Vital Signs, Patient Assessment, and Medication (CCMA)

temperature

pulse

respiration

blood pressure

what are the 4 main vital signs?

temperature, pulse, respiration

what does TPR stand for?

height, weight, body mass index (BMI)

what are the anthropometric measurements?

systolic pressure

the highest blood pressure level that occurs when the heart is contracting

diastolic pressure

the lowest blood pressure level that occurs when the heart is contracting

systolic/diastolic, mmHg

how is BP recorded? what is the measure in?

systole

contraction of the heart

diastole

relaxation of the heart

lower BP

a decrease in blood volume causes a...

higher BP

a higher blood viscosity causes a...

greater peripheral resistance, higher BP

a smaller lumen (diameter) of the artery causes....

systolic higher than 140mmHg

diastolic higher than 90mmHg

what BP reading defines hypertension?

essential hypertension

the most common type of hypertension; occurs when a patient with no other health problems has a BP over 140/90

secondary hypertension

hypertension that occurs due to an underlying pathologic conditions; causes a BP over 140/90

less than 120/80 mmHg

greater than 100/60 mmHg

what range is a normal adult BP in?

systolic: 60-96

diastolic: 30-62

what range is a normal for a newborn's BP?

systolic: 78-112

diastolic: 48-78

what range is a normal for a toddler's (1-3 yo) BP?

systolic: 78-112

diastolic: 50-79

what range is a normal for a young child's (4-6 yo) BP?

systolic: 85-114

diastolic: 52-79

what range is a normal for a child's (7-11 yo) BP?

systolic: 94-119

diastolic: 58-79

what range is a normal for an adolescent's BP?

systolic: 120-139 mmHg

diastolic: 80-89 mmHg

what BP range indicates prehypertension?

systolic: 140-159 mmHg

diastolic: 90-99 mmHg

what BP range indicates stage 1 hypertension?

systolic: over 160 mmHg

diastolic: over 100 mmHg

what BP range indicates stage 2 hypertension?

systolic: below 90 mmHg

diastolic: below 60 mmHg

what BP range indicates hypotension?

using a Sphygmomanometer

1. feel for the brachial artery pulse in the inner elbow crease. place the diaphragm of the stethoscope over this point.

2. close the valve on the bulb and pump rapidly to 160-180 mmHg, or until 30 mmHg above your typical systolic pressure.

3. slowly open the valve to allow the pressure to fall at a rate of roughly 2-3 mmHg per second.

4: identify systolic: note the gauge reading when you hear the first rhythmic tapping sound.

5: identify diastolic: continue listening as the pressure falls until the sound disappears.

6. deflate: quickly release all remaining air

how do you manually take blood pressure?

diastolic pressure is up to 5 mmHg higher

what change occurs in BP when the patient is sitting (vs. in supine position)?

diastolic pressure increases 6 mmHg

what change occurs in BP when the patient is unsupported?

systolic pressure may be raised by 2-8 mmHg

what change occurs in BP when the patient's legs are crossed?

Korotkoff sounds

series of sounds that correspond to changes in blood flow through an artery as pressure is released

sharp, tapping sound as blood resurges into the patient's artery

where systolic BP is recorded

Korotkoff Phase I

swishing sound, as more blood flows through artery.

Korotkoff Phase II

sharp, rhythmic tapping

Korotkoff Phase III

soft tapping, which grows fainter as the blood is flowing easily

where diastolic BP is recorded for children.

Korotkoff Phase IV

all sounds disappear

where diastolic BP is recorded

Korotkoff Phase V

pulse

a measurement of the blood as the heart circulates it through the body. felt as a small movement under the skin in areas of the body where the artery is close to the surface.

stroke volume

the amount of blood ejected from the heart in one contraction (amount of blood pumped into aorta)

60-100 bpm

what is the normal pulse rate of a healthy adult/adolescent?

120-160 bpm

what is the normal pulse rate of a healthy neonate (0-30 days)?

80-140 bpm

what is the normal pulse rate of a healthy toddler (1-2 yo)?

75-120 bpm

what is the normal pulse rate of a healthy young child (3-6 yo)?

75-110 bpm

what is the normal pulse rate of a healthy child (7-11 yo)?

radial artery

major artery in the forearm, most common site to palpate a pulse.

at the wrist on the thumb side.

apical pulse

pulse taken with a stethoscope and near the apex of the heart

carotid pulse

the pulse felt along the large carotid artery on either side of the neck. between the larynx and the sternocleidomastoid muscle.

most commonly used in emergency situations

brachial pulse

pulse point at the inner (antecubital) aspect of the elbow.

most commonly used in infants and small children.

temporal pulse

pulse point located in the temples of the head, parallel/lateral to the eyes

used to evaluate circulation to the head and brain, not necessarily to palpate pulse rate.

femoral pulse

pulse of the femoral artery felt in the groin

popliteal pulse

pulse felt at the back of either knee; lower part of femoral artery

dorsalis pedis (pedal) pulse

pulse felt across the arch of the foot, slightly lateral to the midline, beside the extensor tendon of the great toe.

used to evaluate circulation of the leg, not necessarily to palpate pulse rate.

the apical pulse

if the radial pulse shows irregularity, this pulse point should be used instead:

irregular pulse

pulse is uneven and there is an unequal amount of time between beats.

arrythmia

rhythm is irregular, resulting in an abnormal pulse.

intermittent pulse

pulse in which beats are occasionally skipped; runs in an otherwise regular pulse

can occur with exercise or after drinking caffeinated beverages

premature ventricular contractions (PVCs)

occurs when a heartbeat does not result in blood being ejected; causing skipped beats

pulse volume

strength of the pulse, affected by force of the heartbeat, the strength of the cardiac contraction, and the condition of the arterial wall.

thready pulse

a pulse with a decreased volume that feels weak and thin, hard to palpate

often due to insufficient circulation of blood, not providing enough oxygen to cells.

bounding pulse

a pulse that is very strong (sometimes even visible on the skin surface).

often felt in patients with hypertension.

0.45 kg

1 lb = ____ kg

2.2 lb

1 kg = ____ lb

2.54 cm

1 in = ____ cm

30.48 cm

1 ft = ____ cm

kg/m^2

BMI =

rate

rhythm

depth

3 things to note when taking respirations

30-50 breaths/min

what is the normal respiratory rate of a newborn?

20-30 breaths/min

what is the normal respiratory rate of a toddler (1-3 yo)?

18-26 breaths/min

what is the normal respiratory rate of a young child (4-6 yo)?

16-22 breaths/min

what is the normal respiratory rate of a child (7-11 yo)?

12-20 breaths/min

what is the normal respiratory rate of an adolescent/adult?

dyspnea

difficult or labored breathing

bradypnea

respirations that are regular in rhythm, but slower than normal in rate

apnea

absence or cessation of breathing

tachypnea

rapid, shallow breathing

hypernea

an increase in the depth of breathing that is usually accompanied by hyperventilation

hyperventilation

abnormally prolonged and deep breathing that is usually associated with acute anxiety, emotional distress, or pain

orthopnea

a condition in which the patient must sit or stand to breathe comfortably; often occurring for patients diagnosed with congestive heart failure (CHF) or COPD

wheezing

a high-pitched breath sound heard on expiration, indicative of obstruction or narrowing of respiratory passages, that often occurs with patients who are diagnosed with asthma

rales

abnormal or crackling breath sounds during inspiration

rhonchi

abnormal rumbling sounds on expiration that indicate airway obstruction by thick secretions (mucus) or spasms.

stertorous breathing

strenuous respiratory effort marked by a snoring sound.

cyanosis

skin coloring changes to a bluish color, especially around the mouth and nail beds, due to being unable to inhale enough oxygen, causing increased CO2 in blood

98.2ºF (axillary!)

what is the normal temperature for a newborn?

99.7ºF

what is the normal temperature for a 1 yo?

98.6ºF

what is the normal temperature for someone 6yo-adult?

96.8ºF (orally!)

what is the normal temperature for an elderly person (over 70 yo)?

97.6ºF

what is the normal temperature at the axillary site?

°F = (°C × 9/5) + 32

how to convert ºC to ºF

°C = (°F - 32) × 5/9

how to convert ºF to ºC

continuous fever

a fever in which temperature remains above normal throughout a 24-hour period and fluctuates less than 3 degrees.

intermittent fever

fever which comes and goes over a 24-hour period, alternating between elevated and normal levels.

remittent fever

fever which fluctuates considerably by more than 3 degrees, but the body temperature tends to remain above the normal range.

S: subjective

O: objective

A: assessment

P: plan

what does SOAP notes stand for?

subjective data (S in SOAP)

purpose of the visit, with the patient's words in quotation marks, or a summary of the patient's statement about the chief complaint

objective data (O in SOAP)

observed or measurable data such as vital signs, the exact anatomic location of an injury, and difficulty with gait

inspection

palpation

percussion

auscultation

mensuration

manipulation

what are the 6 methods of examination?

inspection

observation to detect significant physical features or objective data

general appearance, body contour, gait, symmetry, visible injuries and deformities, tremors, rashes, and color changes.

palpation

touching the skin or performing a firmer exploration for underlying masses, often involving the abdomen

percussion

examination technique that It is performed by tapping or striking the body with the fingers or a small hammer to elicit sounds or vibratory sensations.

determines position, size, density, and amount of air in an underlying organ/cavity

auscultation

using a stethoscope to listen to sounds arising from the body.

useful for evaluating sounds originating in the lungs, heart (murmur or bruit), and abdomen (bowel sounds).

mensuration

process of measuring

height and weight, the length and diameter of an extremity, the extent of flexion or extension of an extremity, the size of the uterus during pregnancy, the size and depth of a wound, and the pressure of a grip

manipulation

passive movement of a joint that is used to determine the range of extension or flexion of the body part.