HSA vital signs exam review

History and Physical

• Commonly referred to as the H&P

• The physician records findings in the patient’s chart

• Provides the data on which the physician bases their diagnosis and treatment

Date

The day on which the H&P is done

Demographic data

Age, gender, race, place of birth, marital status, occupation, and religion

Source of referral

Was the patient referred from another doctor?

Chief complaint(s)

The primary problem from the patient’s view.  Why the patient is seeking medical care.

History of present illness

When the problem first started

How frequently it occurs

How long it lasts

Description, location, and severity of symptoms

What relieves the problem?

History (Medical)

General state of the patient’s health and any previous physical or psychological illnesses, accidents, injuries, surgeries, and hospitalizations.

Current health status

List of allergies and immunizations

Normal activity level and diet

Current medications (prescription and over-the-counter)

Tobacco or alcohol used

Sleep pattern disturbances

Family history of illness

Age and health or cause of death of parents, siblings, spouse, and children

Family history of specific diseases or conditions   (ie: diabetes, heart disease, cancer)

Psychosocial history

Home situation/ Work/ Stress

Support structure (family and friends)

Significant information that affects care of patient

Lifestyle (smoking/drinking, exercise, and diet)

Review of all systems

Includes height, weight, vital signs, and a review of each body system.

Head to toe assessment

Why must Health care professionals be able to discriminate between normal and abnormal conditions.

Any change in a patient’s condition may indicate a worsening of the condition, an improvement, a new problem, or a need to change a treatment.

General physical survey (head to Toe)

Overall impression of the patients (healthy/strong or weak/ill)

Posture

Distress

Body proportion

Color of Skin

Odors from body or breath

Character of speech

Height and weight (recent gain or loss of weight?)

Level of  consciousness

Verbal and motor response

Vital Signs

Vital signs

Pulse

Blood Pressure

 Respirations

Temperature

Emotional status:

Are they anxious, angry, depressed, or indifferent?  Are facial expressions appropriate?

Mental status:

Is the patient’s behavior appropriate for their age?  Attention span?  Appropriate questions?  Can patient recall information?

Appearance:

Is the patient dressed appropriately for the weather?  Well groomed?  Good personal hygiene?

Inspection: 

Use the senses of vision, hearing, and smell for observation of patient condition. 

Auscultation

Listening to sounds inside the body with the aid of a stethoscope. (lungs, heart, and bowel sounds) 

Palpation: 

  Using the hands and fingers on the exterior of the body to detect evidence of abnormalities of internal organs.

Percussion: 

Using the fingertips to lightly tap on the exterior of the body to determine position, size, and consistency of underlying structures.

Pain evaluation

A pain rating scale is used since there is no direct method to measure pain.  Faces are helpful to those who do not read yet.

Abnormal Condition

Report any abnormal condition to your supervisor immediately!!

Blood Pressure

• The measurement of the pressure of the blood against the wall of an artery during various stages of heart activity

• Measured in millimeters of mercury (mm of Hg)

What are the Two Phases of Blood Pressure

1. Systolic Pressure

2. Diastolic Pressure

Systolic pressure

when the heart is contracting

Diastolic pressure

when the heart is relaxing

Recording Blood Pressure

• Recorded as a fraction with the systolic pressure on the top and the diastolic pressure on the bottom

• Example:    110/70

What are the Normal Ranges of Blood Pressure?

• Systolic blood pressure:  100-130 mm Hg

• Diastolic blood pressure: 60-90 mm Hg

What are the Newest Blood Pressure Guidelines (2018)

Normal blood pressure should be less than 120 systolic and less than 80 diastolic.

Hypertension

• Either number is over typical values

Hypotension

usually systolic number is below normal values

• Cause an Increase:  

stress, stimulant drugs, exercise, obesity

Cause a Decrease: 

hemorrhage, depressant drugs, shock

How do you take a Blood Pressure

1.   Arm must be supported

2.   Cuff should be placed on upper arm, about  

      1 – 1 ½ inches above the bend of the elbow

3.   Use correct size cuff  (there are regular, pediatric, and thigh cuffs available)

4.   Cuff should fit snugly against arm

5.  Find brachial pulse with your fingers, then place stethoscope over the pulse

6.  Place stethoscope in your ears

7.  Inflate the cuff to 160 mmHg (for this class)

8. Open the valve on the rubber bulb just enough to let the air slowly release

  9.  Listen for the first clear tapping sound

    -Look at gauge to see where arrow is pointing 

    -This is the systolic blood pressure

10. Keep listening until you hear the last clear  tapping sound

  -Look at the gauge to see where arrow is

         pointing

  -This is the diastolic blood pressure

11. Rapidly release the air in the cuff and remove 

       it from the patient

• If you need to retake, wait 30 seconds to 1 minute

Abraham Maslow (1908 - 1970)

New york psychologist who noticed, while working with rhesus monkeys, that some needs take precedence over other. For example, if you are hungry & thirsty, you will take drink over food. You can go longer without food than fluids!

