Examination Basics-Session 1

4 vital signs..

Heart Rate

Blood pressure

Respiration

Temperature

The number of times the heart contracts in a given period..

Heart rate

HR before activity..

HR during or immediately following activity..

HR 1-3 min post activity...

Resting HR

Periactivity pulse rate

Recovery pulse rate

Heart rate normal values..

Neonates: 120-160

Infants: 100-120

Children: 80-100

Adults 60-100

*younger people have higher heart rates

HR less than 60 BPM..

HR more than 100 BPM..

Bradycardia (in adults)

Tachycardia (in adults)

**measured resting

Qualities to look for in pulse..

Rhythm

-regular or irregular

Amplitude

-reflects heart's efficiency in pushing blood into the arteries; subjective rating

High pulse measurement=

Easily palpable and obliterated only by strong finger pressure=

Hard to feel or easily obliterated by slight finger pressure=

Not discernable=

+3 Bounding

+2 Normal

+1 Weak or Thready

0 Absent

Pulse presence or amplitude indicates openness of the arterial vessels..

Patency

-peripheral vascular disease

-thoracic outlet syndrome

**manual or doppler assessments

Highest a person should achieve upon maximal exertion with respect to age...

Maximal heart rate

How to calculate max heart rate?

220-age

50-90% of max heart rate..

**Calculation?

Target heart rate

Max HR x percent of target HR

Variables that impact heart rate...

Age-children are higher

Sex-men are lower

Fitness-Fit is lower

Activity-temporary increase

Autonomics-sympathetic NS is increase and parasympathetic NS is decrease

Environment-Heat is increase

Drugs-beta blockers show minimal change with activity

Methods for measuring pulse..

Palpation

Auscultation: Direct

Auscultation: Stethoscope

Dopper Sonography

ECG and portable electronic monitors

All possible palpation sites within arterial system used for pulse..

Temporal

Carotid

Brachial

Radial

Femoral

Posterior tibial

Dorsalis pedis

Popliteal

Usually for infants use the ___ for pulse.

Brachial pulse

Radial palpation how to...

Distal volar surface of the wrist lateral to the tendons of the finger flexors

Carotid palpation how to...

Lateral neck inferior to the mandibular angle; stay on the same side of the throat; avoid baroreceptor reflexes: don't massage, press too hard or assess both sides simultaneously

Brachial pulse palpation..

Medial arm midway down shaft of humerus

Femoral pulse palpation..

In the femoral triangle a strong pulse but can be covered by large muscles

Popliteal artery pulse palpation...

Posterior knee or slightly superior

Posterior tibial pulse palpation...

Posterior to medial malleolus

Dorsal pedal pulse palpation...

On the dorsum of the foot over cuboid bones

How do you document pulse?

Rate, artery, state of pulse, irregularities/abnormalities

EX: HR: radial 65 bpm, resting

Measures the degree to which hemoglobin is bound to oxygen in the circulating blood. O2 saturation or O2 sats...

Oxygen saturation

What are the normal values of oxygen saturation?

What could skew them?

Normal >95%

Exercise only if >90% (unless otherwise instructed by physician)

Skewed by fingernail polish (low skew), cold fingers (low skew), dark skin (high skew)

Normal blood pressure...

Adults: Systolic=90-140

Diastolic 60-90

Younger people tend to have lower blood pressures

Factors that effect blood pressure..

Blood volume: less=lower

Vessel size: Narrow=higher

Vessel compliance: rigid=higher

Anxiety, tobacco, eating, exertion, alcohol, pain, valsalva maneuver: higher

Normal BP value:

Elevated:

Stage 1 HTN:

Stage 2 HTN:

Hypertensive Crisis:

<120/<80 mmHg

120-139/80-89 mmHg

130-139/80-89 mmHg

>140/>90 mmHg

>180/>120 mmHg

Certain BP changes during exercise or high-level activity serve as serious warnings and exercise should be stopped if....

Systolic reading > 250 mm Hg

Diastolic reading > 115 mmHg

Drop in systolic more than 10 mm Hg from baseline

Failure of systolic pressure to increase w/ increasing workload

A decrease in BP of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing up..

Orthostatic Hypotension

*more common in older adults

A measure of vascular resistance to blood...

Blood pressure

First number: systolic (Korotkoff phase 1)...

Pressure exerted by blood against arterial walls when heart is contracting

Second number: diastolic (Korotkoff phase 5)..

Pressure exerted by arterial walls against blood when heart is not contracting

How do you document blood pressure?

Blood pressure: Seated, L UE: 115/78 mmHg

*Include patient position, artery or extremity used, systolic/diastolic, units

Normal respiratory rates...

Adults 12-20 breaths per min

**Younger individuals have higher respiratory rates

Number of full breathing cycles/minute..

Respiratory rate

One inspiration and one expiration=respiratory cycle

Characteristics of respiratory rate and quality..

Depth

*via chest movement

Rhythm

*rate and consistency

Ease

*labored/difficult or painful

Sounds

*Normal=no sound

If the SCM, trap, or scalene muscles are moving during respiration..

The patient is most likely experiencing difficulty breathing

How do you document respiratory rate?

RR: 15 bpm

*note any abnormalities

How do you document temperature?

Temp: 98.0*F tympanic

*note temperature, location taken and any abnormalities

Pain is a ___ measure and the patient should score their pain without us choosing the number for them..

Subjective measure

*give them time to describe their pain

*ask best, worst or current levels

How do you document pain?

Document at level at worst, best, and current

Include scale used

Document quality (ex: burning, ache, stab, etc)

Cognition Alert and oriented x3 test? x4 test?

1. Who are you?

2. Where are you?

3. What time is it?

4. What are you doing right now?

Common tools for balance tests..

Berb balance test

Tinetti POMA

Anthropometrics measurements include...

height

weight

BMI

Does the Berg Balance test or the Tinetti POMA test gait AND balance?

Tinetti Poma

How is the Berg Balance test scored?

0-4 with 0=lowest and 4=highest

Interpretation of scoring consists of...

41-56=independent

21-40=walking with assistance

0-20=wheelchair bound

A score of <45 on the Berg Balance test indicates...

Individuals may be at greater risk of falling

How is the Tinetti POMA (performance orientated mobility assessment) scored?

0-2 with 0 being the lowest

The Balance score is out of..

The gait score is out of...

16

12

How are the Tinetti POMA scores interpreted?

25-28= low fall risk

19-24= medium fall risk

<19= high fall risk