Copy of CMA TRAINEE STUDY SHEET 2

Normal Ranges for Blood Pressure and Hypertension Classification

Blood pressure is categorized by age groups and clinical thresholds. For individuals older than 12 years, the normal range is a systolic of 110−130 mmHg110-130\,mmHg and a diastolic of 65−80 mmHg65-80\,mmHg. For children aged 6-12 years, the range is 100−120/60−75 mmHg100-120/60-75\,mmHg. Children aged 3-6 years should have a pressure of 95−110/60−75 mmHg95-110/60-75\,mmHg, and toddlers aged 1-3 years should be between 90−105/55−70 mmHg90-105/55-70\,mmHg. It is essential to note that Systolic is the top number of blood pressure, representing the FIRST sharp thump sound heard during auscultation. Diastolic is the bottom number, noted when the LAST sound disappears.

The stages of hypertension are clinically defined for adults. A Normal category is less than 120 mmHg120\,mmHg systolic and less than 80 mmHg80\,mmHg diastolic. Elevated blood pressure is 120−129 mmHg120-129\,mmHg systolic and less than 80 mmHg80\,mmHg diastolic. Stage 1 hypertension is diagnosed at 130−139 mmHg130-139\,mmHg systolic or 80−89 mmHg80-89\,mmHg diastolic. Stage 2 hypertension involves a systolic of 140 mmHg140\,mmHg or higher or a diastolic of 90 mmHg90\,mmHg or higher. A Hypertension crisis is a medical emergency defined as a systolic higher than 180 mmHg180\,mmHg or a diastolic higher than 120 mmHg120\,mmHg.

Proper blood pressure measurement requires selecting the correct cuff size based on upper arm circumference. A small adult cuff is for 8.7−10.2 in8.7-10.2\,in. The standard adult cuff serves 10.6−13.4 in10.6-13.4\,in. A large adult cuff is used for 13.8−17.3 in13.8-17.3\,in, and an X-Large adult cuff is required for circumferences of 17.7−20.5 in17.7-20.5\,in.

Artery Locations and Pulse Assessment

Pulse is evaluated based on rate, rhythm (or regularity), and volume (or strength). Major arteries used for assessment include the Temporal (side of forehead), Femoral (inner groin), Popliteal (behind the knee), Posterior tibial (behind the ankle), Dorsalis Pedis (top of the foot), Radial (thumb side of the wrist), Brachial (inside the upper arm), and Carotid (neck below the jawbone).

Pulse ranges vary significantly by age. For adolescents or older individuals, the normal rate is 60−100 bpm60-100\,bpm. School-aged children (6-15) range from 75−118 bpm75-118\,bpm. Preschoolers (3-5) exhibit rates of 80−120 bpm80-120\,bpm. Toddlers (1-2) are between 98−140 bpm98-140\,bpm, and infants (1 month to 12 months) maintain 100−180 bpm100-180\,bpm. Additionally, adult height should be measured to the nearest quarter of an inch during physical exams.

Respiratory Functions and Abnormal Breathing Patterns

Respiration involves one complete inhalation and exhalation, visually indicated by the rise and fall of the chest. It is evaluated on rate, rhythm, and depth. Normal respiratory rates per minute are 12−2012-20 for adolescents/adults, 18−2518-25 for school-age (6-15), 20−2820-28 for preschoolers (3-5), 22−3722-37 for toddlers (1-2), and 30−5330-53 for infants.

Abnormal breathing patterns are categorized as follows:

  • Hyperventilation: Fast, rapid breathing often caused by intense pain, anxiety, or panic attacks.

  • Hyperpnea: Excessively deep breathing caused by extreme pain or anxiety.

  • Dyspnea: Difficult or painful breathing associated with COPD, pneumonia, asthma, high altitudes, or physical exertion.

  • Orthopnea: Difficulty breathing unless sitting upright, common in congestive heart failure and COPD.

  • Wheezing: A whistling sound during breathing, typically due to asthma.

  • Rales: Small clicking, bubbling, or rattling sounds indicating fluid in air sacs or pneumonia.

  • Rhonchi: Large airway sounds heard in COPD, chronic bronchitis, or pneumonia.

Thermometry, Pulse Oximetry, and Body Mass Index

Temperature norms are site-dependent. A newborn measured axillary has a norm of 98.2∘F98.2^{\circ}F (36.8∘C36.8^{\circ}C). A 1-year-old measured tympanically is 99.7∘F99.7^{\circ}F (37.6∘C37.6^{\circ}C). From age 6 through adulthood, the oral norm is 98.6∘F98.6^{\circ}F (37∘C37^{\circ}C). For those over 70, the oral norm drops to 96.8∘F96.8^{\circ}F (36∘C36^{\circ}C). Pyrexia (fever) is most commonly caused by infection. To ensure accuracy, patients should avoid drinking hot/cold liquids, chewing gum, or smoking prior to an oral temperature reading.

Temperature conversion formulas are essential:

  • Celsius to Fahrenheit: ∘F=(∘C+32)×1.8^{\circ}F = (^{\circ}C + 32) \times 1.8

  • Fahrenheit to Celsius: ∘C=(∘F−32)1.8^{\circ}C = \frac{(^{\circ}F - 32)}{1.8}

Pulse oximetry measures blood oxygen saturation. A normal range is