Vital signs Flashcards
What are the Vital signs (4)
❖Arterial pulse
❖Blood pressure
❖Respiratory rate
❖Temperature
pressure wave generated by ejection of blood into the circulation from the left ventricle
Arterial pulse
3 sites to find Arterial pulse
Radial pulse
Brachial pulse
Carotid pulse
Beats per min
Heart Rate
regular or not
To describe ….
Rhythm
perceived degree
of pulsation
Volume
pulse waveform
impression or shape
Character
brachial, carotid or femoral
Best to feel ….
Volume + Character
Radial artery
Best to feel ….
Rate + Rhythm
Normal heart rate at rest is
60-100beat/min
If the rhythm is irregular, better to ….. and check …..
count the for full one
minute
heart rate by the stethoscope
Bradycardia is defined as ……
pulse rate of < 60 bpm
Tachycardia is defined as
rate of > 100 bpm
Exercise
Cause …….
Tachycardia sinus rhythm
Pain
Cause …….
Tachycardia sinus rhythm
Excitement/ anxiety
Cause …….
Tachycardia sinus rhythm
Fever
Cause …….
Tachycardia sinus rhythm
Hyperthyroidism
Cause …….
Tachycardia sinus rhythm
Sympathominetics eg. Salbutamol
Cause …….
Tachycardia sinus rhythm
Vasodilators
Cause …….
Tachycardia sinus rhythm
Sleep
Cause …….
Bradycardia sinus rhythm
Athletic training
Cause …….
Bradycardia sinus rhythm
Hypothyroidism
Cause …….
Bradycardia sinus rhythm
Beta-blockers
Cause …….
Bradycardia sinus rhythm
Digoxin
Cause …….
Bradycardia sinus rhythm
Verapamil, diltiazem
Cause …….
Bradycardia sinus rhythm
Sinus arrhythmia
Sinus rhythm irregular pulse
Atrial extrasystoles
Sinus rhythm irregular pulse
Ventricular extrasystole
Sinus rhythm irregular pulse
Atrial fibrillation
Arrhythmic tachycardia / Arrhythmia irregular pulse
Atrial flutter
Arrhythmic tachycardia
Supraventricular tachycardia
Arrhythmic tachycardia
Ventricular tachycardia
Arrhythmic tachycardia
Caroited sinus
Arrhythmic bradycardia
Hypersensitivity
Arrhythmic bradycardia
Sick sinus syndrome
Arrhythmic bradycardia
2nd-degree heart block
Arrhythmic bradycardia
Complete heart block
Arrhythmic bradycardia
Atrial flutter with variable responses
Arrhythmia irregular pulse
2nd-degree hear block with variable response
Arrhythmia irregular pulse
regular, but heart rate varies with the respiratory cycle, particularly in children, young adults or athletes
Sinus rhythm
sinus arrhythmia/physiological arrythmia
Other names of …….
Sinus rhythm
there may be an underlying regularity to the pulse, interspersed with periods of irregularity
Intermittent extrasystoles (ectopics) or second-degree atrioventricular block
Intermittent extrasystoles (ectopics) or second-degree atrioventricular block
sometimes referred to as …..
regularly irregular
Pulse has no appreciable pattern ‘irregularly irregular’
Atrial fibrillation (AF)
Pulse volume varies
Atrial fibrillation (AF)
Pulse deficit
Atrial fibrillation (AF)
A large pulse volume is a reflection of ………
large pulse pressure
The large pulse volume and large pluse pressure in exercise
is ……..
Physiological
The large pulse volume and large pluse pressure in pregnancy
is ……..
Physiological
The large pulse volume and large pluse pressure in advanced age
is ……..
Physiological
The large pulse volume and large pluse pressure in increased environmental temperature
is ……..
Physiological
The large pulse volume and large pluse pressure in hypertension
is ……..
Pathological
The large pulse volume and large pluse pressure in fever
is ……..
Pathological
The large pulse volume and large pluse pressure in thyrotoxicosis
is ……..
Pathological
The large pulse volume and large pluse pressure in anemia
is ……..
Pathological
The large pulse volume and large pluse pressure in aortic regurgitation
is ……..
Pathological
The large pulse volume and large pluse pressure in Padget’s disease of bone
is ……..
Pathological
The large pulse volume and large pluse pressure in peripheral atrioventricular shunt
is ……..
Pathological
Severe heart failure has ……. Pulse volume because of ……..
Low
Reduced stroke volume
Hypovolemia has ……. Pulse volume because of ……..
Low
Reduced ventricular filling
Cardiac tamponade has ……. Pulse volume because of ……..
Low
Reduced ventricular filling
Mitral stenosis has ……. Pulse volume because of ……..
Low
Reduced ventricular filling
Coarctation of the aorta has ……. Pulse volume because of ……..
Low
impaired blood flow
Atherosclerosis or stenosis of peripheral arteries
Asymmetric pulses
Aortic dissection
Asymmetric pulses
gradual upstroke with a reduced peak occurring late in systole, and is a feature of severe aortic stenosis
Slow-rising pulse
occurring late in systole
Slow-rising pulse
feature of severe aortic stenosis
Slow-rising pulse
peak of the pulse wave arrives early and is followed by a rapid fall in pressure
Collapsing pulse
exaggerated by raising the patient’s arm above the level of the heart
Collapsing pulse
may occur with severe aortic regurgitation
Collapsing pulse
Double systolic peak, is classically produced by concomitant aortic stenosis and regurgitation
Pulsus bisferiens
Beat-to-beat variation in pulse volume with a normal rhythm, may occur in advanced heart failure
Pulsus alternans
may occur in advanced heart failure
Pulsus alternans
Exaggeration of the normal variability of pulse volume with breathing
Pulsus paradoxus
usually due to accumulation of pericardial fluid (cardiac tamponade) but can occur to a lesser extent with pericardial constriction and in acute severe asthma
Pulsus paradoxus
can occur to a lesser extent with pericardial constriction and in acute severe asthma
Pulsus paradoxus
measure of the pressure that the circulating blood exerts against the arterial walls
Blood pressure (BP)
provides vital information on the hemodynamic condition of patients
Blood pressure (BP)
maximal pressure that occurs during ventricular contraction (systole)
Systolic pressure
maximal pressure that occurs during ventricular filling
Diastole pressure
BP constantly varies and rises with (3)
stress, excitement and
environment
BP Reading record as
BP, which arm, position of patient
Eg. BP 146/92 mmHg, right arm, supine
transient increase in BP caused by the stress of being in a healthcare setting
White coat hypertension
Different BP in each arm
difference of >10 mmHg on repeated measurements suggests the presence of ……
aortic or subclavian artery disease
In Different BP in each arm Record the …………. and use this to guide management
highest pressure
Proper cuff size
bladder should be approximately
80% of the length
40% of the width
of the upper arm circumference
standard adult cuff has a bladder that measures approximately …….
and suits an arm circumference of ……
13×30 cm
22–26 cm
In obese patients a standard adult cuff will
overestimate BP
In obese patients use large adult bladder (…….)
16×38 cm
sounds appear at systolic pressure and disappear for an interval between systolic and diastolic pressure
Korotkoff sounds
Korotkoff sounds found in
up to 20% of elderly hypertensive patients
If the first appearance of Korotkoff sound is missed, the systolic pressure will be recorded at …….
falsely low level
If the first appearance of Korotkoff sound is missed, the systolic pressure will be recorded at a falsely low level.
Avoid this by…….
palpating the systolic pressure first
Appropriate level of patient’s arm
patient’s elbow should be level with the heart
Hydrostatic pressure causes
change of approximately 5 mmHg in recorded systolic and diastolic BP
for a 7 cm change in arm elevation
Respiratory rate (RR)
Should be ….
Quietly observe and time without drawing the patient’s attention to it
drawing the patient’s attention to respiratory rate observe and time may cause it to change
To avoid that ……
Feeling the radial pulse, while timing breathing
At rest (adult), RR is normally
12–20 breaths per minute
Tachypnea, RR is
> 20
Bradypnea, RR is
<10
Avoid the use of glass thermometers with mercury, why?
The glass can break, and mercury is a poison
Electronic thermometers are most often suggested. The probe can be placed in ….. (3)
mouth, rectum, or armpit
results are less accurate than with probe thermometers
Electronic ear thermometers
more accurate than ear thermometers and their accuracy is similar to probe thermometers
Electronic forehead thermometers
When probe placed in the mouth
Place it under the tongue and close the mouth
Keep it for 3 minutes or until the device beeps
When probe placed in the Rectum
Used for infants and small children who cannot hold a thermometer safely in their mouth
Put some lubricant gel on the bulb of a rectal thermometer
Place the child face down on a flat surface or lap Spread the buttocks and insert the bulb end about 1 to 2.5 centimeters into the anal canal
Remove after 3 minutes or when the device beeps
When probe placed in the Armpit
Press the arm against the body.
Wait for 5 minutes before reading
measurement of body temperature can help …… (2)
detect illness
monitor whether or not treatment is working
normal’ oral temperature may range between
35.8°C and 37.2°C (Mean 36.5)
‘normal’ Rectal temperature is about
0.5°C higher than oral
‘normal’ axillary temperature is about
0.5°C lower than oral
increase in body temperature
(morning oral temperature >37.2°C
Or
afternoon temperature of >37.7°C)
Fever
core temperature <35°c
Hypothermia
temperature above 41.1°C
Hyperpyrexia
Respiratory rate (RR) in Anxiety
Described as ….
Tachypnoea
Respiratory rate (RR) in Pain
Described as ….
Tachypnoea
Respiratory rate (RR) in Asthma
Described as ….
Tachypnoea
Respiratory rate (RR) in Metabolic acidosis
Described as ….
Tachypnoea
Respiratory rate (RR) in Chest injury
Described as ….
Tachypnoea
Respiratory rate (RR) in Pneumothorax
Described as ….
Tachypnoea
Respiratory rate (RR) in Pulmonary embolus
Described as ….
Tachypnoea
Respiratory rate (RR) in Brain stem stroke
Described as ….
Tachypnoea
Respiratory rate (RR) in Cardiac arrest
Described as ….
Bradypnoea/ apnoea
Respiratory rate (RR) in Opioids/ other sedative overdose
Described as ….
Bradypnoea/ apnoea
Respiratory rate (RR) in Central neurological causes (stroke, head injury)
Described as ….
Bradypnoea/ apnoea
