HB

Week 11 Notes: Vital Signs and Deteriorating Patients

Week 11 Recap

  • Assessment Task 3:
    • Markers: Kim and [Lecturer's Name].
    • Focus: Pre-procedural check.
    • Feedback: Extensive feedback provided, mirroring classroom discussions.
  • Assessment Task 4:
    • Focus: Workplace health and safety (safe patient handling, hand hygiene, infection control).
    • Due: Next week.
    • Format: E-modules culminating in a quiz.
    • Quiz Attempt: Single attempt allowed.
    • Questions: Questions will only be answered after the due date to ensure fairness.
  • Final Exam:
    • Date: June 19th, Thursday at 10:00 AM.
    • Duration: 1 hour.
    • Access: Via Brightspace page.
    • Technical Issues: Contact the exams technical hotline.
    • Screenshots: Recommended to screenshot errors and send via email.

Today's Content

  • Accidental Injury & Suspected Physical Abuse: Aligns with Emma's content on ethics and law but presented from a clinical perspective.
  • Vital Signs: An important aspect of recognizing a deteriorating patient.
  • Sensitivity: The topic of non-accidental injury can be sensitive.

Learning Objectives

  • Patient Safety: Fundamental concern in any healthcare institution.
  • Early Detection: Vital to detect clinical deterioration to mitigate adverse outcomes.

Vital Signs Overview

  • Definition: Objective measurements to assess physiological function.
  • Accuracy: Accurate predictor of acute deterioration.
  • Importance: Recognize normal vs. abnormal to call for help when needed.
  • Traditional Vital Signs: Heart rate, temperature, oxygen within bloodstream, respiratory rate, blood pressure.
  • Acute Clinical Reactions: Necessary to manage patient deterioration and communicate with colleagues.

Body Temperature

  • Variability: Influenced by external and internal factors.
  • Definition: Measurement of the degree of heat of deep body tissues.
  • Normal Range: 36.5 degrees Celsius to 37.5 degrees Celsius.
  • Fever/Pyrexia: Above 37.5 degrees Celsius, indicates infection or inflammation.
  • Hyperthermia: Elevated body temperature.
  • Hypothermia: Lowering beneath 36.5 degrees Celsius.
  • Hypothalamus: Regulates body temperature to maintain homeostasis (balanced state).
    • Cooling Mechanism: Sweating when hot.
    • Warming Mechanism: Shivering when cold.
    • Vasoconstriction: Narrowing of blood vessels to reduce blood flow to periphery and preserve core temperature.

Measurement of Body Temperature

  • Methods: Axilla (armpit), ear probes, thermal temperature probes (forehead), sublingual pocket (under tongue).
  • Clinical Use: Ear probes are commonly used.

Respiratory Rate

  • Definition: Number of breaths taken in 60 seconds.
  • Normal Rate (Adult): 12 to 20 breaths per minute.
  • Abnormal Rate: Under 12 or over 25 breaths per minute.
  • Significance: General impression of respiratory system status.
  • Terms:
    • Bradypnea: Less than 12 breaths per minute.
    • Tachypnea: Over 25 breaths per minute.
  • Considerations: Depth and pattern of breathing.
  • Interrelation: Vital signs are interrelated; abnormalities often occur collectively.

Tachypnea (Rapid Breathing)

  • Definition: Respiratory rate over 20-25 breaths per minute in an adult.
  • Causes:
    • Exercise:
      • Increased oxygen demand.
    • Stress, anxiety, panic attacks:
      • Clinical context is key.
    • Pathological Conditions:
      • Pain, pneumonia, aspiration, trauma, heart failure.
  • Patient Input: "Is this normal breathing for you?"

Bradypnea (Slow Breathing)

  • Definition: Ventilation less than 12 breaths per minute.
  • Causes:
    • Drug Use/Overdose:
      • Derangement of metabolism.
    • Head Trauma:
      • Affects central nervous system's control of breathing.
    • Hypothermia:
      • Body conserves core temperature.

Pulse Rate (Heart Rate)

  • Definition: Number of heartbeats in a minute.
  • Measurement Sites:
    • Radial artery (wrist).
    • Brachial artery (inner elbow).
    • Carotid artery (neck).
    • Listening to chest with stethoscope.
  • Normal Range: 60 to 100 beats per minute (resting).
  • Influencing Factors:
    • Fitness level.
    • Age.
    • Smoking.
    • Cardiovascular disease.
    • Emotions, anxiety.

Pulse Rate Terminology

  • Tachycardia: Pulse rate exceeding 100 beats per minute.
  • Bradycardia: Pulse rate lower than 60 beats per minute.

Oxygen Demand and Pulse Rate

  • Heart's Role:
    • Maintain homeostasis by providing oxygenated blood to cells.
  • Increased Demand:
    • Exercise, anemia, respiratory disorders, heart failure.
  • Bradycardia:
    • Hypothermia (body conserves core temperature).

