Vitals Signs Review and Emergency Situations Flashcards
when do we monitor vitals/why
- assess readiness for PT session/exercise
- during/after session to assess physiological response to exercise and continued stability
what are you looking for when assessing vitals
adverse reactions
when should vitals be taken in ICU and how
they should be taken continuously through arterial line or dinomap machine
what factors can impact accuracy of vitals
medications
pt positions
equipment (size of cuff)
pain
emotional state
how to document vitals
pt position
extremity
activity being performed (pre/post, moving, standing)
describe different BP values
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
describe effects exercise has on SBP and DBP
SBP should increase in linear fashion
DBP should remain stay or slight decrease
postural hypotension
orthostatic hypotension
when is orthostatic hypotension common following
trauma, blood loss, best rest, medications
describe requirements for orthostatic hypotension
> 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)
sx of orthostatic hypotension
lightheadedness, diaphoresis, dizziness, confusion, blurred vision
how to measure orthostatic hypotension
- 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
describe values for HR
normal: 60-100
tachycardia: >100
bradycardia: <60
normal HR response to exercise
steady increase and should return to pre-exercise state in 3-5 minutes
what should you use to assess HR in patients on beta blockers
Borg RPE
what impact can arrythmias have on HR
can impact cardiac output
normal RR
12-18
at what rate is exercise contraindicated for increased RR
> 50
45 = use caution
what positions make breathing easier/harder
easier: sitting, standing
harder: supine
normal SpO2
> 95%
what does a low SpO2 indicate
decreased oxygen to peripheral tissues
list how to manage seizures
- 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
when to call 911 with seizures
- > 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
s/s of MI/cardiac arrest
chest pain
jaw pain
L arm pain
profuse sweating/indigestion
what to do when suspecting MI/cardiac arrest
- STOP activity and take vitals
- call 911 or nurse/code/RRT
- check ABCs
CPR basics for adult 1-2 rescuers
ratio - 30:2
rate - 100-120 bpm
depth - 2-2.4 inches
CPR basics for child/infant 1 rescuer
ratio - 30:2
rate - 100-120 bpm
depth - infant: 1.5 inches, child: 2 inches
CPR basics for child/infant 2 rescuers
ratio - 15:2
rate - 100-120 bpm
depth - infant: 1.5 inches, child: 2 inches
how to know if a pt is choking
unable to speak/get sound out
universal sign of hands to throat
what to do if pt is choking and is responsive
- perform abdominal thrusts in sitting/standing until object dislodged or pt loses consciousness
what to do it pt is choking and unresponsive
lower to ground, begin CPR
- check mouth each time prepare to give rescue breath to see if item has become dislodged
when is rescue breathing used
when the pt has stopped breathing, but still has a pulse
what often precedes cardiac arrest
respiratory arrest
how to deliver rescue breaths for adults and infants/children
adults: 1 breath every 5-6 sec
infants/kids: 1 breath every 2-3 sec
what do you have to check for during each rescue breath
chest rising
what should you do if the pt loses pulse during rescue breathing
begin CPR
s/s of hypoglycemia
feeling shaky
nervous
sweating/chills/clamminess
irritability
confusion
increased HR
lightheadedness
hunger
nausea
blurred vision
headache
normal fasting glucose levels and hypoglycemia levels
normal: 70-100 mg/dL
hypo: <70 mg/dL
steps to take with hypoglycemia
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
how to differentiate orthostatic hypotension vs hyperglycemia
take Bp
assess at different positions
give them orange juice
when not to initiate PT
- 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
when to terminate PT (relative contraindications)
- 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
