Baseline Vital Signs (U3)

Question 1

What does it start with?

Answer 1

Chief complaint

Question 2

What do measurements of vital body functions do?

Answer 2

Basis for initiating care and reevaluation of interventions

Question 3

What do the measurements include?

Answer 3

Respiration, pulse, BP, temperature, pupils

Question 4

What is the respiratory evaluation based on?

Answer 4

Quality, wheezing, and stridor

Question 5

What is included in quality for respiration?

Answer 5

Breathing sounds, chest expressions, increased effort

Question 6

Qualities in terms of breathing sounds?

Answer 6

Present, diminished, absent

Question 7

Quality in terms of chest expression?

Answer 7

Unequal or symmetricalI

Question 8

Quality in terms of increased effort?

Answer 8

Accessory muscles, nasal flaring, retractions (between ribs, clavicles), cyanosis, shortness of breath, altered mental state

Question 9

What is wheezing?

Answer 9

High pitched whistling

Question 10

What is stridor, and what is it caused by?

Answer 10

High pitch on inspiration, caused by obstruction on vocal cords/epiglottis

Question 11

What are the two main sites for pulse?

Answer 11

Peripheral, and central

Question 12

What is part of the peripheral pulse sites?

Answer 12

Radial, brachial, posterior tibial, dorsalis pedis

Question 13

What is part of the central pulse sites?

Answer 13

Carotid and femoral

Question 14

What does perfusion, in terms of skin, point to ?

Answer 14

Perfusion and oxygenation

Question 15

What are the components of perfusion and skin?

Answer 15

Colour, temperature, moisture, capillary refill

Question 16

Locations of assessment for skin colour?

Answer 16

Nail beds, oral mucosa, conjunctiva

Question 17

What is a normal skin colour?

Answer 17

Pink

Question 18

What are traits of abnormal skin colour?

Answer 18

Paleness, cyanotic, flushed, jaundiced

Question 19

What is paleness caused by?

Answer 19

Poor circulation

Question 20

What is cyanotic caused by and what does it look like?

Answer 20

Blue/grey, poor oxygenation/perfusion

Question 21

What is a flushed look caused by?

Answer 21

Heat/CO exposure

Question 22

What is jaundice caused by?

Answer 22

Liver/gallbladder problems

Question 23

What are types of abnormal temperature?

Answer 23

Hot, cool, cold

Question 24

What is hotness caused by in terms of temperature?

Answer 24

Fever/heat exposure

Question 25

What is coolness caused by, in terms of temperature?

Answer 25

Poor perfusion/cold exposure

Question 26

What is coldness caused by, in terms of temperature?

Answer 26

Extreme cold exposure/excessively dead (just dead)

Question 27

What do you check for moisture in terms of temperature?

Answer 27

Diaphoresis/extremely dry

Question 28

How to do a capillary refill?

Answer 28

Press on a patient’s nail bed till it’s blanched/white, release and count time till it returns to pink

Question 29

Normal capillary refill?

Answer 29

Less than or equal to 2/3 seconds

Question 30

Abnormal capillary refill?

Answer 30

More than 2/3 seconds

Question 31

Why and how should you assess the pupils?

Answer 31

Easy way to assess neutral status, briefly shine a light in a patient’s eye

Question 32

What is evaluated for pupils?

Answer 32

Diameter, reactivity to light, equal size

Question 33

What is PERRL?

Answer 33

Normal pupils,

Pupils
Equal
Round
Reactive to light

Question 34

What are traits of abnormal pupils?

Answer 34

Constricted/pinpoint, dilated, unequal

Question 35

What does constricted/pinpoint pupils mean?

Answer 35

Overdose, opiate

Question 36

What does dilated pupils mean?

Answer 36

Sever lack of O2 (hypoxia), brain death, toxic substance

Question 37

What does unequal pupils mean?

Answer 37

Brain injury

Question 38

How to assess a stable and unstable patient’s vital signs?

Answer 38

Stable: every 4 hours (Q4H)
- Every 15 min if there’s medical intervention

Unstable: every 5 min (blood transfusion, PACU)