Why did maslow arrange his list of human needs as a hierarchy?

According to maslow, people strive to meet their unmet needs ; however, the lower needs must be met before 

What are the implications for Health care professionals?

• Physiological Needs

• Sensory needs

• Motor needs

• Safety and security needs

• Love and belonging needs

• Esteem needs

  Health care workers must understand and recognize the actions that individuals take to meet their needs.

Physiological Needs

• breathing, food, water, sex, sleep, homeostatsis, excretion

• Provide adequate oxygen, food, fluids, sleep, temp, elimination

Sensory needs

hearing, seeing, feeling, taste, mental stimulation

Motor needs

muscular stimulation; prevention of atrophy

Safety and security needs

security of body, emloment, resources, morality, family, health, property

- relives anxiety and fear

-Educate, answer questions

-provide secure enviroment

-provide order and rountine

Love and belonging needs

 Friendship, family, sexual intimacy

-strive to understand likes, dislikes, concerns

-spend time with individual, avoid hurried or rused attitude

- support their need to spend time with others

-Be empathetic, considerate, patient, fair

-Have a positive attitude

Esteem needs

• self-esteem, confidence, echivement, resect of other/for others

• Focus on strengths and assets

• Consider their individual needs and abilities

• Be available and approachable

• Encourage independence and participation

• Respect differences in values

Self-actualization

 morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts; ability to meet your own ongoing goals as they change throughout life

Provide connection to real life

What happens if patients do or don’t get their needs?

• When needs are felt, individuals are motivated to act. 

• If the need is met, satisfaction is obtained

• If the Need is not met, tension or frustration occurs

Direct methods

 hard work, setting realistic goals, situation evaluation, cooperation w/ others. Work by meeting the need and obtaining satisfaction or success.

Indirect methods

Defense mechanisms reduce the need or relieve the tension and frustration created by the unmet need. (acting out, regression, denial, and isolation are examples)

Defense Mechanisms 

• Unconscious strategies or acts that help a person deal with their own undesirable behavior or feelings. All behavior has a purpose. 

• Everyone uses defense mechanisms at some time 

• Some use is helpful and allows the individual to cope with certain situations 

• Can be negative if used in place of more healthy ways of coping 

• Not always negative unless they interfere with reality

What are the equipment needed take blood pressure?

1. Stethoscope

2. Sphygmomanometer

What is a Stethoscope?

a diagnostic instrument that amplifies internal body sounds, allowing healthcare professionals to assess cardiovascular, respiratory, and gastrointestinal health.

What is a Sphygmomanometer?

 blood pressure cuff and gauge (sphygm/o means pulse, manometer means instrument that measures pressure)

• Two types, Mercury & Aneroid

Parts of Aneroid Sphygmomanometer

• Inflatable Cuff: Wrapped around the upper arm; inflates to restrict blood flow so pressure can be measured.

• Bulb (Pump): Hand-operated rubber pump used to inflate the cuff with air.

• Valve: Releases air from the cuff slowly and controls deflation rate.

• Pressure Gauge (Manometer): Displays the pressure in millimeters of mercury (mmHg); used to read systolic and diastolic pressure.

• Bladder: inflatable part inside the cuff that compresses the artery when inflated… —Length: Should be at least 80% of the circumference of the patient’s upper arm. Width: Should be at least 40% of the arm’s circumference.

• Air Inlet Tube: Connects the bulb (pump) to the bladder to inflate it.

• Pressure Gauge Tube: Connects the bladder to the pressure gauge (manometer) to measure air pressure.

• Electronic Blood Pressure Machine

  • Digital read-out

What are the Blood Pressure Categories?

Blood Pressure Category	Systolic (mm Hg)	Diastolic (mm Hg)
Normal	Less than 120	AND Less than 80
Elevated	120 – 129	AND Less than 80
High Blood Pressure (Hypertension) Stage 1	130 – 139	OR 80 – 89
High Blood Pressure (Hypertension) Stage 2	140 or higher	OR 90 or higher
Hypertensive Crisis (consult doctor ASAP)	Higher than 180	AND/OR Higher than 120

What are the ways the make a pulse?

1. Listen to the apical pulse using a stethoscope

2. Feel a pulse point

What is Apical pulse

Apical pulse is when you listen to patients heart

Application of a Stethoscope

• Listen to your heart first

• Move it around for a different sound

• Compare sounds; bell vs diaphragm

• Listen for sounds + Variation

What does a lub-dub sound mean?

One contraction of the heart

What are the different BPM for adults, childs, and infants?

Adult- 60-100 BPM

Child- 70-110 BPM

Infant- 120-160 BPM

*Remember, lower the age higher the BPM

What is Palpitation?

When you feel for pulse by using two fingers

*don’t use thumb as it has a pulse

Where are the different pulse points?

Pulse Point	Location
Temporal	On the temple, just in front of the ear
Carotid	On either side of the neck, beside the trachea
Brachial	Inside of the upper arm, between the biceps and triceps, near the elbow
Apical	Over the apex of the heart, typically at the 5th intercostal space, midclavicular line
Radial	On the thumb side of the wrist
Femoral	In the groin area, where the thigh meets the pelvis
Popliteal	Behind the knee, in the popliteal fossa
Posterior Tibial	Behind and slightly below the bony part of the inner ankle (medial malleolus)
Dorsalis Pedis	On the top of the foot, just lateral to the big toe tendon

Temprature

The measurement of core body heat. The balance between heat gained and lost (homeostasis).

Where are the different routes to take temrature

• Orally- By mouth

• Rectally- By the butt *most accurate

• Axially- Under the armpit

• Tympanic- In the ears

• Temporal- Across the forehead

What are the types of thermostats

1. Digital Electronic - Used for oral, rectal, and axially

2. Thermocan (Digital)- Used for tympanic and temporal (Not super accurate bc Earwax interferes)

3. Mercury- Old thermostat which is now not used as it used toxic mercury and breakable glass which would cause health hazards

What are the Temprature Norms?

Orally- 97.6-99.6

Rectally- 99.6-100.6

Axillary- 96.6-100.6

Tympanic- 97.6-99.6

Temporal- 99.6-100.6

Body temp is lowest in the morning *in degrees F

Which things affect body temperature?

If a patient has eaten, drinken, or smoked within 15 mins of taking their temp

What precautions should be taken with Rectal and Axillary Temps?

• Always hold the meter in place while taking temp

• Always lubricate w/ rectal temp

• remove clothes around axilla

Hypothermia

Low body temp

Hyperthermia

High body temp

What are the abbreviations?

F- Fahrenheit

C- Celsius

Ax- Axillary

R- Rectal

T- Tympanic

Ta- Temporal Artery

O- Oral

Respiration

The interchange of glasses In humans which involves breathing (inspiration & expiration)

Inspiration

Moving air into lungs

Expiration

Pushing air out of lungs

What does one Inspiration and Expiration equal?

A respiration

What should you observe while respiration is under place?

Rate, Rythm, and Character (depth + quality)

How many breaths per minute for adult, child, and infant?

Adult- 12-20

Child- 16-25

Infant- 30-50

Regular rythm

Evenly spaced

Irregular rythm

Unevenly spaced

What are the types of Character of breath (Depth and Quality)

Deep- easy to see chest rise, large amount of air inhaled

Shallow- hard to see chest rise, small amount of air inhaled

Labored- The Individual must work hard to breathe

Stertorous- Noisy, snoring breath

Moist- wet sounding

What are the abnormal breathing terms?

Dyspnea

apnea

Tachypnea

Bradypnea

Dyspnea

Difficult or painful breathing

apnea

absence of breathing

Tachypnea

Rapid breathing

Bradypnea

Slow breathing

Chynea- Stones

Periods of dyspnea alternating w/ periods of apnea—— seen in dying patients

Pcales

Also known as crackles, abnormal rattle sound heard during inspiration

Rhonchus

Resembles snoring; occurs when air that is blocked becomes rough through the large airways

Wheezes

High-pitched sounds produced by narrow airways, can be heard when patient breaths out

How should you Take respirations?

1. Don’t let the patient know you are counting respiration; they will change their breathing pattern

2. Count the pulse for 30 sec, then respirations for 30 sec- transition smoothly without a break

3. Leave your finger on the Radial pulse while you count respiration and hold their wrist In front of their chest

4. Multiply your count of respiration by 2 for breaths per minute