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Pharmacy Practice I > Vital Signs > Flashcards

Vital Signs Flashcards

1
Q

Blood Pressure (BP)

A

• Measurement of force the heart exerts while pumping
• Directly depends on cardiac output (CO) and peripheral vascular resistance (PVR), hence BP = CO x PVR
- Measured in mmHg

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2
Q

Systolic vs. Diastolic BP

A

• Systolic blood pressure (SBP)
- Pressure during contraction of heart
• Diastolic blood pressure (DBP)
- Pressure during relaxation of heart

• BP is reported as: systolic/diastolic (120/80)

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3
Q

Necessary Instruments

A
  • Sphygmomanometer: often attached to an inflatable air-bladder cuff for measuring BP in an artery
  • Stethoscope: auscultation to convey sounds in the chest or other parts of the body to the ear of the examiner
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4
Q

Types of Sphygmomanometers

A
  • Aneroid: widely used; accurate if calibrated; requires maintenance q6 months
  • Mercury: (most accurate but impractical for home use)
  • Digital: preferred for patient self-measurement
  • Finger monitors: inaccurate, not recommended
  • Ambulatory BP monitoring: worn 24h, measures q15-30 min, allows measurement of night readings or if inconsistent readings seen at clinic vs. at home
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5
Q

Step 1: Before Taking BP

A
  • Seat patient quietly x5 minutes
  • Both feet flat on the floor and back supported
  • Upper arm bare and supported at heart level
  • Ask if had caffeine or smoked within 30 minutes
  • Ensure patient has emptied bladder
  • Neither you nor patient should talk during rest period or actual measurement
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6
Q

Step 2: Set Up

A
  • Place yourself in convenient proximity to patient
  • Select cuff with bladder length ≥80% of arm circumference
  • Locate and align midline of cuff with brachial artery
  • Wrap cuff smoothly/snugly around the arm, centering bladder 2 finger widths above elbow bend or at sternum midpoint
  • Place stethoscope diaphragm over brachial artery
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7
Q

Cuff Sizes

A
  • Small adult cuff: 22-26cm
  • Regular adult cuff: 27-34 cm
  • Large adult cuff: 35-44 cm
  • Thigh cuff: >= 45 cm
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8
Q

Step 3: Determining a Starting Point

A 
• While palpating radial artery:
Inflate cuff until you can no longer feel the pulse (AKA systolic pressure or pulse obliteration) - note this level on the manometer
• Add 20-30 mmHg to pulse obliteration 
• Deflate cuff
• Wait 30-60 seconds, then do BP reading
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9
Q

Step 4: Take BP

A

• Insert stethoscope earpieces forward
• Apply bell/diaphragm lightly but completely over brachial artery
• Inflate cuff rapidly to 20-30 mmHg above pulse obliteration
• Release air from cuff at 2 mmHg/second by turning knob
• SBP is the first 2 consecutive sounds (aka “Korotkoff
sounds”); note on manometer
• DBP is the last sound heard; note on manometer
• Continue listening 10-20 mmHg below last sound
• Record BP in even numbers and which arm used
• Wait 1-2 minutes; confirm in opposite arm and average
• If the first 2 readings differ >5 mmHg, take 3rd measurement and average all three

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10
Q

Classification of BP

A
  • Normal: <120 (s), <80 (d)
  • Elevated: 120-129 (s) AND <80 (d)
  • Stage 1: 130-139 (s) OR 80-89 (d)
  • Stage 2: =>140 (s) OR => 90 (d)
  • HTN crisis: >180 (s) AND/OR >120
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11
Q

Factors that Alter BP

A
  • Smoking w/in 30 min
  • Caffeine w/in 30 min
  • Full bladder
  • Incorrect cuff size or placement
  • Cuff over clothing
  • Talking during measurement
  • Back not supported
  • Feet not supported
  • Legs crossed
  • Arm not at heart level
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12
Q

Medications that Increase BP

A
  • Corticosteroids (prednisone, testosterone)
  • Pseudoephedrine, ephedrine
  • NSAIDs (ibuprofen, naproxen, etc)
  • Albuterol
  • Amitriptyline
  • Venlafaxine
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13
Q

Medications that Decrease BP

A
  • Antihypertensives
  • Alprazolam
  • Diazepam
  • SGLT2 inhibitors (empaglifozin, canaglifozin)
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14
Q

Signs/Symptoms of HTN

A
  • Signs: High BP

- Symptoms: asymptomatic, weakness/fatigue, blurred vision, headache

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15
Q

Lifestyle Modifications to Manage HTN

A
  • Weight reduction
  • DASH eating plan
  • Dietary sodium reduction
  • Physical activity
  • Moderate alcohol consumption
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16
Q

Heart Rate (HR)

A

• HR = # of times heart contracts/min
• Recorded as beats per minute (bpm)
• Detected via pulse
-Pulse = the wave or beat of blood coursing through artery after heart contracts
• Inaccurate with certain arrhythmias
- Pulse will feel irregular
With patient’s elbow and forearm resting comfortably on a table and the palm turned upward…find the radial pulse

17
Q

Measuring Radial Pulse / Carotid Pulse

A

• With the pads of your index and middle finger, compress radial/carotid artery until maximal pulsation detected
• Count rate for 15 seconds and multiple by 4
• If unusually fast or slow, count for 60 seconds
- Do NOT use thumb
- Note if regular rhythm

18
Q

Normal HR (bpm)

A
  • Brady = slow, thus bradycardia is pulse < 60 (adult)

- Tachy = fast, thus tachycardia is pulse > 100

19
Q

Medications that Increase HR

A
  • Sympathomimetics: pseudoephedrine, ephedrine
  • Steroids: prednisone, testosterone
  • Bronchodilator: albuterol
  • Hormone replacement: levothyroxine
  • Antidepressants: venlafaxine, amitriptyline
20
Q

Medications that Decrease HR

A

• Blood pressure medications

  • Beta blockers
  • Calcium channel blockers

• Opioids

  • Codeine
  • Hydrocodone
21
Q

Respiratory Rate (RR)

A
  • Rate of breathing
  • Best to measure at rest (patient unaware)
  • Count rate for 30 seconds and multiply by 2
  • Watch the chest rise
22
Q

Observe/Listen for:

A
  • Audible breathing, effort
  • Regularity
  • Abnormal sounds (usually need stethoscope): crackles, rales, wheezing, rhonchi
23
Q

What Affects RR?

A 
• Medications
- Opioids ↓ 
- Sedative/hypnotics ↓
• Stress ↑(emotion/fever/injury)
• Alcohol ↓ 
• Caffeine ↑
24
Q

How many BP readings are recommended each time you measure BP?

A

At least 2.

25
Q

Which of the following is true?

  • You should never measure BP at the thigh.
  • At subsequent visits, it is sufficient to take one BP reading.
  • If you take 2 BP readings and the systolic pressure are 134 and 141, the average should be recorded as SP.
  • At the first visit, BP measurements should be made in both arms.
A

At the first visit, BP measurements should be made in both arms.

26
Q

Which of the following patient postures can cause an error of a higher BP reading?

A

Patient seated on exam table.

27
Q

A physician using a mercury column instrument observes a systolic pressure reading of 133. Which is the correct reading to make in the patient’s chart?

A

134.

28
Q

According to evidence-based guidelines, what is the recommended cuff deflation rate for patients who are not bradycardic?

A

2-3 mmHg per second.

29
Q

What is the recommended frequency for retraining health care professionals on BP measurement techniques?

A

Every 6 months.

30
Q

When selecting the correct cuff size, the bladder should be wide enough to encircle what percent of the upper arm?

A

40%

31
Q

What is the correct time to wait in between two consecutive BP readings on the same individual?

A

At least 1 minute.

32
Q

Which of the following is false?

  • The patient should not talk during measurement.
  • The patient should relax seated for 5 minutes before the first measurement.
  • In the absence of a hard surface to rest their arm, the patient can hold up their arm during BP measurement.
  • Urinary bladder distension can cause a significant error in BP measurement.
A

In the absence of a hard surface to rest their arm, the patient can hold up their arm during BP measurement.

33
Q

Blood pressure measurement guidelines recommend which of the following?

  • Use the bell of the stethoscope.
  • The upper arm should be bare, without constrictive clothing.
  • Inflate the BP cuff to at least 30mmHg above the point where the radial pulse disappears.
  • All of the above.
A

All of the above.

34
Q

What bladder length of arm circumference should be used? Where should you center bladder?

A
  • Select cuff with bladder length ≥80% of arm circumference

- Center bladder 2 finger widths above elbow bend

Pharmacy Practice I (27 decks)

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