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PCC Lectures > General Assessment and Vital Signs > Flashcards

General Assessment and Vital Signs Flashcards

1
Q

BMI means…

A

Body Mass Index

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2
Q

BP means…

A

Blood Pressure

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3
Q

BPM means…

A

Beats per minute

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4
Q

CV means…

A

Cardiovascular

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5
Q

DBP means…

A

Diastolic blood pressure

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6
Q

HTN means…

A

Hypertension

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7
Q

MAP means…

A

Mean Arterial Pressure

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8
Q

mmHg means…

A

Millimeters of mercury

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9
Q

RPM means…

A

Respirations per minute

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10
Q

SBP means…

A

Systolic blood pressure

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11
Q

Describe the different components of a physical assessment.

A
  • General
  • Head, eyes, ears, nose, and throat
  • Neck
  • CV
  • Lungs
  • Abdomen
  • Extremities
  • Neuro
  • Psych
  • Skin
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12
Q

What are weight and BMI?

A

Commonly used to assess weight and obesity.

BMI= weight (kg)/height (m^2)

BMI= [weight (lb)/height (in^2)] x 703

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13
Q

Underweight BMI is:

A

<18.5

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14
Q

Normal Weight BMI is:

A

18.5-24.9

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15
Q

Overweight BMI is:

A

25-29.9

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16
Q

Obesity, Class I is:

A

30-34.9

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17
Q

Obesity, Class II, is:

A

35.0-39.9

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18
Q

Obesity, Class III, is:

A

40.0 +

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19
Q

Why may BMI be considered inaccurate?

A
  • does not consider muscle mass or body fat percentage
  • Was created over 200 years ago by the white race
  • May overestimate risk for Black race and Asian race.
  • Waist-to-hip ratio possible
  • Nothing currently studied to replace BMI clinically.
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20
Q

What is edema?

A
  • Fluid leaking into tissues or swelling
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21
Q

What are examples of chronic edema?

A

Heart function, Kidney function, Liver function, Medications

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22
Q

What are examples of acute Edema?

A

Inflammation, Injury, Diet, Blood clot/obstruction, Pregnancy, Medications

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23
Q

Briefly explain “grading” edema.

A

1+ = Mild pitting (less than or equal to 2mm) , slight indention, no visible swelling.

2+ = Moderate pitting (2-4mm), indention subsides quickly, no visible swelling.

3+= Deep pitting (4-6 mm), indention remains for as short time (may last up to minute), visible swelling.

4+= Very deep pitting (6-8+ mm), indention remains long time (may last 2 to 5 minutes), significant swelling present

24
Q

List the different routes to obtain body temperature and indicate their accuracy.

A

Rectal: Most accurate
Temporal: Accurate
Tympanic: Accurate
Oral: ~0.5-1 degree F lower than rectal
Axillary: ~1-2 degree F lower than rectal

25
Q

What is a normal body temperature?

A

96.8 degrees F to 99 degrees F

OR (in celsius)

36 degrees C to 37.2 degrees C

26
Q

When do we refer a patient (Adults and children above 24 months old) for fever?

A
  • greater than or equal to 104 degrees F
  • greater than or equal to 100.4 degrees F plus non-responsive to medication and lasts longer than 3 days
  • greater than or equal to 100.4 degrees F and symptomatic
27
Q

What is a normal heart rate for all patient demographics?

A

Newborns: 70-170 bpm
6 months-1 year: 70-170 bpm
1-6 years old: 75-160 bpm
6-12 years old: 80-120 bpm
Adults: 60-100 bpm
Conditioned Athlete: 50-100 bpm

28
Q

What is the normal respiratory rate for each patient demographic?

A

Newborn: 30-60 rpm
6 months to a year old: 24-30 rpm
1-6 years old: 20-30 rpm
6-12 years old: 12-20 rpm
Adults: 12-20 rpm
Conditioned Athlete: 12-18 rpm

29
Q

What are the steps you take to obtain the pulse rate?

A
  1. Using the pads of your first and second fingers, place your fingers on the wrist medial to the radial bone.
  2. Press down until you can feel the pulse.
  3. Count the number of beats you feel in 30 seconds and multiply the number of beats by 2 (if the rhythm is regular). If irregular, count the number of beats in one minute.
30
Q

When do we refer patients for pulse?

A
  • greater than 100 bpm while resting and chest pain or discomfort, SOB, weakness, dizziness, or fainting.
  • less than 40 bpm while awake and chest pain or discomfort, SOB, dizziness, fainting, or confusion.
31
Q

What steps do you take to obtain the respiratory rate?

A
  1. Continue to pretend that you are measuring radial pulse but start measuring respiratory rate.
  2. Watch patient’s chest and abdomen for respirations.
  3. Count the number of respirations (inhale and exhale= one respiration) in 30 seconds and multiply by two of rate is regular. If irregular count the number of respiration in one minute.
32
Q

When to refer patients (adults) for the respiratory rate?

A
  • When there is greater than 25 rpm and low BP or change in consciousness.
  • When there is greater than 25 rpm and difficulty breathing, coughing, wheezing, and increased mucous.
  • When there is less than 12 rpm and goes limp, change in consciousness, or turns blue.
33
Q

What is the systolic blood pressure?

A

Maximum pressure on the arteries during contraction of the left ventricle (regulated by the stoke volume).

34
Q

What is the diastolic blood pressure?

A

Resting pressure between ventricle contractions.

