

• Having polycystic ovary syndrome.

• Having a history of heart disease or stroke.

• Being a smoker.

What are the complications of high blood sugar levels?

Potential complications of high blood sugar levels from Type 2 diabetes can include:

• Digestive problems.

• Eye problems, including diabetic retinopathy.

• Foot problems, including leg and foot ulcers.

• Gum disease and other mouth problems.

• Hearing loss.

• Heart disease.

• Kidney disease.

• Liver problems, including nonalcoholic fatty liver disease.

• Peripheral neuropathy (nerve damage).

• Sexual dysfunction.

• Skin conditions.
• Stroke.

• Urinary tract infections and bladder infections.

• Rarely, Type 2 diabetes leads to a condition called diabetic ketoacidosis (DKA). DKA
is a life-threatening condition that causes your blood to become acidic. People with Type 1
diabetes are more likely to have DKA.

How is diabetes managed?

Diabetes affects your whole body. To best manage diabetes, you’ll need to take steps to keep
your risk factors under control and within the normal range, including:

• Keep your blood glucose levels as near to normal as possible by following a diet plan,
taking prescribed medication and increasing your activity level.

• Maintain your blood cholesterol (HDL and LDL levels) and triglyceride levels as near
the normal ranges as possible.

• Control your blood pressure. Your blood pressure should not be over 140/90 mmHg.

• Planning what you eat and following a healthy meal plan. Follow a Mediterranean diet

• Exercising regularly. Try to exercise at least 30 minutes most days of the week. Walk,
swim or find some activity you enjoy.

• Losing weight if you are overweight. Work with your healthcare team to develop a
weight-loss plan.

• Taking medication and insulin, if prescribed, and closely following recommendations

on how and when to take it.

• Monitoring your blood glucose and blood pressure levels at home.

• Quitting smoking (if you smoke).

PREVENTION

Although diabetes risk factors like family history and race can’t be changed, there are other
risk factors that you do have some control over. Adopting some of the healthy lifestyle habits
listed below can improve these modifiable risk factors and help to decrease your chances of
getting diabetes:

• Eat a healthy diet.

 • Get physically active. Walking is great exercise.
• Lose weight if you are overweight. Don’t lose weight if you are pregnant, but check
with your obstetrician about healthy weight gain during your pregnancy.

• Lower your stress. Learn relaxation techniques, deep breathing exercises, mindful
meditation, yoga and other helpful strategies.

• Limit alcohol intake.

• Get an adequate amount of sleep (typically 7 to 9 hours).

• Quit smoking.

Take medications – to manage existing risk factors for heart disease (e.g., high blood
pressure, cholesterol) or to reduce the risk of developing type 2 diabetes – as directed
by your healthcare provider.

2. Hypertension (High Blood Pressure)

Hypertension or elevated blood pressure is a serious medical condition that

significantly increases the risks of heart, brain, kidney and other diseases.

Hypertension is when blood pressure is too high. Blood pressure is written as

two numbers. The first (systolic) number represents the pressure in blood

vessels when the heart contracts or beats. The second (diastolic) number

represents the pressure in the vessels when the heart rests between beats.

Hypertension is diagnosed if, when it is measured on two different days, the

systolic blood pressure readings on both days is ≥140 mmHg and/or the

diastolic blood pressure readings on both days is ≥90 mmHg.

Symptoms of Severe High Blood Pressure

Hypertension is called a "silent killer". Most people with hypertension are

unaware of the problem because it may have no warning signs or symptoms.

For this reason, it is essential that blood pressure is measured regularly.

If your blood pressure is extremely high, there may be certain symptoms to

look out for, including:

Severe headaches

Nose bleed
 Fatigue or confusion

Vision problems

Chest pain

Difficulty breathing

Irregular heartbeat

Blood in the urine

Pounding in your chest, neck, or ears

Common factors that can lead to high blood pressure include:

A diet high in salt, fat, and/or cholesterol.