Personal Baseline

  • Importance of Knowing Your Body: Patients aware of their normal heart rate, activity level.
  • Communication: Inform healthcare providers of your baseline heart rate, especially if low.

Blood Pressure

  • Definition: Force exerted on arterial walls.
  • Hemodynamic Condition: State of blood flow, ensuring perfusion of organs.
  • Hemodynamically Unstable: Inadequate blood flow, not meeting circulatory system needs.
  • Diastolic Pressure: Heart relaxed, receiving blood.
  • Systolic Pressure: Heart pumping, peak pressure.
  • Normal Blood Pressure: 120/80.
  • Hypertension: Persistent blood pressure over 140/90.
  • Acute vs. Persistent:
    • Acute: Indicates acute deterioration.
    • Persistent: May indicate underlying conditions.
  • Variability: Blood pressure varies.
  • Drop in Blood Pressure:
    • Significant trauma leads to fluctuating BP.

Blood Pressure Levels

  • Healthy Range: Systolic 95-140; Diastolic: 60-90.
  • Low Blood Pressure: Less than 95/60.
  • High Blood Pressure: Over 140/90.

Between the Flags Approach

  • Concept: System for escalating patient care based on vital signs.
  • Stable Patient: Vital signs within safe limits.
  • Observations: Four-hourly observations to monitor vital signs.
  • Blue Flags: For vulnerable patients (babies, children, maternity patients).
  • Yellow/Red Flags: For adult patients, indicate need for clinical review or rapid response.
  • Clinical Review: Additional clinicians review within 30 minutes.
  • Rapid Response: Immediate team deployed for acute deterioration.
  • Radiographer's Role: May be called for mobile chest X-ray or urgent head CT.

Escalation Protocols

  • Private Facilities: Call 000 for rapid response.
  • Healthcare Facilities (NSW Health): Use 2222 for urgent responder.
  • Clear Communication: Provide name, location, and patient type (adult or pediatric).
  • Increased Frequency of Observations (Blue).
  • Clinical Review:
    • Patient may be drifting.
  • Rapid Response:
    • Team immediately deployed.
  • Escorting:
    • Inquire if breathing is normal for patients being escorted.

Recognizing a Deteriorating Patient

  • Workplace Learning: Required before clinical practice.
  • Supervision: Never left alone; always supervised.
  • Basic Life Support: Assisting in acute deterioration.
  • Integration: Workplace health and safety and communication is key.

Scenario 1: Bleeding Outpatient

  • Situation: Patient with blood dripping down arm after cannula removal.
  • Response:
    • Stop patient in place.
    • Have patient sit down.
    • Implement PPE.
    • Escalate if needed.
    • Apply pressure to the site.
    • Clean up the area.

Scenario 2: Slumped Patient in Wheelchair

  • Situation: Patient found slumped in a wheelchair.
  • Response:
    • Doctors ABCD (life support stages).

Doctors ABCD

  • Purpose: Correct physiological processes.
  • Focus: Addressing abnormal vital signs to restore homeostasis.
  • Key Elements: Lack of breathing or pulse.

Danger

  • Prioritize Safety: Assess danger before response.
  • Image: Potential hazards are syringes, water/electrical cords, bodily fluid exposure.
  • Electrical Hazards: Water near electrical cords.
  • Sharps Exposure: Unsecured syringes.
  • Bodily Fluids: Blood on the patient.
  • Bed Brakes: Secure bed to prevent movement during CPR.

Precautions

  • Droplet or Airborne.
  • Radiation safety.
    • PPE for anybody present.
    • Radiation safety gowns.

Response

  • Methods: Talk and touch.
  • Verbal: Ask questions to assess awareness."
  • Physical: Apply firm, gentle squeezes to invoke response.

Send for Help

  • Methods: Centralized internal direct phone number (2222), dial 000, duress alarms, shouting.
  • Communication: Clear and succinct messaging to provide the right details.

Airway

  • Assessment: Clear debris from mouth.
  • Common Obstructions: Vomit, sputum, dentures.
  • Methods: Roll patient to the side, suction to remove debris.
  • Head-tilt
    • Chin-lift.
      *Utilize to clear for visibility.
  • Precautions: Avoid excessive force due to potential neck injuries.

Breathing

  • Assessment: Look, listen, and feel.
  • Duration: 10 seconds to determine if patient is breathing normally - movement for breathing
  • Look: Upper abdomen movement, lower chest movement
  • Listen: To breath escaping the nose
    • Feel: For breath on the cheek
  • Action: In absence of breath there can be use to implementation
  • Then start chest compressions on patient fro the cardiopulmonary resuscitation.
  • Depth of Compression:
    • 1/3 pressure compressions
      • One minute- 30 compressions to two breaths. Aiming for 5 cycles.
  • Defibrillation:
    • Adrenaline medication.
    • Shockable rhythm,non tropical rhythm, etc.