Physical Diagnosis Exam 1 Vitals Quiz

What results when the ventricular heart contraction pushes a pressure wave of blood throughout the arterial system?

Arterial pulse

What is the measure of inspiration and expiration?

Respiratory rate

What is the peripheral measurement of cardiovascular function?

Blood Pressure

What is the force of the blood against the wall of an artery as the ventricles of the heart contract and relax?

Arterial blood pressure

What is the force exerted when the ventricles contract?

Systolic pressure

What is the force exerted by peripheral vascular resistance when the heart is filling (relaxed state)?

Diastolic Pressure

T/F: Blood pressure is highest during diastole

FALSE

Highest during systole

Lowest during diastole

What is the difference between the systolic and end-diastolic pressures?

Pulse Pressure

If the blood pressure were 120/80 mmHg, the pulse pressure would be ______?

40 mmHg

120 - 80 = 40

T/F: Infants are more susceptible to hyperthermia due to larger body surface area for weight ratio, thinner skin, and limited ability to cope with this temperature related stress.

FALSE

-- hypothermia

T/F: Infants have a higher pulse rate and blood pressure than adults but the respiration rate is about the same

FALSE

Infants have both a HIGHER pulse & respiration rate but a LOWER blood pressure than adults

Blood pressure in pregnant women commonly decrease beginning at about what week of gestation? It reaches a low point at what point of pregnancy? Diastolic blood pressure then will gradually rise to prepregnant levels by when?

8 weeks

Mid-pregnancy

Term

T/F: Many pregnant women have chronic health conditions associated with their pain, and there is no evidence that these patients have a diminished perception of pain.

FALSE

Older adults

What can temperature provide an important clue to?

Severity of patients illness

What are the 5 routes in which a temperature can be taken? Which is the most accurate?

1) Tympanic/Intra-aural (MOST ACCURATE)

2) Forehead (affected by external air temperature)

3) Oral

4) Rectal

5) Axillary

What is the normal body temperature? At what level is it considered a fever? At what value is it true hyperpyrexia (high fever)?

98.6 F

above 99 F

105 F

T/F: Men normally have a lower temperature than women.

FALSE

Women lower temperature than men

What type of fever (pyrexia) is a fluctuating baseline between normal and fever over the course of the day?

Intermittent

What type of fever (pyrexia) may come and go with temperature fluctuating, but never returning to normal levels?

Remittent

What type of fever (pyrexia) is prolonged fever with little or no change over a 24 hr period?

Continuous/Sustained

What type of fever (pyrexia) is a type of intermittent fever that re-spikes after days or weeks of normal temperature, and is common with animal bites and diseases like malaria?

Relapsing

What type of fever (pyrexia) is an intermittent or remittent fever that is considered this type only IF temperature ranges widely throughout the day, between the highest and lowest temperatures?

Hectic

Where is pulse best palpated?

Over an artery close to the surface of the body that lies over bones

What two areas will we focus on for finding pulse?

Radial & Dorsalis Pedis

What 4 things should we report when it comes to pulse?

1) Rhythm

2) Amplitude

3) Contour

4) Rate

Rhythm should be regular for pulse rate, but if an irregular rhythm is detected, what must you do?

Count for the full 60 seconds instead of counting 30 and multiplying by 2

What is the measure for how strong the force of the pulse is? What is the rating scale for this value and the normal/expected value?

Amplitude

0 = absent, not palpable

1 = diminished, barely palpable

2 = NORMAL (expected)

3 = Full, increased

4 = bounding, aneurysmal

What is the waveform, or shape of the expanding and contracting artery, with normal meaning its pliable, and abnormal meaning its non-compliant and arteries won't have normal waveform?

Contour

What is the average resting pulse rate in adults? What is the it varies generally between? How does this change in athletes?

70-80 bpm

(ranges between 60-100 bpm)

-- can be LOWER in athletes

What is a pulse rate value MORE than 100 bpm? LESS than 60 bpm?

Tachycardia

Bradycardia

How does one assess the respiratory rate of a patient?

Inspect the rise and fall of chest or excursion of abdomen

-- count number of breaths (inspiration & expiration) that occur in 1 minute (OR 30s and multiply by 2)

What is a faster than normal respiration rate? Slower than normal?

Tachypnea

Bradypnea

What is respiration rate that is affected by body's position (ex: sitting to standing)?

Orthopnea

What is the absence of breathing?

Apnea

Where is blood pressure most often measured? How must the patient be positioned?

Right arm over the brachial artery

-- Patient is SEATED

T/F: Blood pressure taken in the supine position tends to be lower than those taken in sitting position.

TRUE

What is a condition where blood pressure drops significantly upon standing form a laying/crouched/sitting position, and in worst cases may cause loss of consciousness?

