WK6: Vitals & Posture

What are the 5 main vital signs?

1. HR/pulse

2. Respiration

3. BP

4. temperature

5. pulse oximetry (SPO₂)

What are the 9 other variations of vital signs?

1. pain

2. perceived exertion scale

3. arousal

4. attention

5. orientation

6. cognition

7. memory

8. hearing

9. visual acuity

What are the 6 instances where you need to check vitals?

1. when pt reports symptoms/appearances of distress

2. when there’s recent change in medications or medical status

3. if the doctor or PT orders it

4. when trying to determine if the desired exercise response was achieved

5. to make sure the pt is working within safe parameters

6. if the clinic/department you’re working in requires you to obtain vitals

What are the 8 symptoms/appearances of distress that indicate you need to check vitals?

1. dizziness

2. lightheadedness

3. diaphoretic (excessive sweating)

4. nauseated

5. “shaky”

6. severe headache

7. confusion

8. severe lethargy

What 9 factors affect a person’s heart rate?

1. activity level

2. age

3. air temperature

4. body position

5. body size

6. emotions

7. gender

8. infection

9. medication use

How does activity level affect HR?

• if someone is moderately active, they might have a lower resting HR since their heart doesn’t need to work as hard

• HR will increase with vigorous activity, then returns to baseline within 3-5 minutes

How does age affect HR?

• infants & children have higher HRs

• people over 65 y/o have decreased HRs

How does air temperature affect HR?

higher temperatures mean heart pumps more blood, so pulse may increase by 5-10 bpm

How does body position affect HR?

• laying down = pulse may be slightly lower as the heart doesn't work as much

• seated = pulse may be more normal as heart is starting to work

• standing = pulse may be slightly higher as heart is working a bit more

How does body size affect HR?

body size doesn’t usually change pulse & obesity is not generally a HR factor

How do emotions affect HR?

if you’re stressed, anxious, really happy or sad, HR can go up since the sympathetic nervous system is acting on the heart

How does gender affect HR?

• males = average 70-72 bpm

• females = average 78-82 bpm

*women have smaller hearts, meaning less blood gets pumped, so the heart has to pump faster for more output

How does infection affect HR?

infection = increased HR

How does medication level affect HR?

• if the meds block adrenaline (aka beta blockers), pulse will be slowed

• if pt is taking thyroid medication or a higher dosage, pulse will be higher

What is the average resting HR of neonates, infants, children, those over 8 y/o, & athletes?

• neonates (1-28 days) = 120-160 bpm

• infants (1-12 months) = 100-120 bpm

• children (1-8 years old) = 80-100 bpm

• over 8 y/o = 60-100 bpm

• athletes = as low as 40-60 bpm

What is the average range of normal heart rate?

60-100 bpm

1. What is bradycardia?

2. What is tachycardia?

1. slow HR; less that 60 bpm at rest

2. fast HR; greater than 100 bpm at rest

What are the 2 different rhythms of the heart & what do they mean?

1. Regular = even beats w/ good force of each beat

2. Irregular = both strong & weak beats &/or uneven beat; may indicate abnormalities in heart conductivity

What is the quality/amplitude of a pulse? What does it indicate?

The strength of the pulse that reflects how efficient the heart is at pushing blood into the arteries; this also reflects the volume of blood & pressure that’s being placed on the vessel walls

What are the 4 ways to describe quality of a pulse? Briefly describe what they mean.

1. bounding (+3) = readily palpable, forceful, & not easily eliminated by finger pressure

2. normal (+2) = easily palpable & it’s eliminated by strong finger pressure

3. weak/thready (+1) = hard to feel & easily palpable by using slight finger pressure

4. absent (0) = not observed

Why do we measure pt temperature?

Shows us if pt has an infection, especially after surgery

What are the average temperatures across the lifespan & by gender?

1. infants & children less than 15 y/o = 95.9-99.5℉

2. adult females = 97.2-100.8℉

3. adult males = 96.3-99.5℉

What are the 3 things a clinician examines when assessing the quality of breathing?

1. depth = deep vs. shallow

2. rhythm = interval btwn breaths should be pretty consistent

3. ease = labored, difficult, or painful

Describe the 3 different levels of ease of breathing.

1. labored = more effort than usual

2. difficult = visible difficulty; may be combined with labored

3. painful = visible &/or audible signs of pain while breathing

How do you measure someone’s respiratory rate?

1. count the rise & fall of the chest for 30 seconds

2. multiply that number by 2

*if the pt has an irregular breathing pattern count for the full 60 seconds

Why should you check respiratory rate when the pt is unaware you’re doing so?

So that the pt breathes normally & doesn’t purposefully speed up or slow down their breathing to “pass a test”

What are the normal respiratory rates across the lifespan?