Chronic conditions such as kidney and hormone problems

diabetes

high cholesterol

Family history, especially if your parents or other close relatives

have high blood pressure.

How can the burden of hypertension be reduced?

Reducing hypertension prevents heart attack, stroke, and kidney

damage, as well as other health problems.

Prevention

• Reducing salt intake (to less than 5g

daily). Eating more fruit and vegetables.

• Being physically active on a regular

basis. Avoiding use of tobacco.

• Reducing alcohol consumption.

• Limiting the intake of foods high in saturated fats.

Eliminating/reducing fats in diet.

Management

Reducing and managing stress.

Regularly checking blood pressure.

Treating high blood pressure.Managing

other medical conditions.

3. OBESITY

Obesity or overweight are defined as abnormal or excessive fat accumulation

that presents a risk to health. A body mass index (BMI) over 25 is considered

overweight, and over 30 is obese.

(World Health Organisation)

What causes obesity?

Eating more calories than you burn in daily activity and exercise — on a

long-term basis — can lead to obesity. Over time, these extra calories add up

and cause weight gain.

Common specific causes of obesity include:

I. genetics, which can affect how your body processes food into energy and

how fat is stored

II. growing older, which can lead to less muscle mass and a slower

metabolic rate, making it easier to gain weight

III. not sleeping enough, which can lead to hormonal changes that make you

feel hungrier and crave certain high-calorie foods

IV. pregnancy, as weight gained during pregnancy may be difficult to lose

and might eventually lead to obesity

V. Certain health conditions can also lead to weight gain, which may lead

to obesity. These include:

a. polycystic ovary syndrome (PCOS), a condition that causes an imbalance

of female reproductive hormones

b. Prader-Willi syndrome, a rare condition present at birth that causes

excessive hunger
c. Cushing syndrome, a condition caused by having high cortisol levels (the

stress hormone) in your system

d. hypothyroidism (underactive thyroid), a condition in which the thyroid

gland doesn’t produce enough of certain important hormones

e. osteoarthritis (OA) and other conditions that cause pain that may lead to

reduced activity

How is obesity diagnosed?

BMI is a rough calculation of a person’s weight in relation to their height.

Other more accurate measures of body fat and body fat distribution include:

skinfold thickness tests

waist-to-hip comparisons

screening tests, such as ultrasounds, CT scans, and MRI scans

Your doctor may also order certain tests to help diagnose obesity-related health

risks. These may include:

blood tests to examine cholesterol and glucose levels

liver function tests

a diabetes screening

thyroid tests

heart tests, such as an electrocardiogram (ECG or EKG)

A measurement of the fat around your waist is also a good predictor of your risk

for obesity-related diseases.

What are the complications of obesity?

Obesity can lead to more than simple weight gain.

Having a high ratio of body fat to muscle puts strain on your bones as

well as your internal organs. It also increases inflammation in the body,

which is thought to be a risk factor for cancer. Obesity is also a major risk

factor for type 2 diabetes.

 Obesity has been linked to a number of health complications, some of

which can be life threatening if not treated:

type 2 diabetes

heart disease

high blood pressure

certain cancers (breast, colon, and endometrial)

stroke

gallbladder disease

fatty liver disease

high cholesterol

breathing problems

arthritis

infertility

How is obesity treated?

If you have obesity and been unable to lose weight on your own, medical help is

available. Start with your primary care physician, who may be able to refer you

to a weight specialist in your area.

Your doctor may also want to work with you as part of a team helping you lose

weight. That team might include a die titian, therapist, or other healthcare staff.

Your doctor will work with you on making needed lifestyle changes.

Sometimes, they may recommend medications or weight loss surgery as well.

Learn more about treatment for obesity.

How can you prevent obesity?

There’s been a dramatic increase in obesity and in obesity-related diseases in

the last couple decades. This is the reason why communities, states, and the

federal government are putting an emphasis on healthier food choices and

activities to help turn the tide on obesity.

