Block 1 - Vital Signs Flashcards
Describe and discuss specific steps and techniques required to assess heart rate/pulse
Number of cardiac cycles/min - may give clues to CV or neuro status, phychogenic factors, or drug use. Average 60-90BPM. Common site: radial pulse. Alt site: carotid pulse. Note: amplitude (0-4+ - 2+ normal), rhythm, regularity
Describe and discuss specific steps and techniques required to assess temperature
Assess severity of illness. Normal range 97.3-99.5 (avg 98.6/37). Methods: oral, rectal (most accurate), axillary, tympanic, temporal.
Describe and discuss specific steps and techniques required to assess repirations
Without pt’s knowledge, observe rise and fall of chest. Alt method: listen to lung sounds. Average 12-20RPM. Note: rate, pattern, depth, signs of distress (include: nasal flaring, cyanosis, labored breathing, access muscles, wheezing, tachypnea, bradypnea).
Describe and discuss specific steps and techniques required to assess blood pressure
Measure of CV function. Represents force of blood against arterial walls. Adult range: <90. Systole: maximal ventricular contraction vs diastole: maximal ventricular relaxation. CO=SV(blood pumped by LV in 1 contraction)xHR. Cuff size: must cover 80% of upper arm. Locate brachial artery and center cuff, palpate radial pulse, inflate cuff until pulse disappears, reinflate cuff to ~30mgHg higher (adjusting for ausculatory gap), deflate noting mmHg when Korotkoff sounds start and stop, repeat in other arm (right tends to be higher). BP affected by: anxiety, hyper/hypotension, vascular resistance, pain, fever, weight, caffeine, alcohol, drugs.
Describe and discuss specific steps and techniques required to assess height
Used to assess development in children. Less important for adults.
Describe and discuss specific steps and techniques required to assess weight
Closely linked to many chronic disease states. Pts often underreport.
Describe and discuss specific steps and techniques required to assess BMI
BMI=weight(kg)/height(m^2). Relates body weight to height. However, should not be used alone as a measure of health.
Describe the geneal physiologic mechanisms of elevated body temperature.
Body temp regulated by hypothalmus. Body temp elevated by: metabolic processes (digestion, exercise), infectious processes (pyrexia), ingestion (hot beverages, drugs), environmental factors (hyperthermia).
Oral body temp: avg temp, pros, cons
98.6/37. Pro: easy pacifier themometers for babies. Con: drinking hot/cold drinks <30mins before reading.
Rectal body temp: avg temp, pros, cons
99.6. Pro: most accurate. Con: Requires undressing, uncomfortable.
Axillary body temp: avg temp, pros, cons
97.6. Pro: easy to read children while sleeping. Con: Not as accurate.
Tympatic body temp: avg temp, pro, cons
99.6. Pro: non-invasive and fairly accurate. Con: accuracy depends on correct technique.
Temporal body temp: pros, cons
Pro: non-invasive, con: less accurate, measures temp of skin not core
Define fever in the following pts/states: oral adult, rectal adult, rectal ped, inpatient
Oral adult: >100F (37.8C)
Rectal adult: >101F (38.3C)
Rectal ped: >100.4 (38C)
Inpatient: >38C
How is the following aspect of the pulse assessed and recorded, and what is its significance: rate/rhythm
Rate = contractions/min. Rhythm is an assessment for regularity. Regularly irregular could be sinus arrhythmia. Irregularly irregular may be heart disease or AFIB.
How is the following aspect of the pulse assessed and recorded, and what is its significance: pulse defecit
Absence of palpable pulse waves in peripheral artery for one or more beats (eg AFIB).
How is the following aspect of the pulse assessed and recorded, and what is its significance: amplitude
Force with which the bolus of blood moves through te artery. Measure on a scale of 0 (absent pulse) to 4+ (very strong).
How is the following aspect of the pulse assessed and recorded, and what is its significance: apical pulse
Central pulse located next to heart apex (bottom).
How is the following aspect of the pulse assessed and recorded, and what is its significance: pulse pressure
Difference b/t systolic and diastolic pressures. Represents force generated with each contraction. Avg: 30-50mmHg.
How is the following aspect of the pulse assessed and recorded, and what is its significance: pulsus paradoxus
Exaggered decrease in systolic (>10mmHg) and decrease in amplitude of pulsation during inspiration and increase in amplitude during expiration. Indicative of abnormal conditions like chronic obstructive pulmonary disease.
Normal range for pulse is…
60-100 beats/min
Define resting pulse
Number of heart beats per min at rest. Varies based on general health, fitness, age, underlying medical condition. Avg: 70BPM.
