Essentials Exam #2: Key Terms in Medicine Study Guide

body temperature, pulse rate, respiratory rate, blood pressure

What are the 4 vital (cardinal) signs?

pain

5th vital sign (JCAHO)

unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage

*perception of an uncomfortable stimulus and the response to that perception

pain scales

1. visual analog scale

2. numerical rating scale

3. FACES pain rating scale

4. thermometer pain scale

BORG (rate of perceived exertion)

individual's perceived exertion

*way to monitor exercise intensity

ranges 6-20

- may correlate to HR (young healthy pple)

gait speed

functional vital sign

ASSOCIATED WITH:

- quality of life

- functional capacity

- general health status

- decreased participation

- presence of depressive symptoms

PREDICTIVE OF:

- frailty

- hospitalization/discharge destination

etc.

distance/time

walk at a comfortable pace

What instructions should a PT give a patient for a self-selected gait speed test (preferred)?

walk as fast as safely possible ("reach a bus that is about to pull out")

What instructions should a PT give a patient for a maximum gait speed test?

3

When evaluating gait speed, the patient should perform ___ trials and calculate the average.

body temperature

the balance between the heat produced by the body and the heat lost from the body

NORMAL:

98.6 degrees F (96.8-100.4)

37 degrees C (36-38)

pyrexia

increased body temperature (febrile)

S/Sx = general malaise, headache, increase pulse, increase RR, chills, piloerection (goosebumps), loss of appetite, sweating, etc.

hyperthermia--> temperature well above normal

*greater than or equal to 106 degrees F or 41.1 degrees C

**may be fatal

yes (proceed with caution)

Can a PT treat a patient with a low grade fever?

(99-100 degrees F)

102 degrees F (38.9 degrees C)

What is considered a high grade fever?

HINT: NO PT allowed

hypothermia

exposure to extreme cold

S/Sx = decrease pulse, decrease RR, cold and pale skin, cyanosis, drowsiness, etc.

- less than 94 degrees F (34.4 degrees C) = thermoregulation is impaired

- 85 degrees F (29.4 degrees C) = thermoregulation is lost

rectal, ear (tympanic), oral, axillary

What are the 4 primary measurement sites for body temperature?

ear (tympanic)

What is the most accurate measurement site for body temperature?

factors that influence body temperature

1. age

*infants higher, elderly lower

2. emotion/stress

*stimulation of sympathetic nervous system = increase epinephrine = temp

3. exercise

*strenuous exercise = increase metabolic rate

**muscle contractions = heat production source

4. external environment

*warm weather = increase temp

**humidity

***clothing

5. time of day

*circadian rhythm

6. menstrual cycle

*increase progesterone during ovulation

7. pregnancy

oral monitoring (temperature)

contraindications

- patients who are uncooperative or unconscious

- newborns/infants

- patients with notable dyspnea (SOB)

- cautionary use on patients with unpredictable seizures

*tympanic = higher, axillary = lower*

pulse rate (PR)

pulse waves of arterial blood created by contractions from the left ventricle

normal adult = 60-100 bpm

*higher in children, lower in trained athletes

radial pulse

Where is the most common peripheral pulse rate taken without issues?

bradycardia

slow heart rate (less than 60 bpm)

tachycardia

rapid heart rate (>100 bpm)

women (small body w/ small heart)

Do women or men have a faster HR?

factors influencing pulse rate

1. age

2. body size

thin = decrease

3. gender

lower in males

4. exercise

- relationship with workload intensity

- used to calculate target heart rate

- trained athletes lower resting HR

5. other factors

- stress/emotions

- medications

rhythm, volume/amplitude/quality, feel of arterial wall

Pulse rate can be described by what 3 things?

rhythm

aspect of pulse rate

describes pattern of pulsations and intervals

*regular vs irregular (patterns)

volume (amplitude, quality)

aspect of pulse rate

amount of blood pushed through artery during each contraction (cardiac output)

