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CMOD Week 6 > Vital Signs > Flashcards

Vital Signs Flashcards

1
Q

What are normal systolic and diastolic BPs?

A

systolic- less than 120 mm Hg

diastolic- less than 80 mm Hg

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2
Q

What are prehypertensive systolic and diastolic Bps? Stage 1 hypertension?
Stage 2 hypertension?

A

systolic- 120-139 mm Hg
diastolic- 80-89 mm Hg

systolic- 140-159
diastolic- 90-99

systolic- above 160
diastolic- above 100

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3
Q

T or F. BP should be red at each office visit

A

T.

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4
Q

What side of a stethoscope should be used?

A

the bell side

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5
Q

Rules of BP taking

A

Patient’s legs should be uncrossed and supported on the floor

Arm should be uncovered and proper sized cuff should be used

arm free of clothing

arm should be positioned so that the brachial artery is at the antecubital crease (at heart level)- roughly AT 4TH INTERSPACE (if the artery is 7-8cm below the heart, the blood pressure will read ~6cm higher- if 7 cm higher, it will read lower)

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6
Q

How should a cuff be worn?

A

width should be about 40% OF UPPER ARM CIRCUMFERENCE

standard size is 12x23cm

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7
Q

Clinical observations are influenced by what factors?

A

the instrument and its accuracy and precision, the patient, and the observer

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8
Q

What does WDWN NAD mean?

A

Well-developed, well nourished in no apparent distress

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9
Q

Good descriptors for dirty people?

A

disheveled or unkempt, don’t say dirty or unclean

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10
Q

Risks for DM, HTN, and CVD increase significantly for waist >35 inches in women and 40 inches in men

A

Risks for DM, HTN, and CVD increase significantly for waist >35 inches in women and 40 inches in men

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11
Q

Rapid shallow breathing is called?

A

tachypnea

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12
Q

Rapid deep breathing is called?

A

hyperpnea/hyperventilation

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13
Q

What is Ataxia Breathing (biot’s)?

A

Unpredictably irregular; respiratory depression and brain damage (usually at medullary level)

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14
Q

T or F. Rectal temperatures are usually slightly higher than oral temps

A

T. about 0.7-0.9F higher

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15
Q

T or F. Axillary temperatures are usually slightly higher than oral temps.

A

F. about 1F lower

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16
Q

Tips for taking a rectal temp.

A

Lie in decubitus position (on side) with hip flexed

  • Use probe with stubby tip
  • Lubricate and insert 3-4cm into anal canal pointing toward umbilicus
  • 3 minutes for regular thermometer; 10 seconds for digital
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17
Q

T or F. Ear temps are usually higher than oral temps

A

T. about 1.4F higher

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18
Q

What is orthostatic hypotension?

A

a fall in systolic pressure of 20mm Hg or more, especially when accompanied by symptoms and tachycardia, indicates orthostatic hypotension

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19
Q

Causes of orthostatic hypotension?

A

drugs, blood loss, prolonged bed rest, and diseases of autonomic nervous system

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20
Q

What are the two organs most likely to suffer ischemic damage if the blood flow is too low from either low BP (hypotension) or arterial blockages.

A

brain and kidneys

21
Q

What are Korotkoff sounds?

A

The brachial artery is occluded by a cuff place around the upper arm and inflated. As the cuff pressure is gradually deflated, pulsatile blood flow is re-establish and the accompanying sounds are detected with a stethoscope held over the artery just below the cuff. These sounds are call Korotkoff sounds.

The first sound represents the systolic blood pressure (SBP) and the fifth sound determines the diastolic blood pressure reading (DBP).

22
Q

What is pulse pressure?

A

the difference between the systolic and diastolic pressures. In the patient whose blood pressure is illustrated above, the pulse pressure is 40 mmHg (120 – 80).

23
Q

What is the ‘auscultatory gap’?

A

In older patients with a high pulse pressure, the Korotkoff sounds may become inaudible between systolic and diastolic pressure, and reappear as cuff deflation is continued. This phenomenon may lead to misreading the diastolic pressure too high or the systolic pressure too low.

Checking the systolic pressure by palpation to reveal how high the cuff pressure should be prior to auscultating the Korotkoff sounds will avoid this error.

