RPT 212 LAB: Vital Signs and Chest Assessment

How to assess pulse

measure using one of the following: radial artery, brachial artery, dorsal pedis, or popliteal; use index and middle finger; assess for 1 minute or 15 seconds (x4) or 30 seconds (2).

How to assess respiratory rate

Count chest rises. assess for 1 minute without informing patient; can be done while checking pulse

how to assess blood pressure

put cuff above elbow. find brachial pulse point and put stethoscope on point. inflate cuff to appropriate level. release pressure slowly; 1st thump is systolic(top) number; last thump is diastolic(bottom) number

normal heart rate(HR)

60-100 beats per minute

tachycardia

pulse > than 100 bpm

bradycardia

pulse < 60 bpm

eupnea

normal respiratory rate(RR)

normal respiratory rate(eupnea)

12-20 breaths/minute

tachypnea

> 20 breaths/min

bradypnea

< 12 breaths/minute

RR < than 6

EMERGENCY

Normal BP

120/80 mm Hg

Systolic BP range

90-140 mm Hg

diastolic BP range

60-90 mm Hg

Hypertension

BP> 140/90

hypotension

BP < 90/60

pulse pressure

difference between systolic and diastolic pressures

normal pulse pressure

30-40 mm Hg

Proper sites for Pulse Oximetry Probes

finger, ear lobe, toe, forehead

normal SpO2 range in COPD patient

88-92 %

normal SpO2 range in non COPD patient

92-100 %

Causes of inaccurate/erroneous SpO2 readings

motion artifact, abnormal hemoglobins, intravascular dyes, low perfusion states, dark skin pigmentation, cold extremities, dark nail polish

hypoxemia

low SpO2 reading

When is continuous pulse oximetry monitoring indicated?

during sleep studies, exercise testing, bronchoscopy procedures, surgery, ICU setting

Sites used to assess body temperature

orally, axillary, rectal, ear, temporal

normal range for body temperature

97.0 -99.5 F(98.6)

Afebrile

normal temperature range

What terms are used to classify a high body temperature?

hyperthermia, hyperpyrexia, febrile

What term is used to classify a low body temperature?

hypothermia

When is body temperature the lowest and highest?

lowest- morning; highest-late afternoon

Why is it important to assess HR and RR for 1 minute?

ensure accuracy

How to assess vocal and tactile fremitus

has patient repeat the word "99"; vibrations heard with stethoscope during vocal and felt through hands during tactile

What does increased vocal and tactile fremitus indicate?

fluids heard; vibrations transmitted through a more solid medium such as with pneumonia

What does decreased vocal and tactile fremitus indicate?

air heard; heard in obese, overly muscular patients or patients with hyperinflation (emphysema); may be reduced or absent in patients with a pneumothorax or pleural effusion

How to assess for thoracic expansion

aka chest motion symmetry; hands placed below breast area with thumbs together then on back below shoulder blades with thumbs together. normally thumbs move 3-5 cm from the midline

What conditions cause asymmetrical chest expansion?

pneumothorax, pleural effusion, atelactisis, flail chest; one hand moves more than the other

How to assess for diaphragmatic excursion

measures by evaluation of chest expansion at peak inspiration and then at peak exhalation. hands placed below diaphragm; patient breaths and distance between thumbs is measured

What causes asymmetrical diaphragmatic excursion?

unilateral or bilateral phrenic nerve paralysis

Assessments you would perform or look for on the skin

evaluate temperature; conditions of the skin- muscle tone, areas of tenderness, lumps or depressions, presence of subcutaneous emphysema; inspect for: cyanosis, diaphoresis, edema, pitting edema, dryness, poor skin turgor(dehydration)

How to perform percussion

place middle finger in intercostal space and tap knuckle and listen to sound

What does hyperresonance to percussion indicate?

heard over areas of increased air- pneumothorax or emphysema

What does hyporresonance/dullness to percussion indicate?

heard over fluid filled organs- pleural effusion, pneumonia, atelectasis

What does flatness to percussion indicate?

Heard over the sternum, muscle or bones.

abnormal chest findings

pectus carinatum, pectus excavatum, kyphosis, scoliosis, kyphoscoliosis, barrel chest

abnormal breathing patterns

apnea, apneustic breathing, asthmatic breathing, biot's respiration, bradypnea, cheyne-stokes respiration, hyperventilation, hypopnea, hypoventilation, kussmauls respiration, paradoxical respiration, retractions

How to perform ausculation(breath sounds assessment)

use systemic pattern beginning at the base and working toward the apices- should include all lobes from the anterior, lateral and posterior aspects

Rhonchi(sonorous wheezing)

low-pitched, continuous sound usually heard during expiration; caused by mucous secretions

Crackles (rales)

coarse, low-pitched, discontinuous bubbling sound heard during inspiration and expiration(during coughing) caused by excessive secretions when collapsed airways pop open during inspiration

wheezes

high-pitched, continuous "musical" sounds usually heard during expiration; caused by bronchospasms, inflammation, tumors, or foreign body airway obstruction

stridor

loud, high-pitched sound heard sometimes "audibly" without a stethoscope during inspiration; caused by an obstruction in the trachea or larynx, epiglottitis, LTB

pleural friction rub

superficial, low-pitched, coarse rubbing or grating sound; sounds like 2 surfaces rubbing together; loudest over lower anterolateral surface

subcutaneous emphysema

crepitus; air leaks out from the lung into the subcutaneous tissues; fine air bubbles produce a crackling sound and sensation when palpated

vesicular(normal) breath sound

low-pitched, soft intensity sounds heard int he peripheral lung areas

bronchovesicular(normal) breath sounds

moderate-pitched, moderate intensity sounds heard around the upper part of the sternum, between the scapulae; should NOT be heard in the peripheral lung areas

tracheal(normal) breath sounds

high-pitched, loud intensity sounds heard over the trachea

blood pressure

the force exerted against the wall of the arteries as blood moves through

What does a pulse oximeter probe do?

Provides estimates of arterial blood oxyhemoglobin saturation levels (SpO2)

pectus carinatum

anterior protrusion of sternum

pectus excavatum

depression of part or all of sternum

kyphosis

convex spine; hunchback

scoliosis

lateral curvature of spine

kyphoscoliosis

combo of both kyphosis and scoliosis