35
Q

What is the most reported blood pressure method?

A

systolic/diastolic blood pressure.

Well established CV disease risk factors.

36
Q

What is MAP?

A
  • [SBP + [2 x DBP]]/3
  • 1/3 SBP + 2/3 DBP
37
Q

What is the auscultatory technique?

A

This is the manual/traditional method. The brachial artery occluded to stop blood flow. Stethoscope to detect appearance and disappearance of Korotkoff sounds. ERROR PRONE

38
Q

What is the oscillometric technique?

A

It is often called the “automatic cuff.” Read based on amplitude of oscillations recorded in the lateral walls of the upper arm. Software on device foes the measuring.

39
Q

Describe the proper position for patient for measuring BP.

A

Seated, arm supported at heart level, back supported, uncrossed legs, feet flat on the floor.

40
Q

What cuff size is best?

A
  • Cuff length at least 80% of the circumference of arm
  • If the regular adult seems to small, get the extra-large cuff.
41
Q

What is proper cuff placement?

A
  • Placed on bare skin NOT over clothing.
  • Shirt sleeve should not be rolled up (could create a tourniquet effect)
  • Bottom of cuff should be 1/2 inch above elbow
  • Once cuff is in place it should be snug (finger should easily fit at the top and bottom)
42
Q

Describe proper stethoscope placement.

A
  • Palpate the brachial artery in the antecubital fossa. (use index and middle finger, find the pulse.
  • Stethoscope should be placed over brachial artery at antecubital space.
  • Make sure the cuff is aligned so that the artery marker points to brachial artery.
43
Q

What are the five phases of korotkoff sounds?

A

Phase I–> Faint and clear tapping (systolic)

Phase II–> Swooshing sound

Phase III–> More intese, crisp tapping

Phase IV–> Muffled sound

Phase V–> Sound stops (diastolic)

44
Q

List patient factors that alter BP.

A

Medications, Drugs of Abuse, Caffeine, Nicotine, Exercise in the past 30 mins, time of day, pain/stress, talking during measurement, full bladder

45
Q

What are the steps taking a manual BP?

A
  1. Insert the earpieces of the stethoscope into your ears
  2. Places the bell of the stethoscope over the palpable brachial artery lightly (with an air-tight seal)
  3. Inflate the cuff rapidly to the maximum inflation level (180 mmHg in a normal patient, 220 mmHg in a patient with history of hypertension)
  4. Release the air slowly (2-3 mmHg/sec)
  5. Note the pressure when the first sound is heard (systolic bp)
  6. Note the pressure when the last sound is heard (diastolic bp)
  7. Continue listening until 20 mmHg below last sound.
46
Q

How do you record/communicate BP readings?

A
  1. Record SBP and DBP
  2. Record pt position and arm that was measured
  3. Note time most recent BP medications were taken prior to reading
  4. Provide patient SBP/DVP verbally and in writing
  5. Help the pt interpret the results
  6. Wait 1-2 minutes in between measurements.
47
Q

How are the parameters of the different blood pressure categories in terms of systolic and diastolic mmHG (upper vs lower number)?

A

Normal –> Less than 120 and less than 80

Elevated –> 120-129 and less than 80

High Blood Pressure Stage 1 (Hypertension)–> 130-139 or 80-89

High Blood Pressure Stage 2 (Hypertension) –> 140 or higher OR 90 or higher

Hypertensive Crisis–> Higher than 180 and/or higher than 120
(and or target organ damage)

48
Q

When do we refer patients for blood pressure in adults?

A

SBP greater than or equal to 180. DBP greater than or equal to 120 and target organ damage (chest pain, SOB, numbness, weakness, vision changes, difficulty speaking, severe headache).

49
Q

How can patients measure BP at home?

A
  • Patients need proper training
  • Upper arm cuff preferred
  • need appropriate cuff size
  • need validated machine
  • advise cuff that stores readings
  • avoids white coat hypertension
50
Q

What is Kiosk monitoring?

A
  • a good starting point
  • needs to be calibrated
  • should be in a quiet environment
  • Cuff is often too small
  • Lack of back support
51
Q

How might weight loss lifestyle change impact BP?

A

Weight loss

  • Ideal body weight as goal
  • Impact on BP may be around -1 mmHg for every 1 kg reduction in weight
  • need to consider available resources, support system, etc.
52
Q

How might the DASH dietary plan lifestyle change impact blood pressure?

A

DASH

  • Diet rich in fruits, veggies, and whole grans
  • Impact on BP by reducing by 11 mmHg
  • need to consider affordability, culturally appropriate, etc.
53
Q

How might reduced dietary sodium lifestyle change impact BP?

A
  • <1,500 mg per day
    • 6 mmHg
  • Affordability, culturally appropriate, etc.
54
Q

How might increased dietary potassium lifestyle change impact BP?

A
  • 3,500-5,000 mg/day
  • 5 mmHg impact on BP
  • Affordability
55
Q

How does physical activity lifestyle change impact BP?

A
  • 150 minutes per week
  • -8mmHg
  • Safe environment
56
Q

How does the moderation in alcohol lifestyle change impact BP?

A

<1 drink per day for women, <2 drinks per day for men
- impacts BP -4 mmHg
- need to consider the available resources, support system, etc.

57
Q

How does tobacco cessation lifestyle change impact BP?

A
  • 0 cigarettes a day
  • 10-20 mmHg
  • Available resources, support system, etc. impact adherence.

PCC Lectures (20 decks)

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