Vital Signs Flashcards
Vital Signs
-Heart Rate
-Respiratory Rate
-Blood Pressure
-Body Temperature
-Pulse Oximetry
Other
-“Pain”
-“Borg rate of perceived exertion”
Why do we care about these measurements in every patient/client?
-Safety
To protect the patient and provider from unnecessary risks
-Prescription of therapeutic activities
Vital signs can inform us of:
- Current health and physiological status
- Readiness to perform activities
- Response to treatment interventions
When do we take vital signs?
- Initial Evaluations
- Before treatment
- During treatment
- After treatment
Initial Evaluations (When do we take vital signs?)
- To help determine readiness for activity/therapies
- Assist care team in identifying latent health conditions
- Assist in developing meaningful goals
Before Treatment (When do we take vital signs?)
Establish a baseline for comparison/monitoring
During Treatment (When do we take vital signs?)
Monitor response and tolerance to treatments and activity
After Treatment (When do we take vital signs?)
Monitor the person’s recovery levels
General Factors Affecting Vitals
-Age
-Gender
-Demographic factors (i.e., ethnicity) u Genetic influences
-Health Status and Past Medical History
(Including level of conditioning; comorbidities, acuteillness, etc)
-Stress / Emotional Status
-Medications
-Environment (geographic location, or body position)
-Reliability of the rater or measurement device
-Time of day
Heart Rate (pulse)
Indirect measure of the contractility of heart’s left ventricle (LV)
-Measured at multiple sites u Most common:
Carotid (neck), Radial(near wrist), Brachial (near bicep)
Others:
Femoral Artery (leg); dorsalis pedis (foot); temporal (forehead), popliteal (behind knee)
HR Normal Resting Values for Adults
- Average = 60-100 bpm
- Well-conditioned athletes = 40-60 bpm
HR Normal Resting Values for Children
- Infants = 90-160 bpm
- 1-10 y.o = 70-130 bpm
Abnormal Adult HR Values
-Tachycardia = >100 bpm u -Bradycardia = < 60 bpm
HR Palpatation SItes
To palpate, always use index and middle finger, never the thumb! Lay fingers flat gently over each site and do not push hard. Don’t poke, lay fingers flat.
Carotid HR Palpatation SItes
Underneath the jawline; anterior to SCOM; posterior to trachea
Radial HR Palpatation SItes
Anterior aspect of the distal wrist; just medial to radial styloid process;
lateral to flexor tendons u
Brachial HR Palpatation SItes
Anterior aspect of distal and medial humerus; underneath the belly of the biceps brachii
Measurement of HR
- Begin with proper infection control and informed consent. -Locate your target pulse site.
- Typically collected at the radial or carotid sites.
- Palpate the pulse, never use the stethoscope…
- Count number of beats in 30 seconds and multiply x2; (or count number in 15 seconds and x4)
- Always start counting at zero when you feel the first beat. u -Record your values in the patient chart.
Common HR mistakes
- Not starting your count from zero
- Using your thumb to palpate
- Improper palpation site
- Using a stethoscope
- Distractions while counting pulse
- Not counting long enough (i.e., # bpm in 10 seconds x 6 = standard error)
- Is not the best method to judge exertion in aquatic exercise…use RPE instead
Blood Pressure
An indirect measurement of cardiac output and peripheral resistance
Blood pressure (BP) is always reported as…
Systolic / Diastolic (mmHg)
Systole (Blood Pressure)
Pressure inside the closed circulatory system during a LV contraction
Diastole (Blood Pressure)
Remaining pressure inside circulatory system in between contractile phases; when the ventricle is at rest and refilling.
Systolic and Diastolic
-Measured by Korotkoff sounds (1-5)
-Korotkoff #1: the first sound heart that is heard through auscultation;
indicates systolic pressure
-Korotkoff #4: a distinct and final muffling of the pulse heard through auscultation; the best indicator of diastolic pressure
-Korotkoff #5: final diastolic phase; sound completely disappears on auscultation; not the correct time to record the diastolic number
Normative Ranges of BP for Adults
- Normal: <120/<80 mmHg
- Prehypertensive: 120-139/80-89
- Stage 1: 140-159/90-99
- Stage 2: 160-179/100-109
Normative Ranges of BP for Children (1-12 y.o.)
100/60 to 120/75
Factors affecting BP
- Age
- Stress and emotions
- Health status and physical condition u Medications
- Hydration status
- Disease or Illness
- Patient position* (orthostasis)
Important Consideration for Therapy
Change in patient positioning during therapeutic activities may cause drop in blood pressure due to gravity dependent forces. Can lead to pooling in the extremities and lack of blood flow to the brain.
Important Consideration for Therapy Elderly
dehydrated; and those who have medical complications or have been in bed for a long time without mobility are at greater risk.
