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Theory and Principles of Respiratory Care > Vitals > Flashcards

Vitals Flashcards

1
Q

5 Vitals

A

-Temperature
-Pulse
-Respiratory Rate
-Blood Pressure
-Pulse Oximetry

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2
Q

-Temperature

A

-Normal

	-Adults 98.6*F or 37*C

-Hypothermia (Low temp) < 95*F

	-Exposure, increased Heat loss, Diaphoresis (Sweating) blood loss, hormone imbalance, hypothalamus injury.

-Hyperthermia (High tmp) >100*F

	-Increased environmental temps, decreased loss (Too many clothes), drugs or medication reaction, hormone imbalance, infection/ Illness
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3
Q

-Pulse

A

-Direct indicator of heart actions

-Note rate and rhythms

-Capillary refill, indicative of local perfusion

	- > 3 seconds = poor perfusion
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4
Q

-Normal Pulse

A

-Adults 6-100 bpm

	-Children have a higher rate
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5
Q

-Bradycardia

A

Slower heart rate < 60 bpm

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6
Q

-Tachycardia

A

(fast heart rate) > 100 bpm

	-Hypothermia, fever, emotional stress, heart abnormality, blood volume loss
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7
Q

-Rhythm of the heart may be irregular due to

A

cardiac arrhythmias or changes in vascular system affecting blood flow

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8
Q

-Measuring pulse

A

-Most Common site - Radial Artery

	-Others: Brachial, ulnar, femoral, carotid, apical, temporal, popliteal, posterior tibial.

	-Use two fingers, and press firmly but gently over pulse site, do not use thumb

	-Count for a full minute, if irregular rhythm otherwise count for 15 seconds and multiply by 4.
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9
Q

-Respiratory Rate

A

-Number of breaths in 1 minute intervals

-Important to count when patients are not aware
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10
Q

-Respiratory Rate -Normal

A

-Adults 12-20

	-Children have a higher rate

-Note, rate depth, pattern, rhythm, and degree of labor, I:E ratio (inspiration to Expiration)
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11
Q

-Eupnea

A

Normal restful breaths

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12
Q

-Hyperpnea,

A

deep breaths

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13
Q

-Hypopnea

A

Shallow breaths

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14
Q

-Tachypnea

A

increased respiration rates

	-Caused by, anxiety, exercise, fever, hypoxemia

	-May indicate respiratory failure
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15
Q

-Bradypnea

A

decreased rate

	-Caused by, narcotics, head injury, hypothermia
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16
Q

Respiratory rate is best to count after….

A

pulse rate

	-Count full min if irregular
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17
Q

-Blood Pressure

A

-Measurement of pressure within arterial systems

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18
Q

-Factors of BP

A

-measuring for pumping action of heart, resistance in cardiovascular system, elasticity of vessel walls, blood volume,viscosity of blood (thickness)

-Systolic pressure, when the ventricles contract

-Diastolic pressure, when ventricles are at rest

	-At this point, the aortic valve closes and pushes the blood through the arterial system

	-The more important measurement of the two
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19
Q

-MAP:

A

Mean Arterial pressure, average of both systolic and diastolic pressure

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20
Q

-Normal BP

A

-Adults 120/80

-Children have lower blood pressure

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21
Q

-Hypotension

A

(low BP)

-Shock, hormone imbalance, depressant drugs, postural (Positioning) Fluid loss.
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22
Q

-Hypertension

A

(High BP)

-Cardiovascular imbalance, hormone imbalance, exercise, stimulate drugs, emotional stress, renal failure, fluid retention
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23
Q

-Acceptable Systolic

A

90-140

24
Q

-Acceptable Disstolic

A

60-90

25
Q

BP is measured by:

A

sphygmomanometer

26
Q

how to use sphygmomanometer

A

-Cuff placed snugly around 1 inch above antecubital space (bladder should be over the brachial artery)

-Have patient relax muscle in arm

-Palpate brachial pulse and inflate cuff

-Slowly deflate cuff, note pressure, when sound 1st appears, systolic

.Note pressure when all sounds cease, diastolic

27
Q

-Pulse Oximetry

A

-Plethysmography (Sp02)

	-5th Vital Sign

	-Measurement of % red blood cells carrying something (Usually O2)

	-Uses different wavelengths of red light passed through capillary bed(Nails)

	-Can be continuous or spot check and is non invasive
28
Q

-Pulse Oximetry -Problems:

A

Ambient light, motion artifact, cold, anemia, PaO2, Vs. SPO2

-Rule 1#: Treat the patient not the monitor
29
Q

-Pulse Oximetry vital readings

A

-Normal 93-97% SaO2

-Critical Values < 88% (Except Chronic Lung Patient)
30
Q

-Heart Sounds

A

-Normal sounds

	-Sounds created by closure of the heart valves

	-Sound 1 normal sound created by the closure of valves at the beginning of ventricular contraction (Lub sound)

	-Sound 2 normal sounds created the the systolic ends and ventricles relax typically during inspiration (Dub sound)

	-Sounds 3, and 4 murmurs are abnormal and suggest heart failure, stenosis (extra sounds generated by aberrant blood flow)
31
Q

-Auscultation

A

-One of the most commonly used physical assessment techniques

-Lung sounds can be normal or adventitious (abnormal)

-Listen in sequence over the back and anterior chest. Refrain from listening anteriorly because it easy of access
32
Q

-Auscultation -Normal breath sounds

A

-Bronchial/ Tracheal breath sounds

-Heard over the trachea or btw scapula posteriorly

-Louder and higher pitched

-Loud and long expiration often longer than inspiration 	

-If heard in periphery of lung could be abnormal
33
Q

-Bronchovesicular

A

-Heard over the main bronchus area

  • Medium pitch

-Expiration is equal to inspiration

34
Q

-Vesicular

A

-Heard over most lung fields

-Soft and low pitched

-Inspiration last longer than expiration
35
Q

-Adventitious breath sounds “Crackles”

A

-Also known as rales

-can be course cracked or fine crackles

-Fine = Results when the terminal airways pop open late in inspiration because of fluid or secretions have accumulated

-Sounds that wax and wane during each respiratory cycle

-Usually heard at the end of inspiration

-Fine in quality and high pitched

-Most often heard over the lung base

-Most common condition is CHF/Pulmonary edema ( Fine crackles at the base.)

36
Q

-Adventitious breathing sound “Rhonchi” (course crackles)

A

-Ronchi is deep rumbling sounds that is more pronounced on expiration

-Likely to be continuous and can be palpated

-Caused by air passing through an airway partially obstructed by thick secretion

-Coarse crackles secretion in large airways rumbling on inspiration and expiration

-Both can usually be cleared or improved through suctioning or coughing
37
Q

-Adventitious breathing sounds “Wheezing”

A

-Can be high or low pitched

-Musical or whistling in nature

-Caused by air passing through narrowed airways

-Can have inspiratory wheezing, expiratory wheezing or both

-Often heard with bronchospasms, asthma, foreign, body aspiration
38
Q

-Adventitious breath sounds “stridor”

A

-Crowing sound commonly caused by inflammation of the larynx and trachea. Usually on inspiration only

-Can be heard after extubation

-Most commonly associated with children with croup

-Often relieved with cool aerosol therapy of racemic epinephrine

-Marked inspiratory stridor is an emergency and requires quick action (Intubation)
39
Q

-Adventitious breathing sounds “Pleural Friction rub”

A

-Continuous grating sound, such as rubbing two pieces of leather together/ balloons

-Sounds produced when the visceral and parietal pleura of the lungs become inflamed

-May accompany pleural effusion, lung trauma, pleurisy

-Usually localized area
40
Q

-Grunting and stertor

A

Grunting is often displayed in newborns with respiratory distress

-Occurs when baby exhales against a closed glottis is closed in an attempt to maintain lung volume

-Stertor is noisy breathing sounds displayed during inhalation by babies

-Low pitched snorting/ snoring sound. Sound that arises from vibrations of fluid or tissue that is relaxed and flabby.
41
Q

-Other lung sounds

A

-Bronchophony

	-Auscultates over an area of suspected consolidation the patient speaking ninety nine, intensity is increased and clearly audible if consolidation is present

-Egophony

-Having the patient say the letter E and it sounds like an A over consolidated lungs

  • Whispering pectoriloquy-Patient is asked to whisper numbers 1,2,3. Normal sounds is soft, but with lung consolidation, it is clearly audible
42
Q

-Patient Assessment

A

-Medical History

-Respect patient

	-Remain professional

	-Establish rapport and obtain essential information

	-Open ended questions (Not yes or no)

	-Demographic data

	-Data and source of information (and reliability)

	-Description of condition

	-Current complaint (CC)/ reason for seeking treatment

	-History of present illness (HPI)

	-Past medical history

	-Family history

	-Social / environmental history
43
Q

-Patient Assessment

-History of present illness (HPI)

A

-Onset, severity, location, quality, aggravations, alleviations factors (OLD CART)

44
Q

-Review of symptoms

A

-Respiratory - cough, hemoptysis, sputum, chest pain, shortness of breath, hoarseness/ change in the voice, dizziness/ fainting, fever or chills, peripheral edma.

