vital signs

exam 1 (5 questions)

learning objectives

learning objectives

• recall physical assessment techniques for bp, pulse, respiratory rate, and temperature measurement

• interpret vitals signs measurements

• demonstrate proper vital sign measurement (skills lab session)

why do we measure vital signs?

• vital signs: objectively quantify several essential bodily functions

  • measure/asses is performed routinely in every healthcare setting

• data to determine pt’s:

  • state of health

  • response to med treatment

  • psychological/physiological stressors

what is body temperature?

• a measurement of balance btwn heat lost/produced by body

• indicates body’s metabolic status

• can be sign of infection/invasion of harmful organism

what is core temperature? how does it deviate? where do you measure?

• temp of deep tissue of bod (abdominal/pelvic cavity)

• rel constant

• rectum, tympanic membrane (ear), pulmonary artery, oral

what is surface temperature? how deviate? where measure?

• temp of skin, subcutaneous tissue, fat

• rises/falls in resp to environ

• skin, axilla (underam)

average of oral (core temperature)?

98.6°F / 37.0°C

average of rectal (core temperature)?

99.6°F / 37.6°C

→ rectal: most reliable measurement

average of axillary (surface temperature)?

97.6°F / 36.4°C

→ axillary (underarm): least accurate measurement

average tympanic (core temperature)?

99.6°F / 37.6°C

→ tympanic = ear

average temporal (surface temperature)?

99.2°F / 37.3°F

what is the deviation of avg normal temp?

0.5°F - 1°F / 0.3°C - 0.6°C

how do you use contact thermometers? what does it commonly use? where do you measure? pros/cons?

• contact/touch body for ↑ accuracy

• uses electronic heat sensors

• forehead, mouth, armpit, rectum

  • pros: records T fast (<1 min), good all ages

  • cons: rectum = uncomfy, oral can be affected by food/drink

how do you use remote thermometers? what does it commonly use? where do you measure? pros/cons?

• x need body contact

• uses infrared radiation

• forehead, ear

  • pros: fast mesurement/easily tolerated

  • cons: ↑ expensive, ↓ accurate (use tech, direct sunlight, cold temp, sweaty forehead, earwax, ear anatomy)

how to convert between fahrenheit and celcius?

what body temp is hypothermic?

<35°C / 95°F

what body temp is normal/afebrile?

36.4-37.5°C / 97.5-99.5°F

what body temp is hyperthermic (febril)? low grade fever? fever?

low grade fever: 37.6-37.9°C / 99.6-100.3°F

fever: ≥38°C / ≥100.4°F

what are the hypOthermia risk factors?

• exhaustion

• age (older age, v young age)

• cognitive deficits (dementia)

• alcohol/drug use

• medical conditions (hypothyroidism, diabetes, storke, spinal cord injuries)

• medications (antidepressants, antipsychotics, sedatives)

what are the hypErthermia risk factors?

• medical conditions (autoimmune, cancer, hyperthyroidism)

• infection

• heat exhaustion

• vax/immunizations

• medications (atropine, recreational drugs)

what is pulse? where can pulse be found?

• # times heart beats per min (bpm)

• wave of blood created each time left ventricle of heart contracts

• pulse can be palpated over any artery

  • carotid (neck) and radial (wrist)

what is the normal range for pulse in adults?

60-100 bpm

what is pulse rate? how to measure?

rate: # pulse beats per min

• palpate radial artery + observe clock hand for 30 sec, multiple by 2 to get the full number of beats per min

  • if pulse = irreg rhythm; count to full 60 sec while palpating

what is it called when heart rate is slow? fast?

• slow HR: bradycardia

• fast HR: tachycardia

what is pulse rhythm? what’s normal/irregular?

• pulse rhythm: regularity (equal spacing) of all beats of pulse

  • normal: heartbeat intervals are same duration

  • irregular: unequal spacing

    • count to full 60 seconds when palpating

what is an irregular rhythm pulse called?

dysrhythmia / arrhythmia

• unequal intervals of heartbeat

what is intermittent pulse?

