Vital Signs & Laboratory Data

Vital Signs

Temperature, Pulse, Pulse Oximetry, Respiration, Blood Pressure, ECG/EKG

Temperature: Tells Us

Cellular activity, metabolism, possible infection, stress, etc.

Temperature

varies by time of day and location. (older people may run colder).

Oral - 98.6 ,

Rectal - 99.8 ,

Axillary 97.6

Temperature Abnormalities

Higher than 99.5 (hyperthermia) is a mild fever, Over 100.4 is considered having a fever, Under 97.6 is hypothermia

Pulse: What it Tells us:

Indicator of general heartbeat, cardiac output, and arterial blood supply.

Pulse Points

Radial (wrist) and Carotid Arter (neck) are most common.

Adult Normal Pulse Value

70-90 or 60-100

Child Normal Pulse Value

70-120

Tachycardia

>100bpm

Bradycardia

<60bpm

Lifestyle considerations for pulse

athletes, thin, or cold people tend to have a lower pulse rate

Pulse Oximetry: What it Tells Us

Assessment of hemoglobin oxygen saturation of arterial blood

Pule Oximetery

95-100%, below 95% is hypoxemia and may indicate a breathing or circulation problem. Consider chronic lung conditions that may have a low pulse ox but a patient has adapted to.

Respiration: What it Tells us & Tricks

Tells us respiratory distress, obstruction, anxiety, etc. Be descreate to avoid the patient changing their breath.

Normal Values respirations per min

Adult: 12- 20.

Child: 20-30

Tachypnea

>20 breaths per min

Bradypnea

<12 breaths per min

dypnea

difficulty breathing

apnea

period of absence of breathing

Orthopnea

difficulty breathing while lying down

Blood Pressure: What it tells us

The force exerted by blood on the arterial walls during contraction an relaxation of the heart

Blood Pressure: To Measure

Use sphygmomanometer and stethoscope

Systolic/diastolic Normal Values

<120/<80

Hypertension

>140/90

Hypotension

<95/60

P-Wave

depolarization of atrial muscle

QRS Complex

Depolarization of ventricular muscle

T-Wave

Repolarization of the ventricular muscle

Electrocardiogram

Normal ECG

Bradycardia (image)

QRS complexes are farther apart otherwise looks normal

Tachycardia (image)

looks normal everything is just closer together

Atrial Fibrillation

can cause blood clots but not immediately life threatening. Looks like a squiggle before each QRS complex

Premature Ventricular Contractions

"flutter" the QRS complex may randomly change length or orientation going upside down.

Ventricular Tachycardia

Ventricle keeps contracting too early no P or T wave

Ventricular fibrillation

No true forceful contraction but uncoordinated quivering. LIFE THREATENING. Just a scribbly line

Asystole

No contraction, mostly strait line

BUN (lab)

measures amount of bilirubin, urea, and nitrogen levels in the blood. Indicator of kidney function, important before giving IV contrast. Normal Values: 7-20 mg/dL

Creatinine (lab)

Measures amount of creatinine (waste product from muscles) in blood. Creatinine is removed by the kidneys. Indicator of kidney function, important before giving IV contrast. 0.5-1.2 mg/dL

GFR (lab)

Measures hwo well kidneys are filtering blood, Indicator of kidney function, important before giving IV contrast

Hemoglobin (lab)

Measures amount of hemoglobin. Important because o2 uses hemoglobin for transport in the blood

RBCs (lab)

Measures number of RBCs, important because oxygen uses hemoglobin, which is a part of the RBC for transport in the blood

Platelets (lab)

Measures ability of blood to clot, important for patients undergoing percutaneous procedures

O2 Saturation (lab)

Measures oxygen saturation of blood, important because hypoxemia can lead to emergency adverse effects. 95-100%

Prothrombin Time (PT) (lab)

Measures how long it takes blood to clot, important for patients undergoing percutaneous procedures

Partial Thrombin Time (PTT) (lab)

Measures how long it takes blood to clot, important for patients undergoing percutaneous procedures

Prothrombin/international normalized ration (PT/INR) (lab)

Measures how long it takes blood to clot, important for patients undergoing percutaneous procedures

Vital Signs: Conscious Effort

Notice, measure, document changes in patient condition. Respond to changes in patient condition

Vital Signs: Prudent practice

What would a safe professional practitioner do in this situation? (code!). Anticipate complications and prepare

Vital Signs: Communication

Discuss observations/situations with other healthcare providers, appropriate supervisors, physicians (near miss)

Vital Signs :Documentation

Include specific details, time/date, entry into official record, and signature or initials.

Assessing a patients mobility

look for yellow armband or socks. Can you stand? Have you fallen in the past year? Has a doctor recommended you use a cane? When was the last time you went to the bathroom by yourself? TRUST YOUR GUT

Why is Fall Prevention so Important?

#1 unintentional injury deaths among older adults, 1/4 older adults report falling, can lead to loss of independence, 32,000 die each year from these falls, 95% of hip fractures in older adults are from falls. Cost 50billion each year.

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