Assessing Vital Signs + Heart Sounds

what PRODUCES a PULSE

contraction of left ventricle

what is identified as the HIGHEST PRESSURE POINT

systole

what is identified as the LOWEST PRESSURE POINT

diastole

what is the AVERAGE HEART RATE of a NEWBORN

125 bpm

what is the NORMAL HEART RANGE (normal limit) for a NEWBORN

70-190 bpm

what is the AVERAGE HEART RATE of a 12 yr MALE

85 bpm

what is the NORMAL HEART RANGE (normal limit) for a 12 yr MALE

65-105 bpm

what is the AVERAGE HEART RATE of a 12 yr FEMALE

90 bpm

what is the NORMAL HEART RANGE (normal limit) for a 12 yr FEMALE

70-110 bpm

what is the AVERAGE HEART RATE of a 18 yr MALE

70 bpm

what is the NORMAL HEART RANGE (normal limit) for a 18 yr MALE

50-90 bpm

what is the AVERAGE HEART RATE of a 18 yr FEMALE

75 bpm

what is the NORMAL HEART RANGE (normal limit) for a 18 yr FEMALE

55-95 bpm

what is the AVERAGE HEART RATE of an ATHLETE

50-60 bpm

what is the NORMAL HEART RANGE (normal limit) for an ATHLETE

50-100 bpm

what is the AVERAGE HEART RATE of an ADULT

75 bpm

what is the NORMAL HEART RANGE (normal limit) for an ADULT

60-80 bpm

what is the AGING AVERAGE HEART RATE

75 bpm

what is the AGING NORMAL HEART RANGE (normal limit)

60-100 bpm

what 8 ARTERIES are palpated to determine the PULSE of an individual

1. radial

2. carotid

3. temporal

4. brachial

5. femoral

6. popliteal

7. dorsalis pedis

8. posterior tibial

what 4 BODY PARTS are used for monitoring PULSE OXIMETER

1. finger

2. toe

3. earlobe

4. forehead

during EXERCISE, what 2 BODY PARTS use for monitoring PULSE OXIMETER

1. earlobe

2. forehead

what 5 FACTORS affect PULSE OXIMETER READINGS

1. nail polish

2. sunlight

3. poor circulation (cool digits)

4. sensor cord movement

5. cleanliness of sensors

does dehydration INCREASE/DECREASE HEART RATE

dehydration = increases heart rate

does dehydration INCREASE/DECREASE STROKE VOLUME

dehydration = decreases stroke volume

does anxiety INCREASE/DECREASE HEART RATE

anxiety = increases heart rate

how is IRREGULAR RHYTHM best monitored

with an EKG

is a LINEAR/NON-LINEAR RELATIONSHIP normally expected between EXERCISE + HEART RATE

LINEAR RELATIONSHIP b/w exercise + heart rate

what effect do BETA BLOCKERS have on EXERCISE + HEART RATE

patients have a BLUNTED HR RESPONSE to exercise

what does a 0 on the PULSE SCALE indicate

absent pulse

what does a 1+ on the PULSE SCALE indicate

diminished (weak, thready) pulse

what is the MAJOR CAUSE a 1+ PULSE

decreased stroke volume

what does a 2+ on the PULSE SCALE indicate

normal pulse

what does a 3+ on the PULSE SCALE indicate

moderately increased pulse

what are 4 CAUSES of a 3+ PULSE

1. slightly increased SV + EF

2. exercise

3. stress

4. anxiety

what does a 4+ on the PULSE SCALE indicate

markedly increased (bounding) pulse

is the MAJOR CAUSE of a 4+ PULSE

increased SV + EF

what is the NORMAL RESPIRATORY RATE (breaths/min) from BIRTH-3 MONTHS

35-55 breaths/min

what is the NORMAL RESPIRATORY RATE (breaths/min) from 1-3 years

20-30 breaths/min

what is the NORMAL RESPIRATORY RATE (breaths/min) from 3-6 years

20-26 breaths/min

what is the NORMAL RESPIRATORY RATE (breaths/min) from 6-10 years

15-25 breaths/min

what is the NORMAL RESPIRATORY RATE (breaths/min) from 10-16 years

12-30 breaths/min

what is the NORMAL RESPIRATORY RATE (breaths/min) at 18 years

12-20 breaths/min

what is the NORMAL RESPIRATORY RATE (breaths/min) for TYPICAL HEALTHY ADULT

10-12 breaths/min

what is BLOOD PRESSURE

is the measurement of the force of blood pushing against the side of the arterial wall

what is the purpose of using a LARGER DIAPHRAGM on a STETHOSCOPE

for high-pitched sounds (lung + normal heart)

what is the purpose of using a SMALLER BELL on a STETHOSCOPE

for low-pitched sounds (abnormal heart: S3 + S4)

what SPHYGMOMANOMETER is considered the MOST ACCURATE

mercury manometer

what SPHYGMOMANOMETER is considered the MOST PORTABLE

aneroid manometer

what is crucial for SPHYGMOMANOMETERS to ensure accurate blood pressure readings

check calibration (needle should be at 0mmHg when deflated)

what is the required BLADDER LENGTH of a BP ARM CUFF

80% of arm circumference

what is the required BLADDER WIDTH of a BP ARM CUFF

40% of arm circumference

what are KOROTKOFF SOUNDS

series of sounds heard through the stethoscope

regarding KOROTKOFF SOUNDS, what occurs after INITIALLY APPLYING PRESSURE

no sounds heard 2 degrees occlusion of artery

when is the FIRST KOROTKOFF SOUNDS heard

as pressure is released

what is the FIRST KOROTKOFF SOUND classified as

systolic blood pressure

regarding KOROTKOFF SOUNDS, what occurs as pressure is continued to be released

sound becomes muffled

when the SOUND becomes MUFFLED, what DIASTOLIC BP PHASE is it classified as

4th phase diastolic BP

when is it best to record the 4TH PHASE DIASTOLIC BP

during exercises, ambulation or other activities

regarding KOROTKOFF SOUNDS, what occurs are the pressure is released more

sound disappears

when the SOUND DISAPPEARS, what DIASTOLIC BP PHASE is it classified as

5th phase diastolic BP

what is the SEQUENCE for a patient with a NORMAL BP (120/80) as the BP cuff is DEFLATED

