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Intro to Patient > Vital Signs > Flashcards

Vital Signs Flashcards

1
Q

Vital Signs Routinely Monitored

A 
temperature 
pulse 
respiration 
blood pressure 
pulse oximetry
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2
Q

Why do We Take Vitals?

A

help make evaluate health of the patient
abnormal vitals help to identify sicker patients and predict which patients are at risk of dying soon after being sent home from an emergency department

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3
Q

Temperature

A

internal body temperature is tightly regulated to maintain vital organ function, particularly the brain
temperature deviation of more than 4 degrees Celsius above or below normal can produce life-threatening cellular dysfunction
-deviations from baseline are either fever or hypothermia
-35 C = 95 F; 37 C = 98.6 F; 40 C = 104 F

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4
Q

Deviation from Baseline Temperature (Elevated Temperature)

A

fever is generally accompanied by tachycardia
-heart rate increase by 10 bpm for every 1 C increase in temp
infection
-ex) cat scratch disease
-fever is trying to kill bacteria or prevent spreading
heat stroke
congenital absence of sweat glands (ectodermal dysplasia)
-can function without them, but very sensitive to heat

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5
Q

Deviation from Baseline Temperature (Lowered Temperature)

A

endocrine hypofunction

 - ex) Addison disease 
 - ex) hypothyroidism
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6
Q

What Creates a Pulse?

A

sinoatrial node (SA) is heart’s normal pacemaker

 - lies in the right atrial wall near entrance of superior vena cava 
 - each contraction, left ventricle ejects volume of blood into aorta that then perfuses arterial tree 
    - pressure moving through tree creates arterial pulse
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7
Q

Pulse

A

radial pulse is used to assess heart rate
-use pads of 2nd and 3rd fingers
-compress artery until maximal pulsation is detected
count the rate for 30 seconds and multiply by 2
range of normal is 50-90 bpm
normal infants and children have higher rates
well-conditioned athletes may have resting rates in low 40s

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8
Q

Abnormal Rhythms

A

even if rhythm abnormality is suspected on physical exam, nothing can be diagnosed with certainty without electrocardiogram
heart rates lower than 55 bpm are bradycardias
heart rates above 100 bpm are tachycardias
exertion may cause acceleration to almost 200 bpm in young, healthy adults

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9
Q

Causes of Bradycardia

A

problems with SA node
problems in conduction pathways of the heart that don’t allow electrical impulses to pass properly from the atria to the ventricles
metabolic problems (ex. hypothyroidism)
damage to the heart from heart disease or attack
certain heart medications cause this side effect

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10
Q

Causes of Tachycardia

A 
damage to heart from heart diseases
abnormal electric pathways in heart present at birth 
     -ex) congenital heart conditions 
anemia 
exercise 
sudden stress
high or low blood sugar 
smoking 
fever
drinking too much 
too much caffeine 
medication side effects 
abuse of recreational drugs 
imbalance of electrolytes 
hyperthyroidism (overactive thyroid)
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11
Q

Atrial Fibrillation

A

rapid heart rate caused by chaotic, irregular electrical impulses in upper chambers of the heart
signals result in rapid, uncoordinated, weak contractions of the atria
irregular pule; no repetitive manner
most ppl with A fib. have structural abnormalities of the heart related to underlying conditions such as heart disease or HBP

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12
Q

Sinus Tachycardia

A

normal increase in heart rate (faster than normal but beats properly)
may be body’s response to common conditions
-anxiety
-strenuous exercise
-fever
-some meds/street drugs

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13
Q

Respiratory Rate

A

observe rate, rhythm, dept, and effort of breathing
count respirations in 1 min. by visual inspection or via stethoscope
normal adults take ~20 breaths per minute
newborns ~44 per minute
some conditions can change rate
-asthma
-anxiety
-lung disease
-congestive heart failure

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14
Q

Pulse Oximetry

A 
test used to measure oxygen level (oxygen saturation) of blood 
clip-like device for finger or ear lobe 
probe uses light to measure 
Conditions that can change oxygen levels 
     -heart attack 
     -heart failure 
     -COPD
     -anemia 
     -lung cancer 
     -asthma 
     -pneumonia 
normal saturation is 95-100%
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15
Q

Blood Pressure (Biologically)

A

heart serves as a pump that generates varying pressures in its chambers as they contract and relax
-systole: period of ventricular contraction (sends blood out into aorta)
-diastole: period of ventricular relaxation (blood fills cavities and pressure falls back below 5 mmHg)
blood pressure in arterial system varies during cardiac cycle, peaking in systole and falling to lowest in diastole

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16
Q

Blood Pressure

A 
measured with a sphygmomanometer 
factors affecting BP 
     -left ventricular smoke volume
     -distensibility of aorta and large arteries 
     -peripheral vascular resistance 
     -volume of blood in arterial system 
normal values systolic: 90-130 mmHg
normal values diastolic: 60-90 mmHg

systolic <80 and >200 BAD
diastolic <55 and >120 BAD

17
Q

Selecting Correct Cuff

A

width of inflatable bladder cuff should be 40% upper arm circumference
length of bladder should be 80% upper arm
std cuff is 12x23 cm
cuff too small (narrow) - BP read high
cuff too large (wide) - BP read low on small arm and high on large

