Block 1 - Vital Signs

Question 1

Describe and discuss specific steps and techniques required to assess heart rate/pulse

Answer 1

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

Question 2

Describe and discuss specific steps and techniques required to assess temperature

Answer 2

Assess severity of illness. Normal range 97.3-99.5 (avg 98.6/37). Methods: oral, rectal (most accurate), axillary, tympanic, temporal.

Question 3

Describe and discuss specific steps and techniques required to assess repirations

Answer 3

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).

Question 4

Describe and discuss specific steps and techniques required to assess blood pressure

Answer 4

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.

Question 5

Describe and discuss specific steps and techniques required to assess height

Answer 5

Used to assess development in children. Less important for adults.

Question 6

Describe and discuss specific steps and techniques required to assess weight

Answer 6

Closely linked to many chronic disease states. Pts often underreport.

Question 7

Describe and discuss specific steps and techniques required to assess BMI

Answer 7

BMI=weight(kg)/height(m^2). Relates body weight to height. However, should not be used alone as a measure of health.

Question 8

Describe the geneal physiologic mechanisms of elevated body temperature.

Answer 8

Body temp regulated by hypothalmus. Body temp elevated by: metabolic processes (digestion, exercise), infectious processes (pyrexia), ingestion (hot beverages, drugs), environmental factors (hyperthermia).

Question 9

Oral body temp: avg temp, pros, cons

Answer 9

98.6/37. Pro: easy pacifier themometers for babies. Con: drinking hot/cold drinks <30mins before reading.

Question 10

Rectal body temp: avg temp, pros, cons

Answer 10

99.6. Pro: most accurate. Con: Requires undressing, uncomfortable.

Question 11

Axillary body temp: avg temp, pros, cons

Answer 11

97.6. Pro: easy to read children while sleeping. Con: Not as accurate.

Question 12

Tympatic body temp: avg temp, pro, cons

Answer 12

99.6. Pro: non-invasive and fairly accurate. Con: accuracy depends on correct technique.

Question 13

Temporal body temp: pros, cons

Answer 13

Pro: non-invasive, con: less accurate, measures temp of skin not core

Question 14

Define fever in the following pts/states: oral adult, rectal adult, rectal ped, inpatient

Answer 14

Oral adult: >100F (37.8C)
Rectal adult: >101F (38.3C)
Rectal ped: >100.4 (38C)
Inpatient: >38C

Question 15

How is the following aspect of the pulse assessed and recorded, and what is its significance: rate/rhythm

Answer 15

Rate = contractions/min. Rhythm is an assessment for regularity. Regularly irregular could be sinus arrhythmia. Irregularly irregular may be heart disease or AFIB.

Question 16

How is the following aspect of the pulse assessed and recorded, and what is its significance: pulse defecit

Answer 16

Absence of palpable pulse waves in peripheral artery for one or more beats (eg AFIB).

Question 17

How is the following aspect of the pulse assessed and recorded, and what is its significance: amplitude

Answer 17

Force with which the bolus of blood moves through te artery. Measure on a scale of 0 (absent pulse) to 4+ (very strong).

Question 18

How is the following aspect of the pulse assessed and recorded, and what is its significance: apical pulse

Answer 18

Central pulse located next to heart apex (bottom).

Question 19

How is the following aspect of the pulse assessed and recorded, and what is its significance: pulse pressure

Answer 19

Difference b/t systolic and diastolic pressures. Represents force generated with each contraction. Avg: 30-50mmHg.

Question 20

How is the following aspect of the pulse assessed and recorded, and what is its significance: pulsus paradoxus

Answer 20

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.

Question 21

Normal range for pulse is…

Answer 21

60-100 beats/min

Question 22

Define resting pulse

Answer 22

Number of heart beats per min at rest. Varies based on general health, fitness, age, underlying medical condition. Avg: 70BPM.

Question 23

Define tachycardia

Answer 23

Pulse rate >100BPM

Question 24

Define bradycardia

Answer 24

Pulse rate <60BPM

Question 25

Discuss physiological mechanisms of tachycardia and bradycardia

Answer 25

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).

Question 26

Define diaphragmatic respiration

Answer 26

Abdominal respirations or belly breathing. The diaphragm does most of work while chest wall muscles are mostly at rest. Normal, quiet breathing.

Question 27

Define thoracic respiration

Answer 27

Performed entirely by expansion of the chest by using chest wall muscles. Abdomen does not move.

Question 28

Define paradoxic breathing

Answer 28

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.

Question 29

Define hyperpnea

Answer 29

Rapid and deep respirations >20 breaths per minute

Question 30

Define apnea

Answer 30

No breathing. Abscence of spontaneous breathing.

Question 31

Define tachypnea

Answer 31

Rapid breathing >20 breaths per min

Question 32

Define bradypnea

Answer 32

Slow breathing <12 breaths per min

Question 33

Define hyperventilation

Answer 33

Can be due to tachypnea, hyperypnea or both. Increased amount of air enters the lungs which results in lowered CO2 levels.

Question 34

Define Cheynes-Stokes respiration

Answer 34

Periodic breathing. Repetitive pattern of apnea followed by gradual increasing depth and frequency of respirations.

Question 35

Define Kussmaul breathing

Answer 35

Rapid, very deep, labored and gasping respirations associated with metabolic acidosis.

Question 36

Normal respiratory rate in adult

Answer 36

12-20 breaths per minute

Question 37

Normal BP range in adults

Answer 37

100-139/60-89

Question 38

Discuss physiological factors influencing arterial blood pressure

Answer 38

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).

Question 39

Describe ausculatory gap, procedure for obtaining it, clinical usefulness of this measurement

Answer 39

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.

Question 40

Describe the procedure for obtaining orthostatic BP and its clinical usefulness

Answer 40

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.

Question 41

Define acute pain

Answer 41

Pain of short duration and sudden onset.

Question 42

Define chronic pain

Answer 42

Persistant pain that last at least several months. Usually supported by pathophysiological process (joint disease, chronic inflammation, cancer, etc).

Question 43

Define nociceptive pain

Answer 43

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.

Question 44

Define neuropathic pain

Answer 44

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.

Question 45

How to measure and document pain in adults

Answer 45

Ask to report pain. If unable, use FACES scale or pain thermometer.
Document: value, location and radiation, quality, character, severity, frequency, and duration.

Question 46

Describe assessment of physical pain behaviors

Answer 46

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).