PPT - Physiological Monitoring and Readiness for OT Flashcards
Baseline vitals needed for all clients, but in particular:
- Clients suffering from recent trauma, hospitalization, etc.
- Current or previous cardiovascular/cardiopulmonary conditions
- Clients who are not active have limited aerobic activities for many weeks/months
- Client’s with general fatigue
- Very young and very old (65+ years)
Factors that Influence a Client’s Vital Signs
- Level or amount of activity
- Emotional status
- Physiological status
- Environmental Temperature
- Client’s age
- What are some things contributing to the physiological status of the client?
Disease, illness, use of medication, trauma - What are some possible adverse and potentially dangerous responses to activity and exercise?
Confusion, slow reactions of movement/response to directions, lethargy, fatigue, loss of consciousness, etc.
Blood Pressure
- Pressure exerted by circulating blood on walls of blood vessels
- Usually refers to brachial arterial pressure
- Pressure of circulating blood decreases as it moves further away from the heart
- Composed of Systolic and Diastolic pressures
Systolic: BP at the contraction of the left ventricle of the heart
Diastolic: BP at the time of rest period of the heart
Blood Pressure – Korotkoff’s Sounds
Sounds are described in phases
Listen using a stethoscope and blood pressure cuff
- Phase 1: first, faint, clear tapping sound which gradually increases (first indication of systolic BP in adults)
- Phase 2: murmur or swishing quality present
- Phase 3: sounds become crisp and louder than before
- Phase 4: distinct and abrupt muffling sounds until a soft, blowing sound is heard (initial indicator of diastolic BP)
- Phase 5: muted sound, disappearance of sound, also known as “second diastolic pressure phase”
We are concerned with two specific Korotkoff sounds: the 2nd Korotkoff sound and the first faint/muted sound…that is the BP to record
Blood Pressure “Norms”
Normal
120/80
Pre-Hypertension
120 – 139/80 -89
Stage I Hypertension
140 – 159/90 – 99
Stage 2 Hypertension
≥ 160/≥ 100
Monitor BP for abnormal responses to activity and/or occupation. Abnormal Responses include:
- Systolic pressure rapidly increasing or does not increase during activity
- Systolic pressure continues to increase or decrease even when the activity has leveled off (plateau)
- Systolic pressure rapidly declines or does not decline as the intensity of the activity declines/terminates
- Systolic pressure declines significantly below resting level when activity is terminated
- Systolic pressure declines during the exercise before the activity intensity declines
- Systolic pressure rate or the amount of systolic pressure increase is excessive** during the exercise or activity period
- Diastolic pressure increases more than 10-15 mmHg during the activity
Respiration
Inspiration and Expiration of air between the lungs and the environment through muscle contraction and relaxation
Respiration rate
number of breaths per minute
Respiration rhythm
regularity of the pattern
Respiration depth
amount of air exchanged with each respiration
Respiration character
deviations from normal, resting or quiet respiration
Accepted normal range for respiration at rest
Adults – 12 -18 respirations per minute
Infants – 30 – 50 respirations per minute
Resting values above 20 respirations per minute or below 10 respirations per minute are considered abnormal for adults
Upper Chest Breather
thorax rises and expands during inhalation and abdomen remains somewhat motionless
Abdominal Breather
expansion of the abdomen with inspiration and there is basically no movement in the thorax
Factors affecting respiration
Age, emotional status, physical activity, air quality, altitude, disease/illness
Heart Rate (HR) and “Norms”
Also known as pulse: indirect measure of the contraction of the left ventricle of the heart
Accepted normal ranges for resting pulse
60 - 100 bpm for Adults
100 – 130 bpm for Newborns
80 – 120 bpm for child between 1 -7 years
Factors Affecting Heart Rate/Pulse
Medication, emotional status, age, gender, temperature of the environment, infection, physical activity, physical condition, cardiopulmonary disease
Descriptions of pulse
Strong and Regular: even beats with good force to each beat
Weak and Regular: even beats with poor force to each beat
Irregular: both strong and weak beats are happening during the assessment
Thready: weak force to each beat, as well as irregular heart beats
Tachycardia: over 100 bpm
Bradycardia: less than 60 bpm
Assessing Temperature and “Norms”
Refers to intensity or degree of heat within the body
Represents balance between the heat produced in the body and heat which is lost
For Adults: acceptable normal range is 96.8 degrees to 99.3 degrees (different depending on where you are reading the temperature)
In humans, body temperature remains rather constant, regardless of temperature outside…exceptions are when a person is exposed to extremes of hot or cold and their body can not regulate changes in temperature
Factors affecting temperature
Time of day, age, emotional status, environmental temperature, infection, site of assessment, physical activity
Assessing Oxygenation Saturation
Measures the client’s oxygen saturation level in the blood (how much oxygen is being carried by the red blood cells)
Also known as SpO2
Monitored with a pulse oximeter
Should be maintained above 90% at rest and during activity
Assessing Pain
Highly personal and subjective
Self report is most reliable indicator of pain
Can include emotional and/or spiritual responses…some clients will not want medication
