Vitals & EKG Flashcards
What should you assess in tachycardic patients?
if they are febrile, dehydrated (nausea/vomiting/diarrhea?), perfusing (skin color, skin temperature and skin dryness), and always match the rate with a blood pressure.
What should you assess in bradycardic patients?
assess their alertness, medications, ask about any existing cardiac conditions or if the patient has passed out recently, and again always match the heart rate with a blood pressure
Is hypotension concerning?
According to the American Heart Association, hypotension isn’t concerning unless it is symptomatic.
Pre-hypertensive systolic blood pressure
between 120 and 129 mmHg with the diastolic blood pressure still being less than 80 mmHg.
Stage 1 Hypertension
SBP starts at 130 mmHg
DBP between 80-89 mmHg.
Stage 2 Hypertension
SBP 140 or higher
DBP higher than 90 mmHg.
Hypertensive Urgency
BP higher than 180/120 W/O any end organ failure.
Hypertensive Emergency
a BP higher than 180/120 mmHg WITH end organ failure
Neurological S/S of end organ failure include
Signs and symptoms of encephalopathy Altered LOC Dizziness Headache Stroke Seizures
Ophthalmology S/S of end organ failure include
Retinopathy
Papilloedema (optic disc swelling)
Retinal Hemorrhage
Cardiovascular S/S of end organ failure include
EKG changes
Chest pain
S3 and S4 heart sounds
Renal S/S of end organ failure include
Hematuria (blood in urine)
Oliguria
How is MAP calculated?
Normal values?
(SBP + (2xDBP) ) /3 = MAP
the heart spends twice as much time in diastole than systole.
Generally the goal for a MAP is between 60 and 100 mmHg.
What is pulse pressure?
Normal values?
a measurement of the difference between the systolic blood pressure and diastolic blood pressure. A normal pulse pressure is between 30-40 mmHg.
What is Pulmonary Wedge Pressure (PWP)?
Normal values?
- Pt would be in ICU*
- a measurement of left atrial pressure.
- a balloon to be placed in a patient’s pulmonary artery branch
- helps to diagnose left ventricular failure and is the gold standard for diagnosis of acute pulmonary edema
~systolic (normal range 15-30 mmHg) and diastolic (normal range 4-12 mmHg)
What signifies if a patient is positive for orthostatic hypotension?
If the SBP is greater or less than than 20 mmHg, the heart rate is greater or less than 20 BPM, or the patient is symptomatic (dizziness, lightheadedness, or fainting with position changes)
What can orthostatic hypotension indicate?
can indicate GI bleeding/blood loss, anemia, dehydration, etc. The first line of treatment, if appropriate, is to give fluids (orally if tolerated) and reassess orthostatics to eliminate dehydration. It is likely that the provider will want to also check for any blood in the stool as well as a CBC for the hemoglobin results.
If a patient is suspicious for an aortic dissection or aneurysm, how are VS assessed?
take the blood pressure in both arms and compare SBPs together and DBPs together. If the blood pressure is more than 20 mmHg of difference, there is a possibility that the patient is having a dissection. Check radial pulses at the same time and assess if they are equal in rate and intensity.
When do you hold cardiac medications?
systolic blood pressure is less than 90 mmHg or if the heart rate is less than 50 or 60 BPM
What is Cardiac Output (CO)?
Calulation?
- how much blood (in liters) the left heart is pumping out to the body per minute through the aorta
- calculated by multiplying how much blood is ejected with each cardiac contraction, which is called stroke volume (SV) multiplied by the number of heart beats per minute.
- In a “normal” patient, this number will be anywhere from 4-10 liters per minute.
What are sensitive indicators your patient is not getting the blood they need (perfusing)?
Skin signs such as a delayed capillary refill over 3 seconds, neuro signs such as altered mentation, and decreased urine output below 0.5mg/kg/hr or 30ml/hr minimum in an adult
Stroke Volume (SV)
the amount of blood in the left ventricle that ejects out with each contraction of the heart.
-arrhythmias like atrial fibrillation or premature beats can affect the ability of the left ventricle to completely fill on diastole and this will alter how much is being ejected.
What is a normal EF?
- A normal EF is 60-80%, and anytime you see the EF less than 50-55%, it is commonly referred to as systolic dysfunction and can be chronic, acute, or acute on chronic during a stressor.
- If you’ve got a patient who is in heart failure, the physician/advanced practice provider will typically order a transthroacic echocardiogram (TTE or “echo”) to evaluate the EF.
Things that can cause ST in patients?
Hypovolemia (dehydration) Fever Caffeine Stress Pain Hypotension Hyperthyroidism
