CH.6 VITAL SIGNS, LABORATORY TESTS, AND OXYGEN ADMINISTRATION

What are vital signs?

• do not require MD order

• RT’s can take vitals signs when RN is not present

When are vital signs taken by RT when RN isn’t present?

• when a patient condition suddenly changes

• before/after an invasive procedure involving medicine

• if patient states non specific symptoms of distress

• document in chart or report to RN/MD when completed

types of vital signs

body temperature, pulse, respiration, and blood pressure

body temperature

balance of heat produces in the tissues to heat lost to the environment

What is the hypothalamus?

body’s thermostat, regulated in the brain. changes occur with difference of 2-3 degree F

Signs and symptoms of body temperature

changes in patient skin color, cold, clammy, heat, sweating

body temperature normal limits effects

change in weather, exercise, environment, gender, weight, hormones, emotions, digestion of food, and disease

body temperature abnormal limits effects

when cellular functions and cardiopulmonary demands change in proportion to the outside environment

prexia

fever

hypothermia

below normal body temp

dehydration

body loses more fluids than it takes in

measuring body temperature

oral = O

tympatic temp = T

temporal = Tm

axillary temp = Ax

rectal temp = R

Why don’t you use thumb when measuring pulse?

It has it’s own pulse

adult pulse

60-90 bpm

child pulse 4-10 years

90-100 bpm

infant pulse

120 bmp

where do you find a apical pulse?

stethoscople over tup of the heart

Where do you find radial pulse?

Wrist, find with finger tips (not thumb)

Where do you find carotid pulse?

Under jaw side of the neck

Where do you find brachial pulse?

In children, near arm pit

Where do you find femoral pulse?

Medical part of groin area in the leg

Where do you find popliteal pulse?

Behind the knee, center of joint

Where do you find temporal pulse?

Side of face, forehead area

Where do you find pedal (dorsal) pulse?

top of foot/side of foot

types of assessment of patients pulse

tachycardia - high heart rate, above 100 bpm

bradycardia - low heart rate, below 60 bpm

What is the respiratory system?

• to exchange oxygen and carbon dioxide

• between the environment (breathe) and cells in the blood

• gas exchange occurs in alveolar lungs and capillaries

• carbon dioxide is exhaled during expiration

• avg rate - one inspiration and one expiration

How many respiration beats in adults?

15-20 bpm

How many respiration beats in infants?

30-60 bpm

types of respiration assessments

dyspnea and cyanosis

dyspnea

shortness of breath

pulmonary embolus (blood clots)

cynaosis

signs and symptoms of oxygen depletion

fewer than 10 bpm

restlessness

apprehension

How is blood pressure measured?

Blood flow x resistance

hemorrhage

trauma or injury causes low blood volume

RBCs/plasma determines viscosity (thickness) of the blood

atherosclerosis

increases plaque in blood

can cause high BP

sphygmomanometer

measures bp by two numbers mm of Mercury Hg

systolic (number on top)

contraction (highest phase), pumping phase of left ventricle

diastolic (number at bottom)

relaxation phase (lowest point)

normal BP in adults

120 mm Hg/ 80 mmHg

normal BP in adolescents

85-135 mm Hg/45-85 mm Hg

blood pressure conditions

hypertensive

hypotensive

orthostatic hypotension

hypertensive

high blood pressure

140/90 mmHg or higher

critical = 180/120mm Hg

hypotensive

low blood pressure, systolic below 90 mm Hg

orthostatic hypotension

occurs when a patient has been recumbent for a lengthy period of time, causing the blood pressure to be low, and the patient may faint upon standing

oxygen

• essential for brain function

• brain tissue will being to atrophy (die) after 4-5 minutes without adequate oxygen supply

• oxygen is not stored in the body

hypoxemia

less oxygen is being pumped through the blood to the cells

hypercapnia

carbon dioxide is retained in the blood, lack of circulation

What does COPD stand for?

chronic obstructive pulmonary disease

normal levels of oxygen

95-100% (concern under 90%)

creatinine

renal function

normal range 0.6-1.2 mg/dl

GFR

glomerular filtration rate >30 (textbook >60)

calculated by creatinine and patients age online

BUN

blood, urine, nitrogren

how hydrated patient can be

renal function

normal range 7-20 mg/dl

What is normal blood pressure reading?

120 mm Hg/ 80 mm Hg

What does baseline BP mean?

resting measurement when you are healthy

What does cyanotic mean?

lack of oxygen

Critical values for pulse?