• heart occasionally skips heat

• normal

what is the strength of the pulse influenced by?

force of the heartbeat

what does the force of the heart beat reflect?

pt’s blood volume, arterial wall status, hydration levels

what is the pulse grading scale?

4. strong, bounding, not obliterated w P

3. normal, strong, easy to palpate, not easily obliterated w P

2. difficult to palpate, may be obliterate w P

1. difficult to palpate, diminished/weak, may be obliterated w P

0. not palpable

what are the five factors that influence pulse rate?

1. air temp

2. body position

3. emotions

4. body size

5. medication use

influence pulse rate: babem (body pos, air temp, body size, emotions, med use)

explain how the five factors influence pulse rate.

1. air temp: ↑T/humidity = heart pump ↑ blood: = ↑ pulse

2. body pos: sititng → standing: ↑ pulse

   • sign of POTS (postural orthostatic tachycardia syndrome)

3. emotions: stress = ↑pulse

4. body size: very obese pts: ↑resting pulse

   • athletes: ↓resting pulse

5. medication use: epinephrine blockers ↓pulse (b-blockers) + excess thyroid med: ↑pulse

what’s the normal range for pulse?

60 - 100 bpm

bradycardia. symptoms? cuases?

bradycardia ( <60 bpm); brad is a little sLOW

• symptoms

  • syncope/near fainting

  • dizziness/light

  • fatigue (esp w exertion)

  • chest pain

  • confusions or memory prob

• causes

  • heart tissue dmg rel to aging/disease

  • medication (antiarrhythmics, anti-hypertensives)

tachycardia. symptoms? causes?

tachycardia (>100 bpm)

• symptoms

  • shortness of breath

  • lightheadedness

  • heart palpitations

  • chest pain

  • fainting (syncope)

• causes

  • excess caffeine/alc

  • fever

  • ↑/ ↓ BP

  • stress

  • medications (stimulants)

what is respiration? what does it consist of? what is equal to one respiration? when is it taken?

• act if breathing; exchange of oxygen and carbon dioxide

• consists of 1 expiration + 1 inspiration

  • exhalation: diaphragm relaxes/moves up

  • inhalation: diaphragm contracts/moves down

• 1 respiration = each rise and fall of pts chest

• taken at same time as pulse/immediately after

what are the four characteristics of respiration?

1. rate: # respirations/min

2. rhythm: pattern/regularity of respirations (spacing btwn breaths) → regular/irregular

3. depth: amnt of air inhaled/exhaled

   • normal, shallow, deep

4. breath sounds

(respiration term) describe stridor.

high-pitched and noisy (most common in children)

(respiration term) stertorous.

noisy breathing, sounds like snorting

(respiration term) crackles/rales.

high-pitched rattling

(respiration term) rhonchi.

coarse, low-pitched breathing

(respiration term) wheezes.

high-pitched whistling

(respiration term) apnea.

temp suspension of breathing/absence of ventilation

(respiration term) eupnea.

normal rate, depth, regular rhythm

(respiration term) hyperventilation.

fast rate and increased depth

(respiration term) tachypnea.

v fast; faster rate, shallow depth, reg rhythm

(respiration term) bradypnea.

v slow; slow rate, shallow or normal depth, reg rhythm

(respiration term) orthopnea.

difficulty breathing in postures other than erect

(respiration term) dyspnea.

difficulty breathing

what are the 4 factors that alter respiration?

1. age (younger: ↑O₂ demands)

2. pain (↑HR/BP → ↑respiratory rate)

3. emotions (∆pattern, rate, depth breathing)

4. air passage resistance (↑resistance —| air enter lunch during each cycle → ↑O₂ demand)

whats the relationship bwtn oxygen demand and respiration?

↑O₂ demand: ↑respiration rate

what are the 4 steps to measuring respiration?