Orthostatic Hypotension

How does one determine the palpable systolic pressure? (2)

1) Deflate cuff completely

2) Inflate until radial pulse is no longer palpable and note the mmHg

When you go to take the blood pressure of a patient, you will re-inflate the cuff until it is ___ - _____ mmHg above the palpable systolic blood pressure. Then, deflate the cuff slowly, about ___ - ___ mmHg per second?

20-30 mmHg

2-3 mmHg

What is the low-pitched sounds produced by the turbulence of blood flow int he artery?

Korotkoff sounds

T/F: Only the diaphragm, not the bell, of the stethoscope can be used in order to take blood pressure

FALSE

diaphragm OR bell

What indicates the systolic pressure reading during blood pressure?

Two consecutive beats

What is the point at which the initial crisp sounds become muffled during blood pressure?

Mid-diastolic (first diastolic)

What is the point at which the sounds disappear during blood pressure?

End-diastolic (second diastolic)

What is the Korotkoff sounds heard that may disappear and reappear 10-15 mmHg below the systolic pressure reading?

Auscultatory gap

What are the two blood pressure readings recorded?

First systolic & the second diastolic sounds (ex: 120/80)

NOTE: repeat the process bilaterally, it may vary by as much as 10 mmHg

What is a normal blood pressure value? Prehypertension? Stage 1 HTN? Stage 2 HTN?

Normal = <120/<80

Prehypertension = 120-139 / 80-90

Stage 1 HTN = 140-159 / 90-99

Stage 2 HTN = >160/>100

NOTE: go off highest number value, so if said the patient has a 145/88, it would be Stage 1 HTN even though its diastolic falls in the Prehypertension category

What affect does cardiac dysrhythmias have on blood pressure?

Requires taking average of several BPs

What affect does Aortic regurgitations have on blood pressure? (TQ)

May obscure DIASTOLIC reading

What affect does Venous Congestion have on blood pressure? (TQ)

LOWER than normal SYSTOLIC

HIGHER than normal DIASTOLIC

NOTE: May be pathological or due to slow/repeated cuff inflation

T/F: Blood pressure abnormalities are less common with newer valves

TRUE

The pulses of newborns are easily palpable, with rates close to ______ bpm that may occur in neonates, and the pulse decreases relativly rapidly to _______ bpm after a few hours of age?

200 bpm

120 bpm

T/F: The newborn's pulse rate is less variable than that of older infants with activities such as feeding, sleeping, and waking

FALSE

-- newborn's pulse rate is MORE variable

When measuring the respiratory rate of an infant, how long should it be counted for? What is the expected rate for neonates?

count respiratory rate for 1 minute

-- neonates vary from 40-60 breaths per minute (but up to 80 may be noted)

T/F: Babies delivered by cesarean section may have a MORE rapid respiratory rate than babies delivered vaginally.

TRUE

What is often used to perform blood pressure in infants?

Electronic sphyngomomanometer with a Doppler

What is the normal range of newborn/infant blood pressure?

60/30 -- 96/62

T/F: In infants/newborns, a sustained increase in blood pressure is almost always significant

TRUE

T/F: The heart rate of children is less variable than those of adults because it reacts less to exercise, fever, and stress.

FALSE

-- MORE variable & reacts more to exercise, fever, stress

T/F: Respiratory rates in children decrease with age with its greatest variation in the first 2 years of life and has no gender difference

TRUE

It is important that in children the correct cuff size is used to obtain an accurate blood pressure reading, with the bladder covering ____% of the arm circumference

80%

Heart rate in pregnant women will gradually _______ throughout pregnancy until it is 10-30% ______ at term (end of pregnancy). Blood Pressure will ________ from 2nd to 3rd trimester.

Increases & Higher

Increase

What condition is when the blood pressure reading is >140 mmHg systolic or 90 mm Hg diastolic, developing in 6-29% of nulliparous (never birthed before) women and up to 4% multiparous (birthed several times before) women, often in late pregnancy, and is also higher in women with multiple gestations?

Gestational Hypertension

What is a complication that includes hypertension and proteinuria (protein in urine), with blood pressure reading of >160 mmHg systolic OR 110 mmHg diastolic

Preeclampsia

In older adults, heart rate may be slower due to increased _______, or it may be more rapid, as it can range form low ______s to more than _____ bpm

Vagal tone

40s

100 bpm

Which blood pressure is often increased in older adults because of stiffness of the blood vessels and increased vascular resistance, less pliable with poorer contour?

Systolic Blood Pressure

What temperature abnormality is found when gallstones (choleliths) obstruct the common duct, and is fever accompanies by chills, right upper-quadrant pain, and JAUNDICE?

Charcot Fever

What are cyclic fevers that rise and fall once every 1-2 weeks, and is associated with Hodgkin's Disease/Hodgkin's Lymphoma?

Pel-Ebstein Fever

What pulse abnormalities can be associated with left ventricular failure?