 On a personal level, you can help prevent weight gain and obesity by making

healthier lifestyle choices:

Aim for moderate exercise like walking, swimming, or biking for 20 to 30

minutes every day.

Eat well by choosing nutritious foods, like fruits, vegetables, whole grains, and

lean protein.

Eat high-fat, high-calorie foods in moderation.

4. OSTEOPOROSIS

Osteoporosis is a condition that affects the bones. Its name comes

from Latin for “porous bones.”

The inside of a healthy bone has small spaces, like a honeycomb.

Osteoporosis increases the size of these spaces, causing the bone to

lose strength and density. In addition, the outside of the bone grows

weaker and thinner.

Osteoporosis symptoms

The early stages of osteoporosis don’t cause any symptoms or

warning signs. In most cases, people with osteoporosis don’t know

they have the condition until they have a fracture.

If symptoms do appear, some of the earlier ones may include:

receding gums

weakened grip strength

weak and brittle nails

If you don’t have symptoms but have a family history of

osteoporosis, talking to your doctor can help you assess your

risk.
Osteoporosis risk factors

1. Age

The biggest risk factor of osteoporosis is age. Throughout your life,

your body breaks down old bone and grows new bone.

However, when you’re in your 30s, your body starts breaking down

bone faster than it’s able to replace it. This leads to bone that’s less

dense and more fragile, and thus more prone to breakage.

2. Menopause

Menopause is another primary risk factor, which occurs in women

around the ages of 45 to 55 years. Due to the change in hormone

levels associated with it, menopause can cause a woman’s body to

lose bone even more quickly.

Men continue to lose bone at this age, but at a slower rate than

women do. However, by the time they reach the ages of 65 to 70,

women and men are usually losing bone at the same rate.

Other risk factors for osteoporosis include:

3. being female

4. having a family history of osteoporosis

5. poor nutrition

6. physical inactivity

7. smoking

8. low body weight

You can control some of these risk factors for osteoporosis, such as

poor nutrition and inactivity. For instance, you can improve your diet

and start an exercise program can benefit your bone health.

However, you can’t control other risk factors, such as your age or

gender
Bone density test for diagnosis

To check for osteoporosis, your doctor will review your medical

history and do a physical exam. They may also run tests of your

blood and urine to check for conditions that may cause bone loss.

If your doctor thinks you may have osteoporosis or that you’re at risk

of developing it, they’ll likely suggest a bone density test.

This test is called bone densitometry, or dual-energy X-ray

absorptiometry (DEXA). It uses X-rays to measure the density of the

bones in your wrists, hips, or spine. These are the three areas most

at risk of osteoporosis. This painless test can take from 10 to 30

minutes.

Osteoporosis medications

The most common drugs used to treat osteoporosis are called

bisphosphonates. Bisphosphonates are used to prevent the loss of

bone mass. They may be taken orally or by injection.

Other medications may be used to prevent bone loss or stimulate

bone growth. They include:

Testosterone

In men, testosterone therapy may help increase bone density.

Hormone therapy

For women, estrogen used during and after menopause can help

stop bone density loss.

Osteoporosis prevention

There are many risk factors for osteoporosis that you cannot control.

These include being female, getting older, and having a family history

of osteoporosis. Some of the best ways to prevent osteoporosis

include:
1. getting recommended daily amount of calcium and vitamin D

2. doing weight-bearing exercises

3. stopping smoking

If you’re at risk of developing osteoporosis, talk to your doctor about

the best way to prevent it.

CORONARY HEART DISEASE (CHD)

Coronary heart disease or Coronary artery disease (CAD)

Coronary heart disease, develops when the coronary arteries become too narrow or cholesterol
blockages develop in the walls. The coronary arteries are the blood vessels that supply oxygen
and blood to the heart.

