Vital signs & obvs Introduction

Question 1

1. Introduction

Answer 1

1. Wash hands
2. Introduce myself- full name, PA, role
   (I’m a medically trained generalist healthcare professional working alongside doc, providing medical care)
3. Confirm patient details - full name, DOB, age
4. Confirm confidentiality
5. Explain obvs & vital signs & blood pressure procedure
6. Obtain consent
7. Explain procedure next step
8. Are you in any pain today?

Question 2

2. Observations

Answer 2

1. Patient sitting 45 degrees
2. Observe 1st impressions
   3 based on patient’s posture, eye-contact, facial expression, responsiveness, mobility
3. Does patient look well/unwell?
4. In pain?
5. In respiratory distress?
6. Well nourished?
7. Pale?
8. Obvious abnormalities?
9. Build?
10. Observe if in pain/ anxious? What gives that appearance?
11. Observe patient environment

Question 3

1. Vital sign- Temperature

Answer 3

1. I am going to take your oral temperature
2. Place underneath tongue
3. Keep your mouth closed
4. For 1 minute

Number of black dots = temp & record

• fever 1 degree higher than normal
• hypothermia (<35 degrees) (diabetes, infection)
• normal (36.5-37.2)

Question 4

2. Vital sign- Pulse

Answer 4

1. Take patient’s right hand
2. Rest it comfortably
3. Locate radial pulse and palpate
4. Do 15 secs x 4 (if not slow & regular)
5. Note rate (speed) , volume (strong/weak) rhythm (regular)
6. Interpret reading (bpm)

• normal 60-100 bpm
• <60 bradycardia (decreased thyroid hypercalaemia)
• > 100 tachycardia (chest pain, CHF)

Question 5

3. Vital sign - respiration rate

Answer 5

1. WHILST DOING PULSE
2. Observe patient’s breathing while pretending to continue to take pulse
3. Count respirations for 15 secs x 4
4. Look ah chest
5. If high 30 secs x 2
6. Note rate and record
7. Breaths / minute bpm

• adults 12-20 breaths per min normal
• occasional sigh normal
• > 25 abnormal
• <8 abnormal

Question 6

4. Vital sign - BMI

Answer 6

1. Measure weight in kg and height cm (shoes off)
2. Interpret BMI chart accurately
3. Record

(Kg/m2) = BMI

• will be higher in women & elderly
• ranges= (<17 underweight= assoc diseases anaemia, osteoporosis, decreased immune system)
  (18-25 ideal, healthy)
  (>25 overweight)
  (>30 obese= assoc diseases = heart disease, stroke, high bp, diabetes, gout)

Question 7

5. Blood pressure (1. Preparation)

Answer 7

1. Ensure patient sitting comfortably
2. Check no pain in arm
3. Explain procedure to patient
4. Remove all clothing from arm
5. Choose appropriate cuff size (standard size) (bladder encircle 80% of arm)

Question 8

5. Blood pressure (2. Measurement)

Answer 8

1. Expose and support patient’s arm
2. Place cuff so midline of bladder is over arterial pulsation, then wrap and secure cuff around upper bare arm
3. Lower edge of cuff 2.5cm above antecubital fossa where head of stethoscope is to be placed
4. Position of arm: antecubital fossa in position with heart, arm slightly flexed, arm well supported
5. Position pressure dial so u can see it & it’s at 0
6. Screw down escape valve on rubber bulb
7. Palpate radial artery
8. Pump up cuff do radial artery is no longer (heard/palpable)
9. Observe and remember pressure reading on manometer
10. Let pressure down by unscrewing valve rapidly
11. NOW feel for pulsations of brachial artery on medial side of antecubital fossa
12. Place diaphragm of stethoscope over brachial artery
13. Inflate cuff to 30mmHg above that previously needed to obliterate radial pulse
14. Let pressure down by 2-3mmHg per sec
15. As pressure in bladder falls- note:
    - 1st repetitive sounds (phase 1, 1st Kortokoff sound)
    - muffling sounds more (phase IV)
    - sounds disappear (phase V/ 5th Kortokoff sound)

Question 9

5. Blood pressure (3. Recording)

Answer 9

1. Deflate for 10mmHg then rapidly & patient rest 30 secs
2. Systolic and diastolic pressures recorded to nearest 2mmHg
3. Record BP in patient record:
4. Write BP, record arm, patient position, record cuff size (standard), note if patient stressed/anxious, note last time of anti hypertensive medication

CONCLUDE WITH PATIENT

• if hypertensive explain follow up: blood pressure monitoring or hypotensive
• recheck after 2 mins to confirm
• hypertensive >140/90
• normal 120/0
• low 90/60

Pre hypertensive: 120-130/80-89
Hyp stage 1: 140-159/90-99
Hyp stage 2- 160/100
Severe - 180/110