Week 2 - Vital Signs, Mental Status Flashcards
What are the 5 stages of level of consciousness?
Alert: the patient is awake and aware
▪ Lethargic: you must speak to the patient in a loud forceful manner to get a response
▪ Obtunded: you must shake a patient to get a response
▪ Stupor: the patient is unarousable except by painful stimuli (sternal rub)
▪ Coma: the patient is completely unarousable
What is the significance of copper bracelet, excess clothing, cut-out holes or slippers,
immobile face, eye stare, breath odor of acetone and of urine?
Copper bracelets are sometimes worn for arthritis.
Excess clothing may reflect the cold intolerance of hypothyroidism.
Cut out holes or slippers may indicate gout, bunions, or other painful foot conditions.
Immobile face may indicate parkinsonism.
Eye stare may reflect hyperthyroidism.
Breath odor of acetone and of urine may indicate diabetes.
What is the significance of fast frequent movement, slow movement, preference for sitting up,
preference for leaning forward with arms braced?
Fast frequent movements suggest hyperthyroidism.
Slow movements suggest hypothyroidism.
Preference for sitting up can be due to left-sided heart failure.
Preference for leaning forward with arms braced could indicate chronic obstructive pulmonary disease.
What are the conditions causing very short stature, and conditions causing long limbs in
proportion to the trunk? What is a cause of height loss?
Very short stature could be due to Turner’s syndrome, childhood renal failure, coarctation of the aorta, and achondroplastic and hypopituitary dwarfism.
Long limbs, in proportion to the trunk, could be indicative of hypogonadism and Marfan’s syndrome.
A cause of height loss could be osteoporosis and/or vertebral compression fractures.
How will you calculate BMI? What are the BMIs of normal, underweight, overweight, and
three stages of obese classes? What is the normal upper limit of waist measurement in both
sexes? What is waist-hip ratio?
(Weight lbs x 700) / (height” x height”)
▪ Underweight: < 18.5 ▪ Normal: 18.5-24.9 ▪ Overweight: 25.0-29.9 ▪ Obesity I: 30.0-34.9 ▪ Obesity II: 35.0-39.9 ▪ Obesity III (extreme obesity): ≥ 40
Upper limit of waist measurement, indicating excess body fat, is anything ≥ 35 for women or ≥ 40
inches for men.
Your waist to hip ratio compares your hip circumference at its widest part to your waist circumference at or just above the belly button.
Compare the prevalence of obesity and overweight among different ethnic groups in USA.
Women: African-American women (69%); white women (47%)
Men: African-American men (58%); white men (62%)
Adolescents: highest prevalence in Mexican-American boys, