BP in a medical setting 135/85. 10-30% of patients.

History Taking/General Survey/Vital Signs Exam Flashcards by Preeksha Lal

What are some vital signs you can take on your patient?

Blood pressure
Heart Rate
Respiratory Rate
Temperature
Can also be;
Height/Weight

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What is the 5th vital sign?

Pain

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What are some kinds of pain?

Nociceptive, neuropathic, psychogenic, idiopathic

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What is nociceptive pain?

somatic pain. pain linked to tissue damage of skin, musculoskeletal system or viscera

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what is neuropathic pain?

pain related to direct affect to somatosensory system

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what can cause psychogenic pain?

psychiatric conditions, personality/coping styles, cultural influences

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idiopathic pain?

no identifiable eitology

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4 A’s when monitoring patient outcomes

Analgesia
Activities of daily living
Adverse effects
Aberrant drug-related behaviors

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what are types of blood pressure cuffs?

sphygmomanometer (aneroid, electronic, hybrid), mercury blood pressure cuffs, home blood pressure monitoring, and ambulatory blood pressure

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best place to hear for BP

brachial artery

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Slow or repetitive inflations of the cuff cause what?

venous congestion

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how much should the cuff be deflated?

2-3 mmHg per second

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Blood pressure differences of >10-15 mmHg suggest what?

subclavian steal syndrome
aortic dissection
supra-valvular aortic stenosis

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what conditions is auscultatory gap associated with?

arterial stiffness and atherosclerotic disease

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what is the auscultatory gap?

silent interval that may be present between systolic and diastolic pressures. can lead to under-estimation of systolic pressure or over-estimation of diastolic pressure.

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what is the gold standard for confirmation of elevated BP?

24 hour ambulatory blood pressure

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what are issues with the 24 hour ambulatory blood pressure?

limited availability and poor insurance coverage

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when is hypertension diagnosed in the office?

after 2 office readings >140/90 on two sep. occasions

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when is hypertension diagnosed at home?

after two home readings >135/85

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when is the hypertension diagnosed after ambulatory automated BP?

24 hour average >130/80, or daytime >135/85, sleep readings >120/70

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What is white coat HTN?

linked to anxiety response. in 20% of patients. high BP in a medical setting (>140/90)

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What is masked HTN?

BP in a medical setting <140/90. When the BP is normal in a medical setting but may be high at home. Ambulatory BP measurements may be >135/85. 10-30% of patients.

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Normal BP

<120/80

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Pre-HTN

120-139/80-89

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Stage 1 (<60 years old)

140 – 159/90 – 99

Stage 1 (>60 years old)

150 – 159/90-99

Stage 2

>160/>100

what are orthostatic blood pressure changes?

decreased systolic reading >20 mmHG and decreased diastolic reading of >10 mmHG

what are causes of orthostatic blood pressure changes?

drugs, blood loss, prolonged bed rest, and diseases of autonomic nervous system

Where can your heart rate be assessed?

radial, brachial, femoral, cardiac apex, carotid

Normal heart rate

60-90 beats a min

What can cause HR to alter?

anxiety, pain, medication effect, cardiac conditions, pulmonary conditions, thyroid disease, and anemia

What causes pulse deficits?

a-fib, heart failure, weak heart contractions

what do diminished pulses show?

arteriosclerotic peripheral vascular disease, low cardiac output

what do asymmetry of pulses show?

indicate coarctation of the aorta or aortic dissection

what does a bounding pulse show?

also called water hammer pulse. can be seen with aortic regurgitation or patent ductus arteriosis

what does pulsus alternans show?

amplitude of pulse alternatives every other beat associated with pericardial effusions arterial pulse with alternating strong and weak beats

Normal adult respirations

14-20 breaths a min

what are frequent sighs associated with?

hyperventilation syndrome

bradypnea

slow breathing

causes of bradypnea

physiologic, diabetic coma, drug-induced respiratory depression, increased intracranial pressure

tachypnea

rapid, shallow breathing

causes of tachypnea

restrictive lung disease, pleuritic chest pain, elevated diaphragm

obstructive breathing

Expiration is prolonged due to narrowing of airways that increase resistance of air flow

causes of obstructive breathing

asthma, chronic bronchitis, COPD

hyperpnea/hyperventilation

rapid, deep breathing

causes of hyperpnea

exercise, anxiety, metabolic acidosis; kidney failure and DKA

causes of hyperpnea if the patient is comatose

infarction, hypoxia, hypoglycemia

cheyne-stokes breathing

period of deep breathing alternating with periods of apnea

causes of cheyne-stokes breathing

normal in children and elderly when sleeping, heart failure, uremia, drug-induced respiratory depression, brain damage

kussmauls respirations

labored, deeper breathing rate

causes of kussmaul respirations

metabolic acidosis (DKA)

ataxic breathing

unpredictable breathing irregularity. breaths may be shallow or deep, with periods of apnea

causes of ataxic breathing

respiratory depression or brain damage

normal temp

37 degrees C, 98.6 degrees F

C to F

C times 1.8 + 32

F to C

F minus 32 divided by 1.8

hyperprexia

> 41.1 degrees C or >106 degrees F

hypothermia

< 35 degrees C or <95 degrees F

causes of hypothermia

can be associated with decreased movement, interference with vasoconstriction, hypothyroidism, and hypoglycemia

what is the gold standard to obtain temperature?

pulmonary artery

other ways to obtain temp

oral, rectal, axillary, tympanic, temporal

causes for fever

infection, trauma, malignancy, drug reactions, immune disorders

general survey

initial impression of the patient. should distinguish a patient from the crowd.

LOC

assesses a patients ability to respond to situations

lethargy

appears drowsy, will easily respond to questioning but then fall back asleep

obtunded

Pt will open eyes and look, but responds slowly and confused. Alertness and interest in surroundings is decreased. Responds to stimuli (not painful)

stuporous

arouses from sleep only with painful stimuli. minimal awareness of self or surroundings

comatose

unarousable with painful stimuli

glasgow coma scale

used to provide info regarding LOC

mild brain injury

13 or higher

moderate injury

9 to 12

severe brain injury

8 or less

Ax4

person, place, time, situation

differential diagnosis

considered after obtaining CC, HPI, ROS