Vital Signs

Question 1

What are the main vital signs? (6)

Answer 1

• T
• HR
• RR
• BP
• SpO2
• Pain

Question 2

When do you assess VS? (5)

Answer 2

• When first encountering a patient
• According to doctor’s orders
• With any change in clinical condition
• After a procedure (follow protocols)
• After starting a new medication (usually cardiac & pain medications)

Question 3

What are “routine” vital signs? (2)

Answer 3

• Once per shift at beginning of shift

- With any change in clinical condition

Question 4

What is the importance of VS? (4)

Answer 4

Provides a rapid overview of stability of patient’s condition

Provides an overview of trends in patient’s condition

Provides clues to cause of patient’s symptoms

Provides clues to problems with the cardiac, pulmonary, renal and nervous systems

Question 5

What is the normal range for temperature?

Answer 5

35.8 - 37.3

Question 6

What are the different types of thermometers? (4)

Answer 6

Oral - common, most accurate

Axillary - 0.5o C lower

Tympanic - reads quickly

Rectal - 0.5o C higher than oral

Question 7

What influences temp? (7)

Answer 7

• Diurnal cycle
• Gender/Age
• Exercise
• Exposure to Cold
• Surgery
• Infection
• Neurological diseases

Question 8

Where should you palpate for a pulse of a responsive pt? How many fingers do you use?

Answer 8

Palpation of radial artery with 3 fingers

Question 9

How do you assess the pulse of an unresponsive pt?

Answer 9

Palpate the carotid artery if pt is unresponsive

Question 10

What are the normal heart rate for newborns, children and adults?

Answer 10

Newborns: 70-190 bpm
Children: 70-110 bpm
Adults: 60-100 bpm

Question 11

What influences HR? (7)

Answer 11

• Exercise
• Fever/hypothermia
• Medications
• Pain
• Fear/anxiety
• Infection
• Dehydration

Question 12

What are the normal RR for infants, children and adults?

Answer 12

• Infants: up to 40
• Children: 20-30
• Adults: 12-20

Question 13

What influences respiratory rate? (6)

Answer 13

• Age
• Exercise
• Anxiety
• Medications
• Respiratory distress
• Head injury

Question 14

What is SBP? What is DBP? What are the ranges?

Answer 14

Systolic pressure (SBP) = Top #

• Maximum pressure in artery during LV contraction
• SBP normal range = 100-120 mm Hg

Diastolic pressure (DBP) = Bottom #

• Resting pressure in artery between contractions
• DBP normal range = 60-80 mm Hg

Question 15

What is considered a normal BP?

Answer 15

Normal BP ~ 100/60 to 120/80 mm Hg

Question 16

What is pulse pressure?

Answer 16

Pulse pressure = SBP - DBP

• Ex: for BP 120/80, PP = 120 – 80 = 40
• It reflects stroke volume, normally 40-60
• It must be interpreted alongside SBP & DBP

Question 17

What is Mean arterial pressure (MAP)?

Answer 17

(MAP) = (SBP + 2DBP)/3

• The average pressure in arteries during one cardiac cycle
• Normal range = 70-110
• It’s a better indicator of perfusion to vital organs than SBP (MAP >/= 60 mm Hg is needed to maintain adequate tissue perfusion)

Question 18

What is BP influenced by? (8)

Answer 18

• Age/gender
• Diurnal rhythm
• Weight
• Exercise
• Stress/emotion
• Medications
• Blood viscosity & volume
• Vessel wall elasticity

Question 19

How is pain rated? How is it described?

Answer 19

Rate intensity from 0-10

Describe pain qualities
PQRSTU

Question 20

What does PQRSTU stand for?

Answer 20

• Provocation (cause)
• Quality (burning/dull)
• Radiate/referred
• Severity (0-10)
• Time (onset)
• Understanding (what do they think it is?)

Question 21

What is a normal SpO2?

Answer 21

> 95%

Question 22

What does a pulse oximetry do?

Answer 22

It monitors percentage of hemoglobin (Hgb) saturated with oxygen