Alternating Pulse Contour

What is a bounding, forceful pulse with a rapid upstroke and descent, associated with aortic regurgitation or patent ductus arteriosus?

Water Hammer Pulse

What respiratory abnormality can be caused pulmonary embolism (RAPID & SHALLOW)? (TQ)

Tachypnea

What respiratory abnormality can be caused by congestive heart failure?

Orthopnea

What respiratory abnormality is the absence of respiration for at least 30 seconds during sleep and can be a cause of heart failure?

Obstructive Sleep Apnea

What respiratory abnormality is when the chest wall/abdominal wall moves in with inhalation and out with exhalation, and is a sign of RESPIRATORY DISTRESS in children and adults?

Paroxysmal (paradoxical) breathing

What respiratory abnormality is deep breathing followed by shallow breathing, and is associated with HEART FAILURE and CEREBRAL DAMAGE?

Cheyne-Stokes Breathing

What respiratory abnormality is due to reduced air pressure in chest cavity, and is associated with OBSTRUCTED AIRWAYS?

Intercostal Retractions

What respiratory abnormality is a respiratory pattern characterized by regular respirations interspersed with periods of apnea?

Biots Breathing

What respiratory abnormality progresses to irregular respirations of varying rate and depth, and is associated with damage to the pons due to stroke, trauma, or uncal herniation?

Ataxic Breathing

What respiratory abnormality is tachypnea (RAPID & DEEP) caused by METABOLIC ACIDOSIS? (TQ)

Kussmaul Breathing

What blood pressure abnormality is HTN after 20th week of gestation, with proteinuria? What is this called if there is the addition of seizures?

Preeclampsia

Eclampsia

What is a rapid drop in BP (decrease of 20 mmHg systolic and 10 mmHg diastolic) caused by a shift in position sitting, laying, crouching to standing, commonly described as getting up too fast, and can result in loss of consiousness?

Orthostatic Hypotension

What is one of the most common disease worldwide and responsible for stroke, renal failure, and congestive heart failure?

Hypertension

What type of HTN is NOT caused by another condition and has a poorly understood pathologic origin and subjectively is asymptomatic?

Essential HTN (primary)

What type of HTN has potential condition causes such as renal disease, renal artery stenosis, aldosteronism, thyroid disorders (HTN), Pheochromocytoma, or coarctation of the aorta and has symptoms such as headache, blurred vision, dyspnea, encephalopathy?

Secondary HTN

What is the MC cause of HTN in Children? Elderly? (TQ)

Children = Renal disease

Elderly =

1) Reduced aortic compliance

2) Peripheral artery resistance (but can also be increased vagal tone)

What are the objective findings in adults for HTN? Children?

Adults = BP at or above 140/90 mmHg

Children = BP at or above 95th percentile for age/gender/height

What 4 pieces of equipment is needed for vital examination?

1) Thermometer

2) Timer

3) Sphygmomanometer & cuffs

4) Stethoscope

How should the patient be positioned on the exam table during the examination of vitals?

Sit on exam table, lower legs hanging off the edge of table

When you go to take the radial pulse bilaterally, how should you be positioned in reference to the patient? What is your contact point and what do you do?

Facing patient or just off to one side

pads of digits 2-4 over both radial pulses (2-3" proximal from base of thenar) simultaneously

Count beats for 30 seconds and multiply by 2 (if irregular, count 60 seconds)

When you do the respiratory rate, what should you do and what are some considerations?

Count/observe quality of breaths for 30 seconds and multiply by 2 (watch excursions of abdomen)

-- done while collecting radial pulse

-- try not to make observations obvious

What are the 5 pieces we report when it comes to pulse? 3 pieces when it comes to respiratory rate?

Radial Pulse

- Rate, rhythm, amplitude, contour, symmetry

Respiratory Rate

- Rate, rhythm, depth

What should you do if you cannot locate the dorsal pedis pult to report the rate and quality?

Have patient remove shoes

-- move up leg until a pulse can be detected (posterior tibial, popliteal, femoral)

What is the procedure of blood pressure (bilateral)?

1) Choose cuff appropriately sized for the patient

2) Line up cuff artery indicator about 1" above antecubital fossa and over brachial artery

3) Palpate pulse (radial) and note when disappears after inflating cuff (palpatory pressure)

4) Place bell of stethoscope over brachial artery in cubital fossa region

5) Reinflate cuff to 20 mmHg above palpatory systolic pressure

6) Slowly release pressure at 2-3 mmHg/sec until you hear first arterial sound, note when grows muffled, and then when cease

What values in relation to blood pressure do you need to report bilaterally? (5)

1) Palpatory systolic

2) Auscultatory systolic (phase 1)

3) Auscultatory mid-diastolic (Phase 4)

4) Auscultatory end-diastolic (phase 5)

Pulse pressures (systolic - end-diastolic)