Orthostatic (Important Consideration for Therapy)
- When moving from supine to sitting to standing
- A drop in systolic pressure > 20 mmHg and diastolic >10 mmHg
- Symptoms such as dizziness, lightheadedness, sweating, nausea, fainting, falling
Assessment of BP
- Pierson and Fairchild 6th edition (p. 60) Table 3.4
- Infection control (provider and equipment) and informed consent
- Locate brachial/radial artery palpation site and correct cuff size
- Ensure there are no contraindications to taking BP
First, find occlusion point (Assessment of BP)
-Apply cuff to arm at heart level just proximal to antecubital fossa
-Palpate radial artery and inflate the cuff slowly until the pulse disappears
(The number at which the pulse disappears is called the occlusion point, Deflate the cuff entirely and wait approximately 60 seconds)
-Now, place the stethoscope over the brachial artery just proximal to the antecubital fossa
-Slowly inflate cuff to 20-30 mmHg higher than occlusion point number
-Carefully and slowly open the BP cuff valve to allow the air in the bladder
to escape…this will cause the dial to drop (The rate of decrease should be 1-2 mmHg per second)
-Listen for Korotkoff sounds #1 and #4 and record appropriately (After you record sound #4 you need to deflate the cuff entirely by fully opening the valve)
Practice BP Measurements
- Practice your BP measurement skills with your friends, family, roommates, etc. u Technique sensitive skills that takes considerable practice
- Invaluable skill at which to become proficient…can protect your patient’s lives
- Even medical students have difficulty with taking manual BP…
Common BP mistakes
-Improper cuff size applied
(Small cuff can increase readings; large cuff can decrease readings)
-Recording incorrect Korotkoff sounds
-Not supporting pts. arm and resting at heart level
-Distractions and noise interfering with Korotkoff sounds
-Not finding the occlusion point prior to inflating cuff, overinflating.
-Deflating the cuff too quickly ( > 1-2 mmHG per second)
-Not checking for contraindications (i.e., hx of breast cancer, lymphedema)
Body Temperature
-Tells us about the homeostatic mechanisms at play internally
-Important with understanding illness and infection
-Oral, axilla, temporal, or rectal
-Oral Normal range: 96.8 – 99.3 degree F (36-37 C)
Oral Average: 98.6 F
-Febrile = >100 degrees F (38 C)
-Measured with oral thermometer or infrared scanning device
Considerations for Temperature
- Tends to decrease overall with age
- May be altered due to environmental exposure
- May be elevated in the evenings
- Varies with location of measurement
- May be elevated with pregnant women and ovulating females
Common temperature mistakes
- Removing temperature probe too quickly
- Improper measurement site, or not properly placed in measurement site
- Faulty device; dying batteries, etc.
Respiratory rate (RR)
-A respiration is a cycle, inhale and exhale
-Measured by one complete inhalation and exhalation
-Watch for chest rise/fall
If auscultating, always place stethoscope against skin
-Normal adult range = 12 – 18 per min
-Infants/toddlers = 30-40 breaths per minute
Respiratory Rate Considerations
- Look for belly breathing, labored breathing, accessory musculature: May be impacted by geography, altitude, humidity, air quality, temperature; May be affected by history of smoking, restrictive or obstructive disease; Accessory use may indicate underlying pulmonary pathology
- Can be impacted by posture/severe scoliosis or bony deformities
- Take into consideration when doing aquatic therapy
Lung Auscultation pattern
- Rehab providers are not primarily involved in the qualification of breath sounds
- However, labored and abnormal breath sounds or patterns are often easily recognized
Abnormal sounds for Lung Auscultation Pattern
- Wheezing
- Gasping or gulping
- High or low pitch rumbles or crackles
- Muffled or wet gurgling
Common respiratory mistakes
- Telling the patient/client you’re going to measure their breathing
- Distractions while counting
- Not starting at zero when counting
- Not counting a full inhale/exhale cycle as one complete respiration
PulseOx
- Quick, easy, reliable! (A function of respiratory rate and heart rate
- Uses infrared sensors to tell us about the level of oxygen available for diffusion in a persons blood
- Cold fingers, long nails, or nail polish can interrupt accuracy
Hypoxemia = (PulseOx)
<90%
- May require supplemental O2
- Notification to nurse/physician and document in chart
Normal O2 saturations = (Pulse Ox)
95-99.5%
100% saturation is technically impossible…
Other Vital Signs
- Rate of Perceived Exertion
- Pain
- Often required by Center for Medicare/Medicaid Services in documentation for billing and coding purposes
Rate of Perceived Exertion
xxx
RPE
- Assessed during activity and therapy to gauge levels of effort
- Always educate patient/client on levels of reporting
- Used to supplement HR measurements during aquatics
- Reliable and valid ways to record a patient’s exertion during therapy/activity
- Can be used to develop goals in rehab process
- Be sure to document which scale is used…modified vs. regular (Distinguish 1-10 from 6-20)
Non-verbal cues of RPE
- Leaning over to catch breath
- Grimacing or bearing down
- Stopping for rest breaks
- Increased sweating, breathing, pulse
- Turning red in the face
Pain
- Often considered “The 5th vital sign”
- Is pain truly a vital sign?
- Emerging evidence suggests deemphasizing
- Overutilization may have led to opioid crisis in western
society. ..
Why measure pain?
- Why should we care?
- Who wants to be in pain
- Important to capture and monitor during therapy u Perhaps, show empathy in some ways…?
- Acknowledge and dignify the patient/client and their needs
- Can be used to develop meaningful goals in rehab process
Benefits of pain measurement
- Initial evaluation and Pre-post comparisons
- Monitor response to treatment
- Patient’s biopsychosocial and physiological responses
- Therapists spend a lot of time with patients, compared to other health professionals.
- Understand activities that ameliorate or exacerbate symptoms/conditions
- Help patients/clients avoid things that continue the pain cycle
Drawbacks of Measuring Pain
- Subjectivity
- A ten?… is not a 10… is not a TEN!!!
- How many times have you been asked, but it’s not applicable?
- Can be easily over or underreported
Reporting accuracy has cultural and demographic considerations
- Males vs. females
- Younger vs. elderly
- Cognitive status
- Cultural and ethnic biases
Collect information from the patient/client on: (How do we measure pain?)
- Location
- Intensity
- Duration
- Region
- Qualities of pain (burning, stabbing, dull, etc.) u What brought it on, and what makes it better?
- Does it change?
- Does the pain migrate to other areas?