24
Q

T or F. Pressures should be identified to the nearest 2 mmHg and documentation should reflect this level of accuracy.

A

T.

25
Q

What things could raise BP?

A

the supine position may elevate the blood pressure readings by as much as 8 mmHg. If the back is not supported or if the legs are crossed, the readings may also be significantly elevated.

If the arm is supported below the level of the heart or the arm is not supported so that the patient must use isometric exercise to maintain the position of the arm, the blood pressures will be elevated. If the arm is supported above the level of the heart, the blood pressure readings will be falsely low.

Variations in room temperature, state of patient activity, alcohol or nicotine consumption, caffine intake, bladder distension, talking and background noise may all contribute to significant deviations in measured blood pressures.

26
Q

T or F. A cuff that is too small will increase the systolic blood pressure reading.

A

T. The “ideal” cuff should have a bladder length that is 80% and a width that is at least 40% of the arm circumference.

Ex. For arm circumference of 22 to 26 cm, the cuff should be “small adult” size: 12X22 cm

27
Q

Phase 1 (systolic) and phase 5 (diastolic) Korotkoff sounds are best heard using the bell of the stethoscope over the palpated brachial artery in the antecubital fossa. Excessive pressure on the bell of the stethoscope will cause the blood pressure to be read lower than it actually is.

A

Phase 1 (systolic) and phase 5 (diastolic) Korotkoff sounds are best heard using the bell of the stethoscope over the palpated brachial artery in the antecubital fossa. Excessive pressure on the bell of the stethoscope will cause the blood pressure to be read lower than it actually is.

28
Q

What is the White Coat Effect?

A

The white coat effect occurs when the blood pressure recorded by a physician or nurse is higher than the reading done without the physician or nurse present. When patients take their blood pressures at home (ambulatory monitoring), blood pressures may often be normal.

29
Q

How is hypotension defined?

A
30
Q

How is orthostatic (postural hypotension) diagnosed?

A

Within 3 minutes from lying or sitting to quiet standing:

  • Decrease in Systolic blood pressure of 20mmHG
  • Decrease in Diastolic blood pressure of 10mmHG
  • Increase in Heart Rate of 20

Can be seen in early or chronic phases of blood loss or dehydration. Should test when someone presents with symptoms of dizziness, light-headedness, but vital signs are normal

31
Q

Hyperpnea is an increased depth of breathing, usually associated with metabolic acidosis. It is also known as Kussmaul’s breathing.

A

Hyperpnea is an increased depth of breathing, usually associated with metabolic acidosis. It is also known as Kussmaul’s breathing.

32
Q

BMI 30 is obese
BMI 30-34.9 Class I obesity
BMI 35-39.9 Class II obesity
BMI≥ 40 Class III obesity

A

High BMIs are associated with cardiac disease, Type II diabetes, increased mortality from cancer and many others. Body fat distribution is also important in assessing the patient’s risks for disease. An increased waist circumference indicates increased risk as opposed to a pear shape body with increased hip size.

Waist circumferences for men > 102 cm (40 inches) and for women > 88 cm(35 inches) is considered upper body obesity.

33
Q

What are some variables that affect temperature?

A

o Diurnal variation: minimum at 6AM, highest at 4 – 6 PM
• Can fluctuate from 0.5 – 2 oF

o Menstruation: morning temps are generally lower during the 2 weeks prior to ovulation, with a further drop just prior to ovulation, followed by a subsequent rise coincident with ovulation.

o Age:
• baseline temperature is lower in the elderly
• Infants and young children generally have higher temperatures than older children and adults. This relates to the greater surface-area-to-body-weight ratio and the higher metabolic rate of infants and small children.
• For each decade increase in age, average temperature in adulthood decreases by 0.08°C (0.14°F)

34
Q

Core temperature is practically defined as the temperature of blood within the _____.

A

pulmonary artery

35
Q

Rectal temperatures are contraindicated in ____ patients

A

neutropenic

36
Q

What is the difference between fever and hyperthermia?

A

Fever is characterized by a resetting of the thermoregulatory center of the hypothalamus to maintain a higher core body temperature in response to endogenous (pyrogenic cytokines) ± exogenous pyrogens

Hyperthermia is an abnormal elevation of body temperature that occurs without a change in the hypothalamic thermoregulatory set point.

37
Q

How is fever defined?

A

Fever in adults is generally defined as temperature in excess of the 99th percentile of maximum oral temperature for healthy adults.

This is a morning temperature of 37.2 oC (98.9 oF) or an evening temperature of 37.7 oC (99.9 oF). In practice, a value of 100 oF or more is generally considered a fever.

38
Q

What is hyperpyrexia?

A

fever over 41.5C (106.7F)- usually due to CNS hemorrhage

39
Q

What are some things that happen during fever?

A

increased metabolic rate, water loss, pulse, RR, decreased Fe and Zn availability

40
Q

What is ‘sustained’ fever?

A

little variation (up to 0.5 F) from day to day

Classic example: lobar pneumonia

41
Q

What is ‘intermittent’ fever?

A

temperature returns to normal between exacerbations
• Classic example: malaria
• Quotidian: exacerbations daily
• Tertian: recurs every 48 hours (i.e., fever is seen every third day)
• Quartan: every 72 hours (i.e., q4th day)

42
Q

What is ‘remittent’ fever?

A

Vary at least 0.5 oF each day, but do not return to normal.

• Classic example: typhoid fever

43
Q

What is relapsing fever?

A

(Pel-Ebstein): periods of fever lasting days interspersed by equally long afebrile periods
• Hodgkin’s disease

44
Q

What is hectic fever?

A

Intermittent or remittent fevers with wide swings in temperature, usually greater than 2.5 oF per day.

Classic example: pyogenic abscess

45
Q

What are some settings in which fever may be absent in spite of the presence of acute infection?

A

o Seriously ill newborns
o Elderly patients
o Uremic patients
o Patients receiving antipyretic treatment (steroids, NSAIDs, etc)
o Immunocompromised patients (e.g., HIV, neutropenia, immunosuppressant medications)

Note that hypothermia can occur in response to infection, especially overwhelming infections such as septic shock. When observed in this setting, hypothermia predicts worse clinical outcomes.

46
Q

What is the classical presentation of drug fever?

A
  • Classically occurs 7-10 days after the introduction of the drug
  • Therefore, drug histories should always include recently administered drugs, not just current
  • Fever pattern may be sustained
  • Skin rash not common
  • Peripheral eosinophilia not common
  • Absence of systemic manifestations
47
Q

Fever is a sign of underlying disease. Treatment of a fever should not be confused with treatment of the underlying cause. Diagnosis and treatment of the cause of the fever is the primary goal.

A

Fever is a sign of underlying disease. Treatment of a fever should not be confused with treatment of the underlying cause. Diagnosis and treatment of the cause of the fever is the primary goal.

48
Q

T or F. o Febrile children should NOT be treated with salicylates (aspirin) because of the potential for Reye syndrome.

A

T.

49
Q

• Hyperthermia is an elevation of core body temperature occurs secondary to excessive heat production or exposure and/or inadequate heat loss (heat stroke, malignant hyperthermia, hyperthyroidism)
o Does not involve pyrogens and the hypothalamic thermoregulatory set point is unchanged.
o Can be rapidly fatal and does not respond to antipyretic agents
o Diagnosis is usually suggested by preceding events, such as heat exposure or treatment with drugs known to interfere with thermoregulation
• Clinical syndromes include:
• exposure (heat stroke),
• malignant hyperthermia (anesthetics and muscle relaxants),
• drug intoxications (anticholinergics, adrenergics [including drugs of abuse]),
• neuroleptic malignant syndrome (major tranquilizers),
• serotonin syndrome

A

• Hyperthermia is an elevation of core body temperature occurs secondary to excessive heat production or exposure and/or inadequate heat loss (heat stroke, malignant hyperthermia, hyperthyroidism)
o Does not involve pyrogens and the hypothalamic thermoregulatory set point is unchanged.
o Can be rapidly fatal and does not respond to antipyretic agents
o Diagnosis is usually suggested by preceding events, such as heat exposure or treatment with drugs known to interfere with thermoregulation
• Clinical syndromes include:
• exposure (heat stroke),
• malignant hyperthermia (anesthetics and muscle relaxants),
• drug intoxications (anticholinergics, adrenergics [including drugs of abuse]),
• neuroleptic malignant syndrome (major tranquilizers),
• serotonin syndrome

CMOD Week 6 (15 decks)

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