STEP Test Vitals!!

Difference between sign and symptom?

Signs are measured while symptoms are spoken

HR for neonates?

120-160 per minute

Age for neonates?

1-28 day

HR for infants?

100-120

Age for infants?

1-12 months

HR for children?

80-100

Age for children?

1-8 years

HR for adults?

60-100

What is normal pulse rate?

+2

What is bounding pulse rate?

+3

What does bounding pulse rate mean?

Readily palpable, forceful, not easily obliterated by finger pressure

What is a weak pulse rate?

+1

How to estimate maximum heart rate?

220-age

What is the target HR equation?

Max HR * desired intensity

What is the modified target HR?

Resting HR + 20 bpm

Why would you use the modified target HR?

Patients on medications that affect their natural heart rate

What is zone 1 for HR?

Moderate to low intensity; about 50-60% max HR

What is zone 2 HR?

Moderate; about 60-70% max HR

What is zone 3 HR?

Moderate-high; about 70-80% max HR

What is zone 4 HR?

High; about 80-90% max HR

What is zone 5 HR?

Very high; about 90-100% max HR

What is heart rate variability?

The variation in time between heartbeats

Is heart rate variability better or worse when high?

Good; suggests that your body is in a “rest-and-digest” mode more often than “fight-or-flight”

What does the systolic pressure indicate?

Pressure at ventricular contraction (pushing blood into the aorta)

What does diastolic pressure indicate?

Pressure at ventricular relaxation and refilling

Normal BP for neonates?

>60/variable

Normal BP for infants?

70-95/variable

Normal BP for children?

80-110/variable

Normal BP for adults?

90-140/60-90

Elevated BP?

120-139/<80

Stage 1 HTN?

130-139/80-89

Stage 2 HTN?

140/>90

Crisis BP?

>180/>120

What is orthostatic hypotension?

Decrease >20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing up

Phase I Korotkoff sound?

Clear tapping sound heard, often faint at first but increasing; indicates the systolic BP

Phase II Korotkoff sound?

Softer sound, may be a swishing sound or murmur

Phase III Korotkoff sound?

Louder and more distinct sound/murmur

Phase IV Korotkoff sound?

Sound changes from distinct to muffled

Phase V Korotkoff sound?

Cessation of sound; diastolic BP

What is the auscultatory gap?

Temporary absence of Korotkoff sounds during manual blood pressure reading which can underestimate systolic BP and overestimate diastolic BP

RR for neonates?

40-60

RR for infants?

25-50

RR for children?

15-30

RR for adults?

12-20

Function of the frontal lobe?

Executive functions, behavioral control

Function of parietal lobe?

Sensory perception, understanding language, mathematical calculations

Function of occipital lobe?

Spatial awareness, visual perception

Function of cerebellum?

Coordinates movements, controls posture, balance, and fine motor movements

Function of brainstem?

Balance, breathing, reflexes, operations required to survive

Function of temporal lobe?

Memory, understanding, language

What do you use to test deep sensations/vibrations?

128 Hz tuning fork

What is sterognosis?

Identification of objects by touch

What is graphesthesia?

Recognition of writing by touch

What is extinction?

Perception of tactile or visual stimuli on only one side when applied bilaterally

Damage to the cerebellum would cause?

Disturbance of voluntary movement, coordination, gait, muscle tone, and equilibrium

Mandibular elevation muscles?

Masseter, medial pterygoid, temporalis

Mandibular depression muscles?

Lateral pterygoid

Mandibular protrusion muscles?

Medial pterygoid, lateral pterygoid, masseter

Mandibular retraction muscles?

Temporalis

Mandibular rotation muscles?

Lateral pterygoid (contralateral) and medial pterygoid (contralateral)

Occipitofrontalis action?

Raises eyebrows and wrinkles forehead

Corrugator supercilii action?

Pulls eyebrows to midline as in frowning

Orbicularis oculi action?

Closes eyes tightly

Procerus action?

Raises skin of nose toward forehead while pulling eyebrows medially

Nasalis action?

Flares nostrils

Levator labii superioris action?

Raise upper lip as in showing teeth and gums

Levator anguli oris action?

Raise one side of upper lip as in sneering

Zygomaticus major action?

Smile

Orbicularis oris action?

Compresses and protrudes the lips

Risorius action?

Pulls lateral angle of lip directly downward

Buccinator action?

Pulls cheeks in against molars and pulls angle of mouth directly backward as in playing a trumpet

Depressor anguli oris action?

Pulls lateral angle of lips downward

Mentalis action?

Raises skin of chin while protruding lower lip

Depressor labii inferioris and platysma action?

Pulls lateral angle of lips downward and backward while tensing skin of neck

Biceps DTR?

C5-C6

Brachioradialis DTR?

C5-C6

Triceps DTR?

C6-C7

Quadriceps DTR?

L2-L4

Posterior tibialis DTR?

L4-L5

Medial HS DTR?

L5-S1

Lateral HS DTR?

S1-S2

Gastrocnemius/soleus DTR?

S1-S2

Abdominal reflex DTR?

T8-10 or T10-T12

Muscles that help with inspiration?

SCM, Pec major and minor, serratus anterior, subclavius, lats, trapezius, iliocostalis, and quadratus lumborum

Muscles that help with forced expiration?

Transverse abdominis, internal and external obliques, rectus abdominis, intercostals, transversus thoracis, and quadratus lumborum

What is dyspnea?

Difficulty breathing

What is bendopnea?

Shortness of breath when bending forward

How does the Borg Dyspnea Scale work?

Increased # = Increased fatigue or difficulty of breathing

Wheeze sound?

Low- or high-pitched whistling; occurs upon expiration and sometimes with inspiration

Stridor sound?

High-pitched, indicative of respiratory obstruction

Crackles sound?

Short, sharp, or rough sounds similar to bubbling or rubbing fingers. Associated with congestive heart failure or pleurisy

Normal temperature?

98.6 F

Hypothermia temperature?

<95 F

Hyperthermia temperature?

>104 F

Normal capillary refill test?

2-3 seconds

What is deep vein thrombosis?

Blood clot forms in a deep vein caused by damage to tissues, excessive blood clotting or impaired venous return

What is intermittent claudication?

Ischemic pain when activity-induced demand for oxygen is not met caused by narrowing of the vessels secondary to peripheral artery disease

What is the Trendelenburg position?

Patient in supine with the table at a 15-30 degree incline so head of bed is lower than feet

What is the Sims position for a one-quarter turn from prone?

Pillow between legs with top leg flexed

What is Fowler’s position?

Supine with HOB at 45-60 degrees