Vital Signs

What are vital signs?

provide critical information regarding a patient's current or changing physiological status

What are examples of vital signs?

body temperature, pulse rate, respiration, and blood pressure

What is a sign?

an observable, objective measure that can often be quantified by using valid and reliable measurement instruments

What is a symptom?

subjective; how a person experiences a condition

If you obtain an abnormal reading in a patient's vital signs what should you do?

examine the context before jumping to conclusions; consider taking the measurement again to be sure the reading is accurate

What is a pulse?

rhythmic bulging of artery walls with each heartbeat

What is heart rate?

the number of times the heart contracts in a given period

What is tachycardia?

abnormally fast heart rate

What is bradycardia?

abnormally slow heart rate

What is a rhythm?

pattern of the heart beat

What is amplitude?

height of a wave

What is a bounding heart rate?

+3; readily palpable and forceful

What is a normal heart rate?

+2; easily palpable and obliterated only by strong finger pressure

What is a thready or weak heart rate?

+1; hard to feel and easily obliterated by slight finger pressure

What is a absent heart rate?

0; not discernible

What is arrhythmia?

irregular heart beat

What is the normal heart rate for adults?

60-100 bpm

What is the normal heart rate for children (1-8)?

80-100 bpm

What is the normal heart rate for infants (1-12 mo)?

100-120 bpm

What is the normal heart rate for neonates (1-28 days)?

120-160 bpm

When do you assess pulse?

resting, during activity, recovery

What are some factors that affect heart rate?

-age

-sex

-fitness

-activity

-ANS

-environment

-drugs

What is a myocardial infarction?

heart attack

What is maximum heart rate?

recommended physiological intensity for a given individual during exercise

How do you estimate maximum heart rate?

220-age

What is target heart rate?

range of intensity a person's heart must work for effective aerobic training

How do you estimate target heart rate?

maximum heart rate x desired intensity (%)

What is the 6 minute walk test?

patients walk as far & as fast as they can in a 6-minute period

What does the 6 minute walk test do?

assess the patients aerobic capacity and endurance

What are some electrical monitors for heart rate?

-self contained HR/BP monitors

-pulse oximeters

-ECGs/EKGs

What are methods of assessing heart rate?

-palpation

-auscultation (direct or stethoscope)

-doppler

ECGs/EKGs

What is auscultation?

listening to the sounds produced by the body using a stethoscope

What are the arteries you can manually palpate for heart rate?

-radial artery

-brachial artery

-carotid artery

-femoral artery

-popliteal artery

-tibialis posterior

-dorsal pedal

How long should you palpate the heart rate?

15 sec x 4; 30 sec x 2; 1 min

What is systolic?

pressure during heart muscle contraction pushing blood into aorta

What is diastolic?

pressure when ventricles relax and refill

What is atrial fibrillation?

irregular and rapid heart rate that occurs when the atriums do not beat in a coordinated manner because of chaotic electrical signs

What is something you should beware of with stethoscopes?

they can harbor bacteria with contamination levels comparable to healthcare workers with unwashed hands

What should you never use to palpate a patient's pulse? Why?

thumbs; you can detect the pulse in your own thumbs

What should you never do when palpating the carotid artery? Why?

palpate bilaterally; it can cut off blood supply to the brain

What is blood pressure?

force of blood against arterial walls

What is the normal systolic pressure for adults?

90-140

What is the normal diastolic pressure for adults?

60-90

What is the normal systolic pressure for children (1-8)?

80-110

What is the normal diastolic pressure for children (1-8)?

highly variable

What is the normal systolic pressure for infants (1-12 mo)?

70-95

What is the normal diastolic pressure for infants (1-12 mo)?

highly variable

What is the normal systolic pressure for neonates (1-28 days)?

greater than 60

What is the normal diastolic pressure for neonates (1-28 days)?

highly variable

What are the factors of blood volume?

less volume, less pressure

What are the factors of vessel size?

less size, more pressure

What are the factors of vessel compliance?

less elasticity, more pressure

What are the factors to consider when taking blood pressure?

-anxiety

-tobacco use

-recent food consumption

-exertion

-alcohol consumption

-exposure to heat or cold

-pain

-forcibly holding breath

What are some blood pressure red flags (need to stop activity)?

-systolic greater than 250 mm Hg

-Diastolic greater than 115 mm Hg

-systolic drop greater than 10 mm Hg from baseline

-failure of systolic pressure to increase with workload

What is blood pressure measured in?

millimeters of mercury (mm Hg)

What is hypertension?

high blood pressure

What is hypotension?

low blood pressure

What is stage 1 of hypertension?

sys: 130-139; dia: 80-89

What is stage 2 hypertension?

sys: >140; dia: >90

What is a hypertensive crisis?

sys: >180; dia: >120

What is the blood pressure equipment?

-sphygmomanometer

-cuff

-gauge

-stethoscope

What is the set up for taking blood pressure?

-left arm (unless you cant)

-not over clothing

-legs uncrossed

-correct cuff size

-patient resting quietly

What is the procedure for taking blood pressure?

-apply cuff snugly

-arm resting at heart level

-stethoscope bell over brachial artery

-inflate cuff

-slowly release valve, noting BP

What are Korotkoff sounds?

sounds heard when taking blood pressure

How high should you inflate the cuff?

200 mm Hg

What is isolated office (white coat) hypertension?

BP elevation caused by anxiety associated with visits to healthcare practitioners

What is respiration?

breathing

What muscles are responsible for inspiration?

muscles attached to the thorax; diaphragm

What causes expiration?

when muscles attached to the thorax relax

What can be activated for active expiration?

accessory muscles

What can potentially affect respiration?

-changes affecting the thorax

-activity

-psychological state

What do you assess during respiration?

-rate

-depth

-rhythm

-ease

-breath sounds

How do you assess respiration?

-visual observation

-auscultation

-electronic monitors

How do you count respiration?

-observe rise and fall

-count for 30 sec x 2

-can be done immediately after palpation of pulse

-best done without patient awareness

What are the steps of respiration?

-ventilation

-pulmonary gas exchange

-gas transport

-peripheral gas exchange

What is chronic obstructive pulmonary disease?

pulmonary diseases characterized by blocked airflow during respiration.

What is the normal respiration rate for adults?

12-20

What is the normal respiration rate for children (1-8)?

15-30

What is the normal respiration rate for infants (1-12 mo)?

25-50

What is the normal respiration rate for neonates (1-28 days)?

40-60

What is dyspnea?

difficulty breathing

What is apnea?

absence of breathing

What is hyperventilation syndrome?

breathing too fast and too deeply, usually associated with anxiety

What is bendopnea?

increased SOB when patient bends forward

What is the normal core temperature?

37 degrees C; 98.6 degrees F

Where do you take the temperature?

-forehead

-mouth

-urine

-ear

What is the new normal temperature?

97.5 degrees F

Does absence of fever rule out infection?

No, especially in the elderly

What factors should you consider when taking temperature?

-time of day

-menstrual cycle

-pregnancy

-aging

-season

-physical fitness

-meals

-alcohol

-temperature

What is a pulse oximeter used for?

indirectly measure O2 saturation level of blood and pulse

What is a common indicator to decrease patient exertion?

SpO2 lower than 90 %

What is acute pain?

recent-onset pain generally associated with tissue damage or perceived tissue damage

What is intermittent claudication?

Leg pain that is brought on by exercise and relieved by rest; symptom of peripheral arterial disease

What is chronic pain?

persistent or recurring pain that lasts more than 3 months

What is a pain assessment?

involves symptoms, numbers, descriptors, and observations

What are methods of assessing pain?

-numeric rating scale

-visual analog scale

-verbal descriptor scale

-pictorial pain scale

What are some common pain descriptors?

-sharp

-dull

-throbbing

-crushing

-aching

-stinging

-burning

-deep

-constant

-intermittent

-stabbing

-sore

-cramping

-shooting

-tingling

-searing

What is perceived exertion?

measure of energy exertion; tends to correlate with other physiological measures

What is a perceived exertion rating of 7?

very, very light

What is a perceived exertion rating of 9?

very light