Define tachycardia
Pulse rate >100BPM
Define bradycardia
Pulse rate <60BPM
Discuss physiological mechanisms of tachycardia and bradycardia
Tachycardia can be induced by increased oxygen demand or metabolic activity, blood volume decease, body working, sympathetic nervous system activation (stress, drugs). Bradycardia can be induced by decreased oxygen demand and metabolic activity, and parasympathetic stimulation (incl. drugs).
Define diaphragmatic respiration
Abdominal respirations or belly breathing. The diaphragm does most of work while chest wall muscles are mostly at rest. Normal, quiet breathing.
Define thoracic respiration
Performed entirely by expansion of the chest by using chest wall muscles. Abdomen does not move.
Define paradoxic breathing
Portion of the chest wall sinks inward with each inspiration - common with chest trauma. Also seen in diaphragm paralysis when the diaphragm ascends during inspiration.
Define hyperpnea
Rapid and deep respirations >20 breaths per minute
Define apnea
No breathing. Abscence of spontaneous breathing.
Define tachypnea
Rapid breathing >20 breaths per min
Define bradypnea
Slow breathing <12 breaths per min
Define hyperventilation
Can be due to tachypnea, hyperypnea or both. Increased amount of air enters the lungs which results in lowered CO2 levels.
Define Cheynes-Stokes respiration
Periodic breathing. Repetitive pattern of apnea followed by gradual increasing depth and frequency of respirations.
Define Kussmaul breathing
Rapid, very deep, labored and gasping respirations associated with metabolic acidosis.
Normal respiratory rate in adult
12-20 breaths per minute
Normal BP range in adults
100-139/60-89
Discuss physiological factors influencing arterial blood pressure
Stroke volume: amount of blood pumped by LV in one contraction.
Heart rate: beats per minute
Peripheral vascular resistance: resistance to expansion of vessel walls by circulating blood
Conditions that affect: exercise, diet (eg sodium), alcohol/drugs/caffeine, stress/anxiety, weight, pain, fever, vascular resistance (eg atherosclerosis).
Describe ausculatory gap, procedure for obtaining it, clinical usefulness of this measurement
Describe: period of silence betwwen the Korotkoff sounds Phase 1 and Phase 2. Generally 10-15mmHg. Can be wider with HTN and narrower with pulsus paradoxus due to cardiac tamponade.
Procedure: palpate BP and add 20-30mmHg.
Usefullness: prevent provider from underestimating systolic BP or overestimating diastolic BP.
Describe the procedure for obtaining orthostatic BP and its clinical usefulness
Procedure: have pt lie supine for 5 mins, measure BP and pulse, have pt stand, measure BP and pulse after 1 and 3 mins
Usefulness: orthostatic BP is defined as a drop in BP of >20mmHg systolically or >10mmHg diastolically. Pts experiencing lightheadedness or dizziness is considered abnormal. Can be a sign of decreased CO, hypovolemia, other diseases (Addison’s, atherosclerosis, diabetes). More common in elderly.
Define acute pain
Pain of short duration and sudden onset.
Define chronic pain
Persistant pain that last at least several months. Usually supported by pathophysiological process (joint disease, chronic inflammation, cancer, etc).
Define nociceptive pain
Type of time-limited pain that resolves when tissue damage has healed. Subjective: onset coincides with injury, pain constant until heals, throbing or aching. Objective: well localized. Somatic: joint, bone, muscle, other soft tissues. Visceral: internal organs.
Define neuropathic pain
Form of chronic pain caused by primary lesion (PNS dysfunction) or dysfunction of CNS that persists beyone expected after healing. Subjective: pain worsens at night, sleep disturbance, interferes with daily life, burning, intense tightening, stabbing. Objective: pain may follow particular pattern, numbness, weakness, loss of DTR in affected area. Central: dorsal horn neurons of the spinal cord are hyperexcited, transmit enhanced pain signals. Peripheral: damaged peripheral nerves fire repeatedly.
How to measure and document pain in adults
Ask to report pain. If unable, use FACES scale or pain thermometer.
Document: value, location and radiation, quality, character, severity, frequency, and duration.
Describe assessment of physical pain behaviors
Pt may display behaviors associated with pain. Useful when pt cannot or will not report pain. Pt may demonstrate: guarding, facial mask of pain, vocalization of pain (grunting), body movements, change in vital signes, pallor and diaphoresis, pupil dilation, dry mouth, decreased attention span. Classic pain behavior include: tender, deep, aching (bone/soft tissue), heavy, throbbing, aching (tumor or mass), clenched fist over chest (MI), cramping spasm (visceral or colic pain).