• neonates (1-28 days) = 40-60 breaths per min

• infants (1-12 months) = 25-50 breaths per min

• children (1-8 yrs) = 15-30 breaths per min

• > 8 yrs-adulthood = 12-20 breaths per min

What is SpO₂ a measure of?

the percentage of hemoglobin in arterial blood that’s saturated with oxygen

What is the normal value of pulse oximetry?

95-100%

If an individual receives a pulse ox measurement of 85% or below, what can that imply?

severe hypoxia (aka oxygen isn’t reaching the tissues)

At what SpO₂ measurement should you stop exercise, as directed by pt & dr. orders?

92%

What is systolic BP?

• top number

• measures the pressure in arteries when the heart beats (heart contracts)

What is diastolic BP?

• bottom number

• measures the pressure in the arteries btwn the heart beats (when the heart is resting btwn beats & refilling w/ blood)

What’s the unit of measurement for blood pressure?

millimeters of mercury (mmHg)

Why does BP cuff size matter?

• too small = may give inaccurately high numbers

• if a cuff is not inflated enough, it’ll be harder to hear the Korotkoff sounds accurately

What are the 9 steps for taking BP?

1. clean the sound head & ear plugs of the stethoscope before placing on the pt

2. ask the pt their preferred arm for BP

3. position the pt’s arm level to their heart or slightly below

4. apply BP cuff (~1.5 finger widths above antecubital space)

5. palpate brachial pulse in antecubital space

6. place sound head of stethoscope over brachial artery w/ firm, but light pressure

7. inflate cuff to 160 mmHg

8. slowly deflate cuff while listening for Korotkoff sounds (1st sound = systolic; last sound = diastolic)

9. fully deflate cuff & remove from pt

What BP is considered hypotensive?

• systolic = less than 90

• diastolic = less than 60

What BP is considered normal?

• systolic = less than 120

• diastolic = less than 80

What BP is considered prehypertension?

• systolic = 120-139

• diastolic = 80-89

What BP is considered hypertension: stage 1?

• systolic = 140-159

• diastolic = 90-99

What BP is considered hypertension: stage 2?

• systolic = 160-179

• diastolic = 100-110

What BP is considered hypertensive: crisis emergency?

• systolic = higher than 180

• diastolic = higher than 110

What are the 3 different pain scales?

1. Visual Analog Scale (VAS)

2. Wong Baker Faces

3. Numeric Pain Scale

What is the visual analog scale (VAS)?

a scale that goes from “no pain” to “worst pain imaginable”

• easy for pts to use, but requires sensory, motor, perceptual skills & abstract thought

• scale may also be used vertically for pt’s w/ mildly impaired thinking or for those from other cultures who read right to left

What is the numeric pain scale?

a scale that provides a number to the level of pain (0-10)

• not a true objective measurement but helps a pt communicate the intensity of their pain

What’s the Wong Baker Faces scale?

a scale with happy to progressively sadder faces

• appropriate for children or individuals w/ limited speech

What is a verbal descriptor scale?

phrases that represent different intensities/types of pain that pts w/ language skills can use to describe their pain

What is orientation?

a pt’s awareness of time, person, & place

How do we document orientation?

“alert & oriented x [number of info correctly said] (what they left out)”

• ex. alert & oriented x2 (person)

What are the 4 methods to measuring pulse?

1. palpation

2. ECG or portable monitors

3. doppler sonography

4. auscultation (listening)

What are the locations of testing for pulse?

1. temporal

2. carotid

3. brachial

4. radial

5. femoral

6. popliteal

7. dorsal pedal

8. posterior tibial

9. apex of the heart

Why do we take pulse in the extremities?

distal pulse locations give an indication of peripheral circulation

What change in pulse can indicate disease or injury?

decrease in pulse amplitude or absence of peripheral pulses all together

• can indicate:

  • thoracic outlet syndrome (TOS)

  • peripheral vascular disease (PVD)

  • trauma to the vessels

How is pulse taken to compare rate & quality?

pulse is taken through B LE palpation simultaneously

How do you calculate max HR?

220 - age

*exercise may need to be stopped if max HR is surpassed

What are the different breath sounds?

1. normal

2. wheezing (rhonchi)

3. stridor

4. crackles

5. stertor

What is wheezing (rhonchi) breathing?

• low- or high-pitched whistling sounds

• occurs during expiration & sometimes inspiration

What is stridor breathing?

• high pitched sound, like wind blowing

• indicates respiratory obstruction

*you might hear this at end stage of life

What is crackle breathing?

• short, sharp, rough sounds

• sounds like bubbling or rubbing the fingers near the ear

• associated w/ CHF & pleurisy

What is stertor breathing?

• deep snoring or heavy breathing

• may occur during sleep or coma

• indicative of partial larynx or upper airway obstruction

What are the 2 primary inspiration muscles?

1. diaphragm

2. external intercostal muscles

Is typical expiration an active or passive activity?

passive activity related to the recoil of the chest & pressure changes

What 5 accessory muscles are involved in inspiration?

1. SCM

2. pec minor & major

3. latissimus dorsi

4. trapezius

5. scalenes

What 4 accessory muscles are involved in expiration?

1. internal & external obliques

2. transverse abdominis

3. rectus abdominis

4. intercostals

What is dyspnea?

labored or difficulty breathing

What 7 conditions that affect blood oxygen levels would prompt you to have to take a pulse oximetry measurement for a pt?

1. heart attack

2. heart failure

3. chronic obstructive pulmonary disease (COPD)

4. anemia

5. lung cancer

6. asthma

7. pneumonia

What 7 factors may impact SpO₂?

1. gel nail polish

2. low BP

3. cold body temperature

4. cold fingers

5. poor circulation

6. squeezing the sensor

7. raising the arm above heart level

If someone has pneumonia or moderate-severe COPD, what would their normal oxygen saturation level be?

between 88-92%

What oxygen levels are considered dangerous?

1. below 88% → identify physician

2. 84% or below → go to the hospital

3. 80% or lower → dangerous for vital organs & needs urgent treatment

Why should you not rely on pulse oximetry alone to assess respiratory health?

because readings can only be interpreted in context + it measures hemoglobin saturation, not ventilation

Why should you not supply supplemental O₂ to someone who has excess CO₂ in their bloodstream (hypercapnia)?

they already have inadequate ventilation, so more O₂ can worsen the pt’s hypercapnia

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 0?

nothing at all

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 0.5?

very, very slight shortness of breath

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 1?

very mild shortness of breath

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 2?

mild shortness of breath

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 3?

moderate shortness of breath

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 4?

somewhat severe

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 5?

strong or hard breathing

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 7?

severe shortness of breath or very hard breathing

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 9?

extremely severe

According to the Modified Borg Rating Scale for Perceived Dyspnea, what is a 10?

shortness of breath so severe that you need to stop

What is a grade of 0 on the ATS dyspnea scale?

only gets breathless with strenuous activity

What is a grade of 1 on the ATS dyspnea scale?

SOB when hurrying on level ground

What is a grade of 2 on the ATS dyspnea scale?

walks slower on level ground than people of the same age due to breathlessness or has to stop to catch breath when walking at own pace

What is a grade of 3 on the ATS dyspnea scale?

stops for breath after walking around 100 yards or after a few minutes on level ground

What is a grade of 4 on the ATS dyspnea scale?

too breathless to leave the house or becomes breathless dressing

What factors affect BP?

1. blood volume

2. age

3. physical activity

4. emotional status

5. medications

6. arm position

7. muscle contractions

8. cardiac output

How does age affect BP?

• younger pts have lower BP

• older pts have high systolic & slightly lower diastolic

How does physical activity affect BP?

• systolic increases w/ exercise

• diastolic remains unchanged or increases by 10-15 mmHg

How does emotional status affect BP?

increases w/ stress, anxiety, or fear

How do medications affect BP?

they change the size & condition of the arteries

How does arm position affect BP?

• BP will increase if arm is held too low

• BP will decrease if arm is held too high

How do muscle contractions affect BP?

if muscles are actively contracted during testing, BP can increase

*this is why arms are straight & feet are flat during testing

How does cardiac output affect BP?

size of measurements; there’s up to a 10 mmHg difference btwn R & L sides, but that’s normal

What is the average resting BP across the lifespan?

neonates (1-28 days):

• systolic = >60

• diastolic = highly variable

infants (1-12 months):

• systolic = 70-95

• diastolic = highly variable

children (1-8 years old):

• systolic = 80-110

• diastolic = highly variable

What is orthostatic hypotension (aka postural hypotension)?

within 3 minutes of standing, there’s a:

• decrease in systolic BP of at least 20 mmHg OR

• decrease in diastolic BP of at least 10 mmHg

1. When does orthostatic hypotension occur?

2. What does a pt typically report they feel?

3. Why does this happen?

1. when moving from sit → stand or supine → sit

2. dizziness or lightheadedness, which may lead to syncope (temporary loss of consciousness)

3. pressure in the arteries is not enough to move the blood against gravity back to the brain

What 6 conditions is orthostatic hypotension associated with?

1. cardiac conditions

2. decreased cardiac output

3. medications

4. central, peripheral, autonomic nervous system disorders

5. dehydration

6. position change following prolonged bed rest

What is postural orthostatic tachycardia syndrome (POTS)?

HR increases of at least 30 bpm in adults (or at least 40 in adolescents) during the first 10 min of standing

• only diagnoses when orthostatic hypotension is ruled out, there’s no acute dehydration, & no blood loss

What 4 BP changes are warning signs during exercise?

1. systolic reading greater than 250 mmHg

2. diastolic reading greater than 115 mmHg

3. drop in systolic pressure more than 10 mmHg from baseline

4. failure of systolic to increase with increasing workload