*strong/full vs. weak/thready vs. bounding

feel of arterial wall

aspect of pulse rate

should be smooth, elastic, soft, flexible

*with advancing age - sclerotic changes

respiration

RATE: number of breaths per minute (bpm)

normal adult = 12-20 breaths/min

*minimum of 30 seconds for testing

RHYTHM-->time interval between breaths

regular vs irregular

DEPTH--> amount of air exchanged with each breath

shallow vs deep

dyspnea

shortness of breath (SOB)

apnea

absence/interruptions of breathing

factors influencing respiration

1. age

increase in adults due to decrease in vital capacity

newborns/toddlers: 25-50 breaths/min (decreases with age)

* > 70 = alarming

2. body size and stature

men & tall/thin = low

3. exercise

increase in rate and depth

4. other

- medication

- stress/emotions

- body position on diaphragm

dyspnea scales

1. Talk Test (0, 1+, 2+, 3+, 4+)

2. MRC Breathless Scale (0-4)

MRC breathlessness scale

0 = only breathless with strenuous exercise

1 = SOB hurrying or walking up hill

2 = walks slower than same age people

3 = stops for breath walking 100+ yds

4 = too breathless to leave house

pulse oximeter

assess oxygen saturation level (%) in peripheral arterial blood

normal adult SaO2 = 95-100%

*may decrease slightly during exercise

90

An SaO2 < ____% is ABNORMAL!

*need O2, chronic condition --> requires medical attention

blood pressure (BP)

force that blood exerts against arterial wall as the heart contracts and relaxes, expressed as a fraction (in mmHg)

CO x total peripheral resistance = ?

systolic

top number

*max pressure during ventricular contraction

diastolic

bottom number

*min. pressure during ventricular relaxation

pulse pressure

difference between systolic and diastolic pressure

peripheral resistance

resistance to blood flow within vessel

INFLUENCED BY:

1. diameter/elasticity of arteries

2. blood viscosity

cardiac output (CO)

DETERMINED BY:

1. strength, rate, rhythm of HR

2. blood volume

SV x HR = ?

normal blood pressure

systolic < 120

AND

diastolic < 80

high blood pressure stage 1

systolic: 130-139

OR

diastolic: 80-89

*start lifestyle modifications (PT intervention)

high blood pressure stage 2

systolic: 140 or higher

OR

diastolic: 90 or higher

*need medication

hypertensive crisis

systolic: higher than 180

AND/OR

diastolic: higher than 120

*consult a doctor immeadiately

factors affecting blood pressure

1. exercise

physical activity increases CO efficiency

2. cuff size

too small = false HIGH readings

too large = false LOW readings

3. arm position

should be supported with cuff at heart level

4. Valsalva manuever

5. orthostatic hypotension

Valsalva manuever

drop in BP followed by rapid increase as breath is released

orthostatic hypotension

sudden drop in BP with upright standing

laying down (blood closest to heart)

Blood pressure is highest in which position?

diaphragm (stethoscope)

flat endpiece (larger dome) of the stethoscope used for hearing relatively high-pitched heart sounds

*usually used for breath sounds and BP

(C IN IMAGE)

bell (stethoscope)

smaller dome used for low frequency sounds

*preferred use for heart sounds

(B IN IMAGE)

forward

The earpieces of the stethoscope should face _______________.

sphygmomanometer

instrument to measure blood pressure

*mercury, aneroid (USED IN CLASS), electronic

Korotkoff sounds

series of sounds heard through stethoscope when measuring BP

PHASE 1 = first clear, faint rhythmic tapping sound (SYSTOLIC PRESSURE)

PHASE 5 = last discernable sound before disappearance of sound altogether (DIASTOLIC PRESSURE)

arterial occlusion

used to estimate systolic pressure

*palpate the radial artery and pump up cuff and note when pulse disappears

**wait 60 seconds for recovery and then use this value + 30 mmHg for blood pressure

sensation

a mental process (such as seeing, hearing, or smelling) resulting from the immediate external stimulation of a sense organ often as a distinguished from a conscious awareness of the sensory process

*an impression produced by impulses conveyed by an afferent nerve (away from CNS) to the sensorium

sensory integration

organization, interpretation and use of sensory information

*provides a representation of the environment that informs and guides motor response

**occurs without conscious effort in an intact system

sensory testing

specific examination of sensory integration

WHY?

- determine location and extent of an injury

- how does the injury affect movement

- provide rationale for PT

- reassess for effective treatment

afferent, efferent

In an intact system, an ______________ signal travels from PNS to the CNS where info is processed and then relayed to the body via an _______________ signal.

afferent signal

signal going to the spinal cord/brain from the skin

*by sensory neurons

efferent signal

nerve impulses carried away from the central nervous system to effectors such as muscles or glands

impairments, activity limitations, participation restrictions

Sensory dysfunction may occur in PNS, CNS, or combined systems and may result in what 3 things?

peripheral nerve injury

sensory loss along cutaneous nerve distribution

ex. stocking glove neuropathy (impaired sensation in hands and feet)

spinal nerve root injury

sensory loss along dermatome distribution

CNS lesion

sensory loss with diffuse distribution

ex. MS, Parkinson's, etc.

dermatome

"skin segment"

area of skin sensation supplied by one dorsal nerve root (SINGLE NERVE)

*cutaneous nerve distribution

**lesion at the level of the nerve root

superficial (exteroceptors), deep sensation (proprioceptors)

What are the 2 sensory receptor divisions?

superficial sensation (exteroceptors)

cutaneous & subcutaneous tissue

*perceive pain, temperature, light touch, pressure

deep sensation (proprioceptors)

muscle and joint

*position sense, joint awareness, kinesthesia, vibration

astereognosis

inability to determine an object by feel

abarognosis

inability to tell the weight of an object of difference between two

paresthesia

abnormal sensations

ex. pins and needles, prickly

dysesthesia

painful sensation

*burning, itchy

allodynia

hypersensitive response to painful stimulus that is not typically severe

hypoesthesia

reduced skin/tactile sensation

HINT: anesthesia--> total absence of skin sensation (med-induced or not)

hyperesthesia

increased sensitivity to (any) sensation

hypalgesia

diminished sensitivity to pain

HINT: analgesia = total absence of pain perception

hyperalgesia

extreme sensitivity to pain, usually used in context of total pain response

stereognosis

ability to recognize objects by feeling their form, size, and weight while the eyes are closed

*use small familiar objects of varying sizes

kinesthesia

awareness of movement in space

*move a joint through small ROM

"up/down", "left/right", "in/out"

proprioception

position sense at rest

*joint moved in small increments

**patients asked to identify or demonstrate contra-laterally at a static point

vibration

use a 128 hz tuning fork

*base on bony prominence

**can be used to detect fractures (sometimes missed by x-rays)

two-point discrimination

perception of two points of contact simultaneously

*mostly used for upper extremity

**"one" or "two" response

graphesthesia

trace figure identification

*letters, numbers, shapes "drawn" on palm

**use finger, eraser end of pencil

texture recognition

"familiar" fabrics used

*silk, cotton, wool

**identify actual fabric or describe texture (soft, smooth, rough, etc.)

barognosis

weight recognition test

*different weights placed in palm (individually or simultaneously)

**"heavier" or "lighter" response

spinal nerve

area of skin supplied by the spinal afferents of a single nerve - therefore there is almost more than one nerve root involved

deep tendon reflexes (DTR)

aka muscle stretch reflex, myotatic reflex, monosynaptic reflex

involuntary muscle contraction in response to striking muscle tendon with reflex hammer

*results from stimulation of the stretch-sensitive IA afferent nerves of neuromuscular spindle

**produces a contraction via monosynaptic path

reflex

an involuntary, predictable and specific response to a stimulus that requires an intact reflex arc

biceps, brachioradialis, triceps, achilles, patellar

List the 5 deep tendon reflexes we tested in lab.

2+

What is the "normal" value rating for a DTR?

HINT: must test both sides

Jendrassik maneuver

hooks fingers together and try to pull hands apart

*reinforces knee jerk reflex when patellar ligament is tapped

neuron replacement, conduction velocity, axon size, Meissner's corpuscles, Pacinian corpuscles

What 5 sensory changes are decreased as a person ages?