1. 120 mmHg -> 1st Korotkoff sound

2. 107 mmHg -> 2nd Korotkoff sound

(potential auscultation gap)

3. 90 mmHg -> 3rd Korotkoff sound

4. 85 mmHg -> 4th Korotkoff sound

5. 80 mmHg -> 5th Korotkoff sound

what is the SOUND PROGRESSION that occurs with the 1st KOROTKOFF SOUND

silence to snapping (faint tapping)

what is the SOUND PROGRESSION that occurs with the 2nd KOROTKOFF SOUND

snapping to murmur (swishing)

what is the SOUND PROGRESSION that occurs with the 3rd KOROTKOFF SOUND

murmur to thumping (distinct tapping)

what is the SOUND PROGRESSION that occurs with the 4th KOROTKOFF SOUND

thumping to muffling

what is the SOUND PROGRESSION that occurs with the 5th KOROTKOFF SOUND

muffling to silence

what is the OPTIMAL NORMAL RESTING BLOOD PRESSURE

SBP: <120 mmHg

DBP: <80 mmHg

what SBP + DBP is considered PREHYPERTENSION

SBP: 120-139 mmHg

DBP: 80-89 mmHg

what SBP + DBP is considered HYPERTENSION STAGE 1

SBP: 140-159 mmHg

DBP: 90-99 mmHg

what SBP + DBP is considered HYPERTENSION STAGE 2

SBP: ≥160 mmHg

DBP: ≥100 mmHg

with AGING, does both SBP + DBP tend to RISE/LOWER

SBP + DBP tend to RISE

(rise 2 degree less compliant arteries)

does SYSTOLIC BLOOD PRESSURE tend to GRADUALLY INCREASE/DECREASE through life

gradually increases

what AGE RANGE is DIASTOLIC BLOOD PRESSURE INCREASE UNTIL

until 50-60 years

what is the ACSM EXERCISE CONTRAINDICATION for RESTING BP

SBP: >200 mmHg

DBP: >110 mmHg

what is the ACSM EXERCISE CONTRAINDICATION for EXERCISE BP among low risk patients

SBP: >250 mmHg

DBP: >115 mmHg

what is the ACSM EXERCISE CONTRAINDICATION for EXERCISE BP among cardiac patients

SBP: >10 mmHg (decrease in SBP)

DBP: ≥110 mmHg

what occurs to the DIASTOLIC BP among YOUNG + TRAINED ATHLETES during EXERCISE

decreased slightly with dynamic exercise

(2 degree decrease in total peripheral resistance)

what is considered the NORMAL DIASTOLIC BP among YOUNG + TRAINED ATHLETES during EXERCISE

DBP: increased/decreased <10 mmHg

should DBP VARY/NOT VARY among OLDER AGING INDIVIDUALS with EXERCISE

DBP should NOT vary

what 4 CONDITIONS is ABNORMALLY INCREASE DBP seen in

1. CAD

2. CABG

3. HTN

4. compensated CHF

what are 2 GUIDELINES for EXERCISE based on BLOOD PRESSURE

1. monitor BP during + immediately after exercise

2. alter duration/intensity of exercise base on BP values

why should BP be monitored IMMEDIATELY AFTER EXERCISE

BP is returning to normal 15 minutes after exercise cessation

what 2 MOVEMENTS can cause ORTHOSTATIC HYPOTENSION

1. supine to stand

2. sit to stand

what is ORTHOSTATIC HYPOTENSION classified as

decreased ≥20 mmHg or decreased ≥10 mmHg SBP + DBP with a concomitant pulse increase of ≥15 bpm (within 3 minutes)

what is the potential TREATMENT for ORTHOSTATIC HYPOTENSION

tilt table

what is the proper procedure for HEART AUSCULTATIONS

place bell (small end) of stethoscope on appropriate area of heart + insert ear tips pointing forward in ears

what 4 AREAS should be AUSCULTATED using both diaphragm + bell of stethoscope

1. aortic area

2. pulmonic area

3. tricuspid area

4. mitral area (apex)

what AREA is considered the APEX

mitral area

what 2 HEART SOUNDS are considered NORMAL HEART SOUNDS

1. S1

2. S2

what SOUND does S1 + S2 create

lub-dub

at the APEX, is the FIRST SOUND ("LUB") LOUDER/SOFTER

louder

at the APEX, is the FIRST SOUND ("LUB") LONGER/SHORTER DURATION

longer duration

at the APEX, is the SECOND SOUND ("DUB") LOUDER/SOFTER

softer

when does the FIRST HEART SOUND (S1) occur

onset of ventricular systole (AV valves close)

when does the SECOND HEART SOUND (S2) occur

onset of ventricular diastole (semilunar valves close)

what are 4 ABNORMAL HEART SOUNDS

1. S3 (apex)

2. S4 (apex)

3. murmur (valves)

4. pericardial friction rub (3rd/4th intercostal space)

where does the S3 + S4 ABNORMAL HEART SOUNDS occur

apex

where does a MURMUR occur

valves

where does a PERICARDIAL FRICTION RUB occur

3rd/4th intercostal space