1. clinical skills pearl: measure the respiratory rate immediately following measurement of pulse

2. continue hold wrist + watch chest

   • one rise one fall = one respiration

   • (x see chest) hold pt’s arm across chest, feel chest move

3. count respirations for 15-30 sec and multiply by 4/2 to get 60 seconds

4. look/listen for any signs of abnormal breathing

bradypnea. symptoms? causes?

bradypnea (<12 breaths per min)

• symptoms

  • lightheadedness/dizziness

  • headaches

  • altered mental status

• causes

  • medical conditions (chronic obstructive pulmonary disease, sleep apnea, etc.)

  • medication (optiods, benzodiazepines, sleep aids)

tachypnea. symptoms? causes?

tachypnea (>20 respirations per min)

• symptoms

  • shortness of breath

  • chest pain

  • cyanosis (blueness) of lips/fingers

• causes

  • excess caffeine/alc

  • exercise

  • fever

  • high/low BP

  • sudden stress

  • medications (stimulants)

whats the normal range of respiration?

12 - 20 respirations per min

what denotes hypertension?

• systolic BP ≥ 130 mmHG or

• diastolic BP ≥ 80 mmHG or

• taking medication for hypertension

what is hypertension? what is it broken down into? define such.

• BP: force of blood pushing against walls of arteries that carry blood from heart to other parts of bod

  • no symptoms of hypertension

• BP broken down to 2 numbers

  • systolic BP: artery P when heart beats

  • diastolic BP: artery P when heart relaxes

what 4 things should pts avoid doing 30 mins before BP measurement?

1. caffeine (↑BP)

2. smoking (↑BP)

3. exercise (↑BP)

4. eating a meal (↑BP: using O₂ in blood to digest food)

what should pts rest from for 5 mins before BP measurement? what does this help?

• rest wo using phone 5 mins before

  • help w white coat hypertension

should pts completely empty bladder before BP measurement?

yes; full bladder ↑BP 10-15 mmHg

how does tightness/looseness of BP cuff translate to in readings? how do you select BP cuff?

• tighter cuff: ↑BP

• looser cuff: ↓BP

select size by finding mid-upper arm circumference and look on box for rec cuff size; test by interting 2 fingers into cuff = snug

where is the BP cuff placed? how should the pt be while taking measurement?

• on bare arm abt 2 fingers above antecubital crease

• should be level with pts heart when arm supported

• pt refrain from talking, have seated upright w back fully against chair, feet flat w legs uncrossed

what us auscultatory gap? what does it result in? how do you overcome it?

• intermittent disappearance of initial korotkoff sounds after first appearance

• may result in underestimation of systolic BP

• overcoming auscultatory gap:

  • palpate radial pulse while rapidly inflating cuff to 80mmHg

  • slowly inflate cuff ~10 mmHg every 2-3 sec until no longer feel radial pulse = obliteration pressure

  • inflate bulb for an additional 20-30 mmHg after obliteration P

  • place stethescope directly over brachial artery

  • slowly deflate cuff at rate of 2 mmHg/sec and listen for korotkoff sounds

    • first korotkoff sounds = systolic BP

    • point where sound gone = diastolic BP

    • pick closest even number for both measurements

  • write down values and what arm used

how do you document BP for initial visits? follow up visits? how do you communicate readings?

• inital: measure BP in both arms, document readings and which arm has highest reading

  • highest reading → use for future visits

• follow up visits: measure 2/+ on same arm, spaced 1-2 mins apart, avg readings, document measurements/avgs

• communicate readings to pt verbal/writing

how do you interpret BP readings? normal? elevated?

• normal BP <120 mmHg/ <80 mmHg: within range

  • systolic/diastolic

• ≥ 120mmHg or ≥ 80mmHg: elevated/above range

what is the pharmacists role in BP screening?

• counsel pts on importance of self-monitoring BP/BP screenings

• normotensive pts: encourage continue healthy habits and periodic checkups

• pts rsk for hypertension: encourage lifestyle modifications take active role in health

• pts w hypertension: emphasize lifestyle modifications and schedule follow up appts, stress medication adherence