vital signs for all ages/ patient asessment Flashcards
Adult respiratory rate
12-20
Adult pulse rate
60-100 sinus
Adult blood pressure
120/80
BGL
80-120
ETco2
35-45 mm HG
With appropriate waveform
Normal skin
Pink warm and dry
Pulse ox
94%+
With matching pleth to QRS
Capillary refill
<2 seconds
Pupils
PEARRL
pupils equal round and reactive to light
neonate RR
30-60
neonate pulse
100-205
neonate BP
systolic: 67-84
diastolic: 35-53
neonate core temperature
98-100
infant RR
30-53
infant pulse
100-180
infant BP
systolic: 72-104
diastolic: 37-56
infant core temperature
96.8 - 99.6
toddler (1-2 yrs) RR
22-37
toddler (1-2yrs) pulse
98-140
toddler (1-2 yrs) BP
systolic: 86-106
diastolic: 42-63
toddler (1-2 yrs) core temperature
96.8-99.6
preschool age (3-5) RR
20-28
preschool age (3-5) pulse
80-120
preschool age (3-5) BP
systolic: 89-112
diastolic: 46-72
preschool age (3-5 yrs) core temp
98.6
school age (6-12) RR
18-25
school age (6-12) Pulse
75-118
school age (6-12) BP
systolic: 97-120
diastolic: 57-80
school age (6-12) core temp
98.6
adolescent (12-15) RR
12-20
adolescent (12-15) pulse
60-100
adolescent (12-15) BP
systolic: 110-131
diastolic: 64-83
adolescent (12-15) core temp
98.6
Mean arterial blood pressure calculation
diastolic pressure + 1/3 pulse pressure
OR
(Diastolic pressure + systolic pressure) /2
mean arterial blood pressure usefulness
perfusion pressure of the different internal organs a low MAP can signify lack of perfusion and ischemia and hypoxia to internal organs
hypotension in children to ten formula
70 + (age x 2)
neonate MAP
45-60
infant MAP
50-62
toddler MAP
49-62
preschool age MAP
58-69
school age MAP
66-79
adolescent MAP
73-84
adult MAP
70-110
prehypertension
systolic 120-139
diastolic: 80-89
stage one hypertension
systolic: 140-159
diastolic: 90-99
stage two hypertension
systolic: >160
diastolic: >100
biot ataxic respirations
irregular breathing pattern, rate, depth of respiration with intermittent periods of apnea,
- caused by ICP
Cheyne stokes respiration
gradual increase in respiratory rate and depth followed by a gradual decrease with intermittent periods of apnea
- caused by brainstem injury/insult
Kussmaul respirations
deep gasping respiration associated with DKA
agonal gasps
guppy gasps caused by cerebral anoxia, preceded by death and can be happening during death.
chest pain assessment areas
- skin pulse and blood pressure
- look at trauma for the chest
- breath sounds
- assess for pedal and dependent edema
- obtain 12 lead
abdominal pain assessment areas
- skin, pulse, BP
- trauma to abdomen, palpate for tenderness and rigidity
- check for specialty signs
- 12 LEAD
SOB assessment areas
- skin pulse BP
- rate and depth of respirations
- assess for airway obstruction
- listen carefully for breath sounds
- assess for hypoxemia
- pedal/dependent edema and obtain 12 lead
dizziness assessment areas
- skin,, pulse, BP adequacy of respiration
- Monitor LOC carefully
- check head for signs of trauma
- evaluate for signs of stroke
- history of inner ear problems
-BGL - further inquire into history/ environmental conditions
- 12 lead
-electrolytes
bones joint assessment areas
- skin, pulse, sensation distal to affected area
cardiac bruit
whooshing sound that indicates turbulent blood flow moving through narrowed arteries, most commonly the carotid
cardiac murmur
abnormal whooshing sounds heard over the heart that indicated turbulent blood flow around the cardiac valve.
cardiac lift/heaves
suggestive of hypertrophy is when the heart sounds like its beating very strong
cardiac thrills
vibrations that can be auscultated and palpated, suggestive of underlying bruit of murmur.
auscultation location of aortic valve
second intercostal space to the right of the sternum
auscultation of the pulmonic valve
second intercostal space to the left of the sternum
auscultation location of the tricuspid valve
lower left sternal border
auscultation location of the mitral valve
over cardiac apex lateral to the lower left sternal border near the midclavicular line
heart tones S1 S2
LUB-DUB
location: 2-3rd intercostal space at the right sternal border
heart tones S3
LUB-DUB-CKY
location: 4th, 5th , 6th intercostal space at left sternal border
- associated with abnormally increased filling pressures in the atria secondary to severe heart failure
heart tones S4
GlLP-LUB-DUB
location: apex of the heart 5th to 6th intercostal space at the left midclavicular line
-decreased stretching compliance of the left ventricle or increased pressure in the atria
Cranial nerve 1 l
olfactory nerve
smell
cranial nerve 2 ll
optic nerve
vision
cranial nerve 3 lll
oculomotor
movement of eyes pupils and eyelid
cranial nerve 4 IV
trochlear
movement of the eye
cranial nerve 5 V
trigeminal
chewing, pain, temperature, touch of the mouth and face
cranial nerve 6 VI
abducens
movement of the eye
cranial nerve 7 VII
facial
movement of the face, tears, salvation and taste
cranial nerve 8 VIII
auditory
hearing and balance
cranial nerve 9 IX
glossopharyngeal
swallowing taste, sensations in the mouth and pharynx
cranial nerve 10 X
vagus
sensation and movement of the pharynx, larynx, throat and GI system, gag reflex
cranial nerve 11 XI
accessory
movement of the head and shoulders
cranial nerve XII
hypoglossal
movement of the tongue
H & T cardiac arrest HS
hypoxia
hypovolemia
hydrogen ions
hypo-hyperthermia
hypoglycemia
hypo/hyperkalemia
H & T cardiac arrest TS
thrombosis
tamponade
tension pneumothorax
toxins
trauma
Para
Number of babies delivered
Gravida
Number of pregnancies had
indications for fluid resuscitation adult and peds
- hypotension
- fatigue
- dark color urine
- dry mouth
-headache - prolonged vomiting or diarrhea
- non traumatic bleeding (vaginal/GI)
- suspected rhabdomyolysis
- paramedic discretion
- poor skin turgor
- delayed capillary refill in peds
pulsus alternans
beat to beat difference in heart rate
pulsus deficit
difference between the apical and peripheral pulse rate
causes of decreased S1 sounds
- fibrosed or calcified mitral valve / AV valves
- obesity
- emphysema
- cardiac tamponade
louder S2 sounds
chronic hypertension/ pulmonary hypertension
Cannon A wave
When atria and ventricles contract simultaneously. blood in the right atria is then pushed against a closed tricuspid valve causing a large venous pulsation in the venous system.
what is distension of the jugular veins when the liver is gently pressed specific to right sided heart failure
hepatojugular reflux
what is bronchophony
if you can understand the word 99 through your stethoscope then there is lung consolidation
what is egophony
when you tell the PT to say (EEEEEE) and you hear AYYY it can indicate pleural effusion
what is whispered pectoriloquy
when the patient whispers and you can understand what is said