CAD tends to develop when cholesterol builds up on the artery walls, creating plaques. These
plaques cause the arteries to narrow, reducing blood flow to the heart, or can cause
inflammation in and hardening of the walls of the blood vessel. A clot can sometimes obstruct
blood flow, causing serious health problems.Coronary arteries form the network of blood
vessels on the surface of the heart that feeds it oxygen. If these arteries narrow, the heart may
not receive enough oxygen-rich blood, especially during physical activity. CAD can sometimes
lead to a heart attack.

Symptoms of coronary heart disease (CHD)

The main symptoms of coronary heart disease are:

chest pain (angina)

shortness of breath

pain throughout the body

feeling faint

feeling sick (nausea)

But not everyone has the same symptoms and some people may not have any before coronary
heart disease is diagnosed.

Causes of coronary heart disease (CHD)

Coronary heart disease is the term that describes what happens when your heart's blood supply
is blocked or interrupted by a build-up of fatty substances in the coronary arteries.
 • Over time, the walls of your arteries can become furred up with fatty deposits. This
process is known as atherosclerosis and the fatty deposits are called atheroma.
• Atherosclerosis can be caused by lifestyle factors, such as smoking and regularly
drinking excessive amounts of alcohol.
• You're also more at risk of getting atherosclerosis if you have conditions like high
cholesterol, high blood pressure (hypertension) or diabetes.
• Lack of regular exercise.
• Stress may exacerbate CAD by releasing hormones that raise blood pressure and
damage the lining of the blood vessels.

Diagnosing coronary heart disease (CHD)

If a doctor feels you're at risk of coronary heart disease, they may carry out a risk assessment.

• They'll ask you about your medical and family history and your lifestyle, and they'll
take a blood test.
• Further tests may be needed to confirm coronary heart disease, including:

a treadmill test

a CT scan

an MRI scan

coronary angiography

Treating coronary heart disease (CHD)

Coronary heart disease cannot be cured but treatment can help manage the symptoms and
reduce the chances of problems such as heart attacks.

Treatment can include:

• lifestyle changes, such as regular exercise and stopping smoking

• medicines
• angioplasty
• Stent and balloon therapy
Preventing coronary heart disease (CHD)

You can reduce your risk of getting coronary heart disease by making some simple lifestyle
changes.

These include:

• eating a healthy, balanced diet

• being physically active
• giving up smoking
• controlling blood cholesterol and sugar levels

Keeping your heart healthy will also have other health benefits.

FITNESS ASSESMENT

Body Mass Index

Body Mass Index is a simple calculation using a person's height and weight.

The formula is BMI = kg/m2 where kg is a person's weight in kilograms and

m2

is their height in metres squared. A BMI of 25.0 or more is overweight,

while the healthy range is 18.5 to 24.9.

According to the National Institutes of Health (NIH) : A BMI of less than 18.5
means that a person is underweight. A BMI of between 18.5 and 24.9 is ideal.

A BMI of between 25 and 29.9 is overweight.

Example: If a person weighs 65 kg and the person's height is 165 cm (1.65 m),

the BMI is calculated as 65 ÷ (1.65)2 = 23.87 kg/m2, which means that the

person has a BMI of 23.87 kg/m2 and is considered to have a healthy weight.

Waist-hip ratio

The waist-hip ratio or waist-to-hip ratio (WHR) is the dimensionless ratio of the

circumference of the waist to that of the hips.

This is calculated as waist measurement divided by hip measurement (W⁄H).

For example, a person with a 30″ (76 cm) waist and 38″ (97 cm) hips has a

waist-hip ratio of about 0.78.

The WHR has been used as an indicator or measure of health, fertility, and the

risk of developing serious health conditions. WHR correlates with perceptions

of physical attractiveness.

What does waist to hip ratio tell you?

The waist-to-hip ratio (WHR) is a quick measure of fat distribution that may

help indicate a person's overall health. People who carry more weight around

their middle than their hips may be at a higher risk of developing certain health

conditions