week 2: vital signs Flashcards
parts of a clinical interview
- preparation
- initiation
- exploration
- closing/termination
preparation
the setting
- ensure privacy
- eliminate distractions
- ensure clients comfort
- where will you be in relation to the client
- maintain an attentive body position
initiation
introduce yourself
clean hands
inform the client about session and gather consent
exploration
ask questions that will set the context for the interview (open-ended questions)
closing/termination
summarize the information provided
devise a problem list with priorities
determine short and long term goals
create plan of action
SOAP notes
subjective, objective, analysis/assessment, plan
before beginning a clinical skills task
introduce yourself (first and last name)
hand hygiene
confirm clients name and preferred name
provide overview of the session
gather informed consent
what are vital signs
measures of the bodys core ability to stay alive
- pumping blood through the heart
- breathing
- maintaining core temperature
they are the most frequently measured objective data for monitoring vital body functions and are often the most important indicator for patients changing condition
four main vital signs
- respiration
- pulse/ heart rate (HR)
- blood pressure (BP)
- temperature
three other vital signs
- pulse ox
- pain rating scales
- level of perceived exertion
what are vital signs used to establish
- baseline physiological information to guide exercise program development
- physiological response to activity to guide continuation, modification, or discontinuation of a program
- patients/clients immediate health risk
- emergency cardiac or respiratory interventions
heart rate
goal is to determine the clients physiological response to activity
to obtain an accurate picture of clients cardiac response to activity
how to assess HR
- resting HR (5 mins before activity)
- activity HR (during or immediately following activity)
- recovery HR (1 - 5 mins post-activity)
what is heart rate
an indirect measure of the rate and rhythm of the contraction of the left ventricle
what characteristics measure HR
- rate (bpm)
- rhythm
- intensity
measuring HR at carotid
- stand on same side of the carotid artery (not across)
- don’t press too hard
- massage like actions can decrease HR and produce bradychardia
- dont palpate - may cut off blood supply to the brain
measuring HR at radial and brachial
- support left arm on stable surface at level of the heart with elbow extended and forearm supinated
- using 2+3rd digits, palpate gently for the brachial pulse (medially above elbow crease) and radial pulse (1-2cm above wrist crease lateral to the flexor tendon)
- measure number of beats in 1 min
HR safety
**
- HR increase ~10bpm per 1 MET
- should decrease by at least 12 during 1st min of recovery
- should decrease by 22 by end of 2nd min of recovery
respiratory rate characterization
- rate: # of breaths per min
- pattern: eupnea, tachypnea, bradypnea, apnea
- mechanics
RR mechanics
inspiratory to expiratory ratio (I:E)
- normal is 1:2 or 1:3
blood pressure
a physiological variable which reflects the effects of CO, peripheral vascular resistance and haemodynamic factors
- an indirect measure of the pressure inside an artery caused by blood flow through the artery
- recorded as mmHg
systolic vs diastolic pressures
systolic: the pressure at the time of the contraction of the left ventricle
diastolic: the pressure at the time of ventricular filling (resting pressure)
5 phases of blood pressure sounds (Korotkoff’s)
phase 1: first clear tapping sound heard, faint at first but increasing (initial flow through the artery as the constriction of artery is released - systolic)
phase 2: softer sound (no clinical significance)
phase 3: louder and more crisp sound (no clinical significance)
phase 4: sound is muffled (first diastolic BP - useful during exercise assessment)
phase 5: cessation of sound (diastolic BP)
BP errors of measurement
- inappropriate cuff size
- tested arm unsupported
- legs crossed while sitting
- unsupported sitting
- arm that is not level with the heart
- rapid deflation of the cuff
- equipment malfunction
- auditory errors due to incorrect placement of equipment
