Vitals Signs Review and Emergency Situations

Question 1

when do we monitor vitals/why

Answer 1

• assess readiness for PT session/exercise
• during/after session to assess physiological response to exercise and continued stability

Question 2

what are you looking for when assessing vitals

Answer 2

adverse reactions

Question 3

when should vitals be taken in ICU and how

Answer 3

they should be taken continuously through arterial line or dinomap machine

Question 4

what factors can impact accuracy of vitals

Answer 4

medications
pt positions
equipment (size of cuff)
pain
emotional state

Question 5

how to document vitals

Answer 5

pt position
extremity
activity being performed (pre/post, moving, standing)

Question 6

describe different BP values

Answer 6

normal: <120/<80
hypotension: <80/<60
elevated: 120-129/<80
HTN Stage 1: 130-139/80-90
HTN Stage2: >140/>90
hypertension crisis: >180/>120

Question 7

describe effects exercise has on SBP and DBP

Answer 7

SBP should increase in linear fashion
DBP should remain stay or slight decrease

Question 8

postural hypotension

Answer 8

orthostatic hypotension

Question 9

when is orthostatic hypotension common following

Answer 9

trauma, blood loss, best rest, medications

Question 10

describe requirements for orthostatic hypotension

Answer 10

> 20 mmHg decrease in SBP or >10 mmHg decrease in DBP on standing within in 3 minutes
(may also see subsequent increase in HR –> no longer a requirement)

Question 11

sx of orthostatic hypotension

Answer 11

lightheadedness, diaphoresis, dizziness, confusion, blurred vision

Question 12

how to measure orthostatic hypotension

Answer 12

• pt lay down for 5 min
• measure BP and HR in supine
• ask pt to stand
• repeat BP and HR at 1 and 3 minutes

Question 13

describe values for HR

Answer 13

normal: 60-100
tachycardia: >100
bradycardia: <60

Question 14

normal HR response to exercise

Answer 14

steady increase and should return to pre-exercise state in 3-5 minutes

Question 15

what should you use to assess HR in patients on beta blockers

Answer 15

Borg RPE

Question 16

what impact can arrythmias have on HR

Answer 16

can impact cardiac output

Question 17

normal RR

Answer 17

12-18

Question 18

at what rate is exercise contraindicated for increased RR

Answer 18

> 50
45 = use caution

Question 19

what positions make breathing easier/harder

Answer 19

easier: sitting, standing
harder: supine

Question 20

normal SpO2

Answer 20

> 95%

Question 21

what does a low SpO2 indicate

Answer 21

decreased oxygen to peripheral tissues

Question 22

list how to manage seizures

Answer 22

• call for help/rapid response team in hospital
• stay with pt until seizure has ended
• protect pt/comfort (pillow, clear area, roll on side)
• monitor length of seizure (time of seizure and recovery)
• stay calm
• keep onlookers away
• don’t forcibly hold pt down
• don’t put anything in pt’s mouth
• monitor respiratory status

Question 23

when to call 911 with seizures

Answer 23

• > 5 minutes
• one seizure occurs after another without person regaining consciousness
• seizures closer together than usual for pt
• breathing becoming more difficult/choking
• seizure occurred in water
• injury may have occurred
• pt asks for medical help

Question 24

s/s of MI/cardiac arrest

Answer 24

chest pain
jaw pain
L arm pain
profuse sweating/indigestion

Question 25

what to do when suspecting MI/cardiac arrest

Answer 25

- STOP activity and take vitals - call 911 or nurse/code/RRT - check ABCs

Question 26

CPR basics for adult 1-2 rescuers

Answer 26

ratio - 30:2 rate - 100-120 bpm depth - 2-2.4 inches

Question 27

CPR basics for child/infant 1 rescuer

Answer 27

ratio - 30:2 rate - 100-120 bpm depth - infant: 1.5 inches, child: 2 inches

Question 28

CPR basics for child/infant 2 rescuers

Answer 28

ratio - 15:2 rate - 100-120 bpm depth - infant: 1.5 inches, child: 2 inches

Question 29

how to know if a pt is choking

Answer 29

unable to speak/get sound out universal sign of hands to throat

Question 30

what to do if pt is choking and is responsive

Answer 30

- perform abdominal thrusts in sitting/standing until object dislodged or pt loses consciousness

Question 31

what to do it pt is choking and unresponsive

Answer 31

lower to ground, begin CPR - check mouth each time prepare to give rescue breath to see if item has become dislodged

Question 32

when is rescue breathing used

Answer 32

when the pt has stopped breathing, but still has a pulse

Question 33

what often precedes cardiac arrest

Answer 33

respiratory arrest

Question 34

how to deliver rescue breaths for adults and infants/children

Answer 34

adults: 1 breath every 5-6 sec infants/kids: 1 breath every 2-3 sec

Question 35

what do you have to check for during each rescue breath

Answer 35

chest rising

Question 36

what should you do if the pt loses pulse during rescue breathing

Answer 36

begin CPR

Question 37

s/s of hypoglycemia

Answer 37

feeling shaky nervous sweating/chills/clamminess irritability confusion increased HR lightheadedness hunger nausea blurred vision headache

Question 38

normal fasting glucose levels and hypoglycemia levels

Answer 38

normal: 70-100 mg/dL hypo: <70 mg/dL

Question 39

steps to take with hypoglycemia

Answer 39

15-15 rule: give 15g of carbohydrates and recheck every 15 minutes - glucose tablets, 4 oz juice/regular soda, 1 tbsp sugar/honey/corn syrup, hard candy

Question 40

how to differentiate orthostatic hypotension vs hyperglycemia

Answer 40

take Bp assess at different positions give them orange juice

Question 41

when not to initiate PT

Answer 41

- resting HR <50 or > 120 - resting SPB <90 or >200 - resting glucose < 70 or >200 be aware of pt trends monitor sx and check with nursing

Question 42

when to terminate PT (relative contraindications)

Answer 42

- HR increase > 20 bpm over resting HR (not proportionate to activity) - HR >120 and RPE of 13 - RR > 35 - SpO2 < 90% - decrease SBP with activity - HTN response: >250/>115 monitor sx and be aware of baseline/pt trends