18
Q

Finding Systolic Pressure by Palpation

A

with arm at heart level, center inflatable bladder over brachial artery
lower border of cuff should be 2.5 cm above elbow crease
feel radial artery with fingers and inflate cuff until pulse disappears
-read pressure and add 30 mmHg to it
use this sum as target for next inflation
deflate cuff and wait 15-30 sec

shortcut: pump bladder to 150-180 mmHg
- may not capture upper limit of systolic pressure for patients with HBP

19
Q

Taking Blood Pressure Reading

A

arm at hear level, bladder over brachial artery, lower cuff boarder 2.5 cm above elbow crease
position arm so slightly flexed
place bell of stethoscope over brachial artery, make air seal wth full rim
inflate cuff to about 20 mmHg above pressure at which radial pulse was blocked, then deflate slowly at rate of about 2-3 mmHg per second
level at which you hear two consecutive beats again (Korotkoff sound) = systolic reading
sounds disappear = diastolic reading

systolic/diastolic (ex. 120/80)

ideally, take more than 1 reading and average
-if first 2 readings differ by more than 5 mmHg, retake

numerous studies show home BP readings more predictive of CV disease than office measurements

20
Q

Inaccurate Readings

A

deflating too slow: cause venous congestion and can alter reading
deflating too fast: miss first audible pulse
not sitting with back support can elevate BP by 5-10 mmHg
speaking can elevate BP by 8-15 mmHg
smoking tobacco increases systolic BP by 20 mmHg within 4 minutes
number of medications can effect BP

21
Q

Pain

A

Joint Commission - 2001 rolled out Pain Management standards
-made pain the 5th vital sign
-required Drs. to ask every patient about pain bc thought pain was under treated
-now we have an opioid problem
-Physicians for Responsible Opioid Prescribing asked Commission to no longer consider pain vital sign
Many researchers not been able to demonstrate improved pain treatment or better pain outcome by measuring pain as 5th vital sign using numerical pain scores

22
Q

Chronic Pain

A

pain not associated with cancer or other medical conditions that persists for more than 3-6 months
pain lasting more than 1 month beyond course of acute illness or injury
pain recurring at intervals of months or years

23
Q

Assessing Severity of Pain

A

visual analog scale
numeric rating scale
Wong-Baker FACES pain rating scale
faces pain scale by Int’l Association for the Study of Pain
more detailed scales available but take longer to administer
brief pain inventory
McGill Pain Questionnaire

24
Q

Types of Pain: Nocicpetive

A

somatic pain linked to tissue damage to skin, musculoskeletal systems, or viscera
-but sensory nervous system intact
can be acute or chromic
mediate by A-delta and C-fibers
involved afferent nociceptors can be sensitized by inflammatory mediators and modulated by both psychological processes and neurotransmitters like endorphins, histamines, acetylcholine, serotonin, NE, and dopamine

25
Q

Types of Pain: Neuropathic

A

direct consequence of a lesson or disease affecting the somatosensory system
over time may become independent of inciting injury
-become burning, lancinating, or shock-like
mechanisms postulated to evoke neuropathic pain:
-CNS brain or spinal cord injury from stroke or trauma
-peripheral nervous system disorders causing entrapment or pressure on spinal nerves (ex. Trigeminal neuralgia)
-referred pain syndromes with increased or prolonged pain responses to inciting stimuli

26
Q

Trigeminal Neuralgia (TN)

A

most commonly affects maxillary branch
rare condition that affects women
4-13/100,000 ppl
incidence risk increases w/ age
hypertension may be a risk
Classic TN - neurovascular compression (80-90% cases)
Idiopathic TN - nerve compression by other than vascular comp. (postherpetic, space-occupying lesion, MS)
symptoms: pain in one of the distributions of CNV

27
Q

Classic Trigeminal Neuralgia Definition

A

three attacks of unilateral facial pain
pain occurring in one or more of the trigeminal nerve distribution without pain beyond those distribution
three of the 4 criteria:
-paroxysmal attacks with duration of 1-120 sec.
-severe intensity
-pain is electric-shock like, stabbing, or sharp
-precipitated by innocuous stimuli on corresponding side of face

28
Q

Types of Pain: Central Sensitization

A

alteration of CNS processing of sensate, leading to amplification of pain signals
lower pain threshold to nonpainful stimuli, response to pain may be more painful than expected
fibromyalgia is example which has a strong overlap with depression, anxiety, and somatization disorders
best responds to meds that modify neurotransmitters
-ex)serotonin and dopamine

29
Q

Types of Pain: Psychogenic

A

involves factors that influence patent’s report of pain
-psychiatric conditions like anxiety or depression, personality and coping style, cultural norms, and social support

30
Q

Types of Pain: Idiopathc

A

pain without an identifiable etiology

31
Q

Types of Pain: Central Sensitization

A

alteration of CNS processing of sensate, leading to amplification of pain signals
lower pain threshold to nonpainful stimuli, response to pain may be more painful than expected
fibromyalgia is example which has a strong overlap with depression, anxiety, and somatization disorders
best responds to meds that modify neurotransmitters
-ex)serotonin and dopamine

32
Q

Types of Pain: Psychogenic

A

involves factors that influence patent’s report of pain
-psychiatric conditions like anxiety or depression, personality and coping style, cultural norms, and social support

33
Q

Types of Pain: Idiopathc

A

pain without an identifiable etiology

Intro to Patient (10 decks)

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