140/90 mm Hg or higher

180/120 mm Hg

below 90 mm Hg

What is a normal respiration rate?

adult 15-20 bpm

infant 30-60 bpm

Where do you find the pulse for CPR?

carotid - under jaw side of neck

What does GFR mean? How/why is it calculated?

glomerular filtration rate

calculated by creatinine and patients age online

detects early kidney damage

When should vital signs be taken by the radiographer?

• when a patient is brought into the diagnostic imaging department for any invasive diagnostic procedure or treatment

• before and after the patient receives medication

• any time the patients genral condition suddenly changes

• if the patient reports nonspecific symptoms of physical distress, such as simply not feeling well or “different”

What body temperature is it rare to survive?

105.8 F -111.2 F

oral temperature

most accurate reading on adults and children over 4

tympanic membrane thermometer

also called aural thermomter

axillary temperature

safest way to take temp bc it’s not invasive

useful when taking infant temp

rectal temperature

most reliable measurement of body temperature because factors that can alter the results are minimized

taken only on infants, not adults

temporal temperature

taken 2 ways: scanner and touchless

contactless temperature recognition

useful for scanning everyones temp that enters a facility

doesnt give an actual temperature reading but rather an indication of normal or abnormal

What type of pulse measurement is most accessible on the adult patient?

radial pulse and should be counted for one full minute

If there is any irregularity in the radial pulse rate, what pulse should you use?

apical pulse and carotid pulse

What pulse is most accurate for cardiovascular assessment?

apical pulse

equipment needed to assess the pulse

a watch with a second hand and a pad and pencil to record findings

What do you need to monitor a apical pulse?

a stethoscope that has been cleaned

Where is cyanosis easily observed?

around mouth, in the gums, in nail beds, or in the earlobes

Adolescents have lowest BP overall. T/F

true

pulse pressure

difference between the systolic and diastolic blood pressure and is an indicator of the stroke volume of the heart

decreases when a patient is in a state of hypovolemic shock

What sphygmomanometer is most accurate?

Mercury manometer

What does an automated vital sign monitor do?

measures pulse, BP, and mean arterial pressire

Korotkoff sounds

tapping, knocking, or swishing sounds

Where should blood pressure be taken?

Left arm above brachial artery

oxygen tension

amount of oxygen in either air or blood and is written as PO2.

What is the purpose of pulse oximetry?

check how well the heart is pumping oxygen through the body

What conditions can affect blood oxygen levels?

• chronic obstructive pulmonary disease (COPD)

• asthma

• pneumonia

• lung cancer

• anemia

• heart attack or heart failure

• congential heart defects

What are reasons for performing pulse oximetry?

• to assess how well a lung medication is working

• to evaluate whether a patient needs help breathing

• to evaluate how helpful a ventilator is

• to monitor oxygen levels during or after procedures that require sedation

• to determine how effective supplemental oxygen therapy is, especially when treatment is new

• to assess a patients ability to tolerate increased physical activity

What is pulse oximetry abbreviation?

SaO2

How can creatinine clearance be measured?

calculated by a formula using serum (blood) creatinine level, patients weight, and age

What does it mean if the GFR falls to 15 and lower?

signs of kidney failure

red blood cells (erythocytes)

carry oxygen from the lungs to the body tissues and cardio dioxide as a waste product, away from the tissues and back to the lungs

hemoglobin

carries oxygen from the lungs to the tissues of the body

platelets

cells help in the clotting process by gathering at a bleeding site and clumping together to form a plug

thrombocytosis

excessive clotting in smaller vessels, especially in heart or brain

prothrombin time

test used to help detect and diagnose a bleeding disorder or excessive clotting disorder

What is prothrombin time used for?

To measure how blood thinners are working

Which of the following are essential parts of the initial assessment of a patient who is in the diagnostic imagining department for an invasive procedure?

Taking a blood pressure, taking a pulse, taking a temperature

Why is the initial assessment so important to perform?

to establish a baseline

Systolic blood pressure can be defined as

the highest point reached during contraction of the left ventricle

What range of breaths per munute is the normal adult respiratory rate?

15 to 20

An adult patient is considered to be hypertensive or to have hypertension if the systolic blood pressure and diastolic blood pressure are consistently greater than

140 systolic and 90 diastolic

Oxygen can be toxic to patients if it is incorrectly used. State two reasons why this is so.

• excessive amounts of oxygen may produce toxic effects to the lungs and central nervous system or may depress ventilation

A patient may be considered to have tachycardia if the pulse rate is higher than

90 bpm

Which of the following items must be in the diagnostic imaging department and in working order?

• oxygen (usually wall-mounted)

• blood pressure equipment