45
Q

-General Appearance

A

-Age, height, weight

-Sensorium (level of consciousness)

-Confused, delirious, lethargic, obtunded, stuporous, comatose, “Oriented X 3 , person, place , time.

-Vital signs

-Head, ears, eyes, nose, throat, (HEENT), inspection

-Nasal flaring, cyanosis, pursed lip breathing

-Neck, inspection and palpation

-Position of trachea, jugular venous distention (JVD) enlarged lymph node.

-Thorax, inspection, palpation, auscultation

46
Q

-Inspection
-Chest configuration

A

-Barrel chested (Ap diameter increased)

	-Pectus carinatum/ pectus Excavatum (caved in chest/ pigeon breasted)

	-Kyphosis/ scoliosis/ kyphoscoliosis

	-Notice any bumps, lumps, of concussions
47
Q

-Inspection
-Breathing patterns and efforts

A

-Retractions, sinking in of skin overlying the chest wall (Intercostal, supraclavicular, subcostal

	-Inspiratory: expiratory ratio (I:E ration)

	-Kussmaul, deep and rapid breaths

-Biot, short burst of uniform, deep respirations

-Cheyne stokes: increased/ decreased depth and rate with pauses

-Tachypnea, faster than 20 bpm

-Bradypnea, Slower than 12 bpm

-Apnea; Absence of breaths

-Platypnea: difficulty breathing unless laying flat

-orthopnea: difficulty breathing unless reclining. Patient must be sitting up of using several pillows to breath

48
Q

-Palpation

A

-Vocal fremitus/ tactile fremitus

	-Ninety-nine

	-Increased vibrations through more solid tissues

	-Decreases obesity over muscular, hyper inflation

-Thoracic expansion/ diaphragmatic excursion- equal bilaterally (Both thumbs should be moving equally )
49
Q

Percussion

A

-Tapping on the surface to evaluate underlying tissue

-Indirect,place middle finger on chest, tp sharply with the middle finger of your other hand

-Normal resonance, moderately low pitched ringback

-Consolidation, decreased or absent resonance = Dull

-Hyperinflation , Increased resonance (Hypercasonant)
50
Q

-Auscultation

A

-Listening to breath sounds with a stethoscope

	-4 parts, Bell, diaphragm, tubing, earpieces

		-Bell, listen to heart sounds

		-Diaphragm, listen to lung sounds

		-Earpieces, directed anteriorly into ears

	-Normal and abnormal sounds

		-Soft/rigid

		-Tenderness
51
Q

-Extremities

A

-Clubbing, enlargement of terminal phalanges of fingers and toes

-Compensatory mechanism when someone has chronic hypoxemia

	-Infiltrative or interstitial lung disease

	-Bronchiectasis

	-Some cancers (Lung cancer)

-Cyanosis

-Pedal edema (Swelling like in feet and hands)

-Capillary refill

-Peripheral skin temperature and color (pallor, cyanosis, flush.)
52
Q

-Cardiopulmonary symptoms

-Dyspnea

A

shortness of breath as perceived by patient

	-Measured using a scale (Dyspnea borg scale.)
53
Q

-Cardiopulmonary symptoms
-Cough

A

-Cough, Forced expiratory maneuver that expels mucus and foreign materials from airways

	-Cough receptors in Larynx, trachea and large bronchi

	-Effectiveness depends on patient being able to take a deep breath

	-Dry and loose

	-Productive or unproductive

	-Acute or chronic

	-Time of day
54
Q

-Cardiopulmonary symptoms
-Sputum production

A

-Sputum production: Mucus produced in the airways

	-Normal is minimal

	-Mucociliary escalator

	-Phlegm, material from tracheobronchial tree, not contaminated by oral secretions

	-Sputum, comes from lungs nut passes through mouth

	-Purulent, contains pus (Suggest bronchi infection)

	-Fetid, foul smell

	-Mucoid, thick and cleat ( Common in airway diseases like asthma )
55
Q

-Cardiopulmonary symptoms
-Hemoptysis

A

-Hemoptysis, coughing up blood or blood streaked sputum

	-Massive >300 cc over 24 hours

	-Infection , can be blood streaked

	-Cancer, TB, trauma, pulmonary embolism
56
Q

-Cardiopulmonary symptoms
-Chest Pain

A

-Chest Pain

	-Pleuritic (Lungs), literally or posteriorly, worsens on inspiration, sharp stabbing.

	-Nonpleuritic ( Not the lungs), central anterior, dull ache or pressure, angina, GERD, or gallbladder.

Theory and Principles of Respiratory Care (4 decks)

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