Vital Assessments Flashcards
What are vitals?
Measure of the main organs (such as the heart and lungs) that are necessary for life.
Includes heart rate (bpm), blood pressure (mmHg), pulse, oxygen saturation, breathing rate, temperature.
What is heart rate?
Measurement of the mechanical activity of heart contractions (typically of the ventricle) over a unit of time (ie. bpm).
Varies with breath and ANS influence (leading to HRV).
Can see a pause in between beats of heart rates when breathing due to pressure from within lungs changing how the heart contracts.
Typically increases with stress or physical exertion, lowers in rest.
Typical resting HR varies between 60-100 bpm.
Heart rate variability (HRV)
Variability between beats.
At higher heart rate, beats are more in rhythm because the heart is beating so fast.
At a lower heart rate will see more variability in the heart rate because there is more paise in between.
What happens when HR starts to reach 100bpm?
becomes what we call tachycardia which is most common in inactive populations.
Abnormalities in HR
Referred to as arrhythmia’s.
Low heart rate = bradycardia.
High heart rate = tachycardia.
How is HR regulated?
Regulated by SNS and PSNS input.
Heart rate rhythm is regulated by the sinoatrial node (SA node) which is considered to be the heart’s natural pacemaker.
-sends signals through nerve pathways to get eh heart to beat (most efficient way for heart to beat)
-in arrhythmia’s, there is an issue with the nerve pathway/bundle/SA node which causes the heart to go to cell to cell conduction which is slower and not as efficient.
Increased heart rate caused by withdrawal of PSNS activity, then see increase in SNS after a bit of exercise.
Electrical pathways of the heart exist for fast conduction.
-cell to cell conduction is much slower.
Normal Electrical Conduction of the Heart
SA Node -> AV Node -> Bundle of His -> Bundle of branches -> purkinje fibers.
Heart Rate Measurements
Measurement of the physical/mechanical activity (contractions) of the heart (not the electrical activity).
Includes pulse palpation, wrist monitors, chest monitoring, ECG monitors.
Pulse palpation
radial, jugular, dorsalis pedis, or posterior tibial arteries
Wrist monitors
garmin, apple watch, fitbit
Measures volume of blood difference underneath the monitor.
Chest monitoring
polar, garmin
Work better in exercise
Measure at closer level to the heart, so they are more accurate than wrist monitors.
Typically less effected by sweat and movement.
ECG monitors
Looks at electrical activity
Measure most accurately due to accurately measuring electrical activity of the heart.
Measures heart’s electrical activity from electrodes on the skin (records voltage over time).
Helps to determine electrical function of the heart and if abnormalities or arrhythmias exist
-used to help determine if someone’s had a heart attack.
Can be measured with 3, 5 or 12 lead ECGs.
-12 lead views the heart in 12 angles (classic)
-5 lead views the heart in 7 angles
-3 lead views the heart in 3 views (more in clinical settings).
Limitations of Measuring HR at the Wrist (Radial pulse or Wrist Monitor)
Further from the heart, making the measurements less accurate.
Averages beats over certain amount of time (2s, 5s, 10s).
-longer time of the average the less accurate the represented HR is.
Impacted by arm movement and sweat.
Pulse palpation can have more human error or counting error when multiplying to get to bpm
-only recommend to use to test pulse strength and rhythm.
How do you take radial pulse/heart rate?
Place the tips of your index and middle fingers on the groove on the radial side your wrist.
Gently press until you can feel each beat.
Count the beats for 30s and x2 to get bpm (or 15s x4).
-based on the situation
Good opportunity to check strength and rhythm.
Heart Rate Assessment
At rest, 60-99bpm is normal.
Relative CI if >100 bpm (tachycardia) or <60bpm (bradycardia).
In exercise heart rate varies greatly (depends on the person).
May have certain HR cut off prescribed.
-atrial fib = heart rate cap of 120 bpm because if they go above 120 the person’s heart stops pumping efficiently.
-concussions have a heart rate cap = buffalo treadmill test has clients run until concussion symptoms appear, check HR to determine cut off so client can still exercise at a lower intensity until they can increase the cut off.
Pulse Assessment
Weak vs Strong pulse
Regular vs irregular pulse rhythm.
-absolute CI if new arrhythmias present (after taking pulse many times previously).
Blood Pressure
Pressure exerted on arterial walls and the heart.
-care about the pressure put on the heart (not as much on the arterial walls)
-take it at an artery level
-systolic (SBP) = maximal pressure within the arteries during ventricular systole.
-diastolic (DBP) = minimal pressure at the end of ventricular diastole.
Pulse pressure is difference between SBP and DBP.
Mean pressure = DBP +1/3(SBP/DBP).
Typical arterial blood pressure rests at 120/80 mmHg
Measurements of Blood Pressure
Manual vs automatic
-ie. manual sphygmomanometer and stethscope
How to take blood pressure?
Client should be seated and relaxed for >5min.
Blood pressure should ideally be taken on the left arm, but right arm may be used if left has impeded flow such as from traumatic injury or surgery (could affect reading).
Select appropriate cuff size
-too small = artifically high readings and too large won’t close properly
Cuff should be fitted snuggly around upper arm, with centre of the cuff/tube positioned over the brachial artery and lower border of the cuff ~2cm above elbow crease.
Arm should be relaxed, supported, and at the level of the heart.
Inflate cuff while palpating the radial pulse to note the pressure point of the pulse ceases, and continue to inflate 20-30 mmHg above this (typically 180).
Place the stethoscope over the brachial artery.
Deflate the cuff at a rate of 2-3 mmHg per second or per heart rate.
First sound represents the SBP.
Disappearance/change of the sound represents the DBP.
If high, have client sit for another 5 mins and repeat test.
-possible white coat hypertension.
Repeat as many time as necessary.
How to take blood pressure at the legs?
Can measure at the mid-thigh or at ankle.
Mid-thigh readings will use the popliteal artery, whereas ankle readings will use the posterior tibial artery.
Blood pressure measured at the ankle is used for the ankle-brachial indexes when determining or diagnosing peripheral arterial obstructive disease (PAOD).
PAOD
Occlusion at the arms and legs which impacts measuring blood pressure, so measure at ankle to help diagnose this.
Types of Blood Pressure Measurements
Clinical measurements.
Home measurements (self measured with automatic cuff).
Ambulatory blood pressure (24hr Holter).
-cuff worn for 24 hours and gives feedback on changes throughout the day.
Blood Pressure Grades
Normal <120/80
High-normal 120-139/80-89
Grade 1 hypertension (mild) 140-159/90-99
Grade 2 hypertension (moderate) 160-179/100-109
Grade 3 hypertension (Severe) >180/>110
Isolated systolic hypertension >140/<90
Isolated systolic hypertension with widened pulse pressure >160/<70
An “or” situation (ie. 180/90 mmHg = grade 3 hypertension no matter if both measurements are in the range or just one).
When systolic and diastolic BP falls into different categories, the patient is categorized according to the higher BP reading.
Distolic is our set number (or number of concern) because that is the minimal amount of pressure placed on the heart.
Also concerned about systolic, but more about diastolic.
Isolated systolic hypertension = heart is working too hard.
It is normal for blood pressure to increase with exercise.
Blood Pressure in Rest
Take blood pressure pre and post exercise in seated position, feet flat on the ground, ideally on left arm.
Relative contraindication to beginning exercise exist if resting bp is >140/90.
-may need medical clearance before exercising.
-based on how comfortable you feel putting them through exercise
Absolute contraindication to beginning exercise is if resting bp is >180/110.
-must go see doctor before exercise, most likely go on medication.
-based on how comfortable you feel putting them through exercise.
Hypotension (<110/70) is also a cause for concern as it can lead to fainting especially in exercise (relative contraindication).
-it is normal to have a lower blood pressure if you are healthy/young or on blood pressure medication.
-make sure that they know to tell you if they feel lightheaded or dizziness which could indicate a dip in bp.
-approach with caution.
Blood Pressure in Exercise
Bp readings can be difficult to get while exercising.
Consider the types of equipment being use and if bp is strictly needed or not.
-hypertensive clients with heart conditions should always have bp monitored.
-automatic bp cuff don’t like movement or talking = will error out
-that will play into what equipment you are using (ie. don’t use treadmills, maybe use bike instead.
-do it manually if planning to take bp while exercising (less errors occur).
Blood pressure should rise in exercise and increase with and increase in exercise intensity.
-if not increasing, then not a good thing (ie. want to increase because that means increasing blood flow to the body).
-typically bp doesn’t increase due to lack of input from ANS, medications, etc.
-if doesn’t increase, refer to doctor
Cut off for blood pressure in exercise is >220/110
-cease exercise at this point and proceed to passive recovery.
-no active cool down
Oxygen Saturation
The amount of oxygen circulating in blood.
Typical level at rest and exercise 95-100%.
Can be lower in certain conditions such as chronic lung conditions or at high elevation.
-monitor closely and make sure that they are feeling fine.
How to measure oxygen saturation?
Measured with pulse oximetry.
-measure oxygen saturation at finger with pulse oximeter.
-middle finger tends to be best for circulation.
-can be altered with poor circulation or nail polish.
