Vitals: Ch. 10

Question 1

what are the 6 Vital signs?

Answer 1

Temperature
Pulse
O2 Sats 
Respirations
BP
Pain Assessment

Question 2

Temperature

• Normal range (F and C)
• Mode
• Children vs Adult vs Older Adult

Answer 2

• 96.4 - 99.1 F (35.8 - 37.3 C)
• Controlled by the hypothalamus

-Oral (most common), rectal (most reliable, but invasive), tympanic (careful of user error), axillary (least reliable), temporal.

• Child: higher temp, fever common, rectal temp. used when concerned about infection (insert 2-3 cm towards umbilicus)
• Adult: 98.6 F (37 C), fever means infection
• Older adult: lower temp, fever uncommon

Question 3

Pulse

• Normal range
• Radial palpation necessary observations
• Apical
• Diff. in tachycardia & bradycardia

Answer 3

-50 to 100 BPM

Radial:

• rate- bpm
• rhythm- regular/ irregular
• force- 0 to 3 (0= absent in an alive person, 1= weak/ thready and need a doppler, 2= normal, 3= bounding

-Apical: used for babies and CVD patients. Place stethoscope @ 5th intercostal rib and mid-clavicular line (just under left nipple). count for full minute

• Tachycardia: > 100 bpm (pain, fever, stress, exercise)
• Bradycardia: < 50 bpm (beta-blockers, digoxin, lack of profusion)

Question 4

Respiration

• Normal range
• Necessary observations
• Pulse to resp. ratio
• Diff. in , tachypnea & bradypnea

Answer 4

-10 to 20 (inhalations + exhalation), 30 to 60 in infants, older adults breath slightly faster than adult

• Rate: breaths/ minute
• Rhythm: normal pattern of breathing
• Depth: chest rise and fall
• Effort: use of accessory muscles, automatic and unlabored

-Ratio of 1:4 (60bpm : 15 breaths/ min)

• Eupnea: normal
• Tachypnea: > 20 breaths/ min (eg: stress)
• Bradypnea: < 10 breaths/ min (eg: opium use)

Question 5

Blood Pressure

• Normal range
• Systolic vs Diastolic
• Method
• Pulse Pressure
• MAP

Answer 5

• <80 / <120 (sys/dia)
• 3y + measure annually
• 2 step method: avoids reading systolic wrong
• Thigh: when there is not an arm available. Popliteal artery. Will have about a 10mmHg higher reading than the arm.
• Systolic: Max pressure on arterial walls during contraction
• Diastolic: Elastic recoil, resting pressure exerted between each contraction
• Pulse pressure: SBP - DBP = stroke volume
• normal range 40 - 60 mmHg
• Mean Arterial Pressure (MAP): the pressure forcing blood into the tissues averaged over the cardiac cycle
• Normal >or= 60mmHg

Question 6

Orthostatic Vital Signs

-what is orthostatic hypotension?

Answer 6

BP and HR when patient is lying, sitting, and standing.

-orthostatic hypotension is defined by drop in SBP > 20mmHg with position change sit to stand.

Question 7

SpO2

-Normal range

Answer 7

Oxygen saturation in blood.
- >95% on room air (RA) (consider altitude)

-Always document RA vs supplemental (liters)

Question 8

how do you take respirations of an obese patient

Answer 8

Rest hand on chest, 1 minute count, do not inform them that you are assessing breathing

Question 9

what is an auscultatory gap

Answer 9

Silence for 30 to 40 mmHg during deflation; an abnormal finding. Occurs in about 5% of people, most often from hypertension.
Use the 2 step method to avoid missing this finding.

Question 10

Hypertension & what it causes

Answer 10

High BP

• Increase in blood volume
• Increase in central venous pressure
• Increased cardiac output
• During vasoconstriction more pressure is required to push blood contents resulting in a high BP

Question 11

Hypotension & what it causes

Answer 11

Low BP

• Decreased cardiac output
• Decreased blood volume

Question 12

What is Coarctation of the heart? and how to do test for it?

Answer 12

A congenital form of narrowing of the aorta.
Arm pressures are high. Thigh pressure is lower because the blood supply to the thigh is below the constriction.

SBP in the leg will read about 10 - 40mmHg higher than arm, DBP will be the same.