Vital Signs Flashcards
Vital Signs Routinely Monitored
temperature pulse respiration blood pressure pulse oximetry
Why do We Take Vitals?
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
Temperature
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
Deviation from Baseline Temperature (Elevated Temperature)
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
Deviation from Baseline Temperature (Lowered Temperature)
endocrine hypofunction
- ex) Addison disease - ex) hypothyroidism
What Creates a Pulse?
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
Pulse
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
Abnormal Rhythms
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
Causes of Bradycardia
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
Causes of Tachycardia
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)Atrial Fibrillation
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
Sinus Tachycardia
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
Respiratory Rate
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
Pulse Oximetry
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%Blood Pressure (Biologically)
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
Blood Pressure
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
Selecting Correct Cuff
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
Finding Systolic Pressure by Palpation
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
Taking Blood Pressure Reading
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
Inaccurate Readings
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
Pain
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
Chronic Pain
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
Assessing Severity of Pain
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
Types of Pain: Nocicpetive
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
Types of Pain: Neuropathic
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
Trigeminal Neuralgia (TN)
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
Classic Trigeminal Neuralgia Definition
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
Types of Pain: Central Sensitization
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
Types of Pain: Psychogenic
involves factors that influence patent’s report of pain
-psychiatric conditions like anxiety or depression, personality and coping style, cultural norms, and social support
Types of Pain: Idiopathc
pain without an identifiable etiology
Types of Pain: Central Sensitization
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
Types of Pain: Psychogenic
involves factors that influence patent’s report of pain
-psychiatric conditions like anxiety or depression, personality and coping style, cultural norms, and social support
Types of Pain: Idiopathc
pain without an identifiable etiology
