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ICM 1 > Vital Signs > Flashcards

Vital Signs Flashcards

1
Q

Should you wash your hands before physical exam?

A

YUP or sanitize

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2
Q

What is the general survey?

A

General overview of how the patient appears which provides some context for the remaining exam

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3
Q

Synonym for general survey?

A

General appearance

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4
Q

6 parts of general survey?

A
  1. Apparent state of health: Acute or chronically ill, frail
  2. Level of consciousness: Awake, alert, responsive or lethargic, obtunded, comatose
  3. Signs of distress: Cardiac or respiratory; pain; anxiety/depression
  4. Dress, grooming, and personal hygiene: Appropriate to weather and temperature, clean, properly buttoned/zipped
  5. Facial expression: Eye contact, appropriate changes in facial expression
  6. Odors of body and breath
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5
Q

5 vital signs?

A
  1. Height and weight
  2. Blood pressure
  3. Heart rate and rhythm
  4. Respiratory rate and rhythm
  5. Temperature
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6
Q

When is the general statement given?

A

After the vital signs

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7
Q

What is BP a result of?

A
  1. Pumping action of the heart
  2. Viscosity of the blood
  3. The diameter of the blood vessel
  4. Rigidity of the blood vessel
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8
Q

How to take pulse?

A

Palpate radial artery; count for 15 seconds and multiply by 4

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9
Q

How to take respirations?

A

Count for 30 seconds and multiply by 2

Do not inform patient

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10
Q

How to take BP?

A
  1. Correctly place cuff on arm and ensure feet are uncrossed and flat on the floor
  2. Support arm at heart level
  3. Palpate brachial artery and place stethoscope at this location
  4. Inflate cuff to 180 mmHg or to pulse obliteration pressure
  5. If Koratkoff sounds still heard at 180 mmHg, inflate until sounds absent
  6. Deflate cuff slowly (<5 mmHg/sec) until the first 2 Korotkoff sounds (heart beats) are heard as the systolic pressure
  7. Continue deflating, record the disappearance of Korotkoff sounds as the diastolic pressure
  8. Listen till pressure falls another 10 –20 mm Hg to confirm absence of further Korotkoff sounds (important to make sure you are not in the ausculatory gap), then deflate rapidly and completely
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11
Q

What to do if pulse is abnormal?

A

Count for 30 seconds to one minute

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12
Q

How to make sure BP measurement is correct?

A

Wait 2 min and repeat, both arms at least once

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13
Q

Should the BP be the same in both arms?

A

Normal difference between 5 and 10 mmHg

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14
Q

Why should BP sometimes be taken by palpation? How?

A

If a patient is especially sensitive to cuff pressure (eg 180 mmHg causes pain) or you are having a hard time determining the systolic pressure, then systolic BP can be estimated by determining the pressure at which the palpable radial pulse disappears (approximation of systolic pressire)

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15
Q

What is the auscultatory gap?

A

A silent interval that may be present between the systolic and diastolic blood pressures; i.e., the sound disappears for a while, then reappears

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16
Q

What can cause BP to “appear” high?

A

Caffeine within 30 min

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17
Q

How can cuff size impact BP reading?

A

Small cuff overestimates systolic pressure and vice versa

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18
Q

In what % of patients does white coat HT occur?

A

20%

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19
Q

What happens to BP if the arm is above the heart?

A

False low

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20
Q

What happens to BP if the arm is below the heart?

A

False high

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21
Q

Is automatic or conventional BP measurement more accurate?

A

Automatic

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22
Q

How can you tell that a cuff is appropriately sized?

A

Index line and range on the cuff

23
Q

What is orthostatic hypotension? What causes it?

A

Drop in blood pressure with change in position from sitting or lying to standing.

Cause: inadequate physiologic response to postural changes in blood pressure due to:

  1. dehydration or blood loss
  2. Disorders of the neurologic, cardiovascular, or endocrine systems
  3. Medications
  4. Prolonged bed rest
24
Q

4 symptoms of orthostatic hypotension?

A
  1. Dizziness, lightheadedness, or fainting
  2. Blurred vision
  3. Weakness
  4. Palpitations
25
Q

2 types of orthostatic hypotension?

A

Acute or chronic

26
Q

Can HT be diagnosed with one reading?

A

NOPE

27
Q

BP target for patients over 60?

A

Less than 150/90

28
Q

BP target for patients under 60?

A

Less than 140/90

29
Q

BP target for patients above 18 with chronic kidney disease?

A

Less than 140/90

30
Q

BP target for patients above 18 with diabetes?

A

Less than 140/90

31
Q

Does BP fluctuate throughout the day?

A

YUP

32
Q

Diagnostic est for orthostatic BP?

A
  1. Measure blood pressure and heart rate with the patient supine.
  2. Have the patient stand up.
  3. Wait 1 minute.
  4. Now repeat the measurements

RESULTS: Normal: systolic BP drops slightly or remains unchanged; diastolic BP rises slightly

Orthostasis: systolic BP drops >20mm Hg or diastolic BP drops >10 mm Hg

33
Q

What does it mean for humans to be endothermic?

A

Warm-blooded

34
Q

What is a normal HR?

A

60-100 bpm

35
Q

Which fingers to use for HR?

A

Index and middle finger

36
Q

Where is the radial pulse?

A

Between abductor pollicis longus and flexor carpi radialis tendon; radius is palpable deep

37
Q

Average oral temp?

A
  1. 8 C

98. 2 F

38
Q

How does rectal temp compare to oral?

A

0.5 C (1 F) ABOVE oral

39
Q

How does axillary temp compare to oral?

A

0.5 C (1 F) BELOW oral

40
Q

How does tympanic temp compare to oral?

A

0.8 C (1.4 F) ABOVE oral

41
Q

Normal RR?

A

14-20/min

42
Q

3 things to observe for RR?

A
  1. Observe rhythm: regular, irregular
  2. Observe depth: shallow, gasping
  3. Observe effort: normal, labored
43
Q

Trick for RR?

A

Place your hand on the patients shoulder while you are palpating the radial pulse and count the rise and fall of your hand. You can act as if you are still taking the pulse in order to avoid the awkwardness of just staring at the patient while they breath.

44
Q

What does pulse oximetry measure?

A
  1. Arterial O2 sat

2. O2 delivery to tissues

45
Q

What constitutes hypotension?

A

BP < 100/60

46
Q

What is a fever?

A

Elevated body temp secondary to hypothalamic mechanisms. Depending on reference either above 99.5F or 100.8F

47
Q

What is hyperthermia?

A

Elevated body temp secondary to non-hypothalamic mechanism

48
Q

What is hypothermia?

A

Body temp below 95F

49
Q

What is tachycardia?

A

Pulse > 100

50
Q

What is bradychardia?

A

Pulse < 60

51
Q

What is tachypneia?

A

RR > 30

52
Q

What is bradypneia?

A

RR < 12

53
Q

Rate temps by location and high to low.

A

Rectal > Oral > Axillary

ICM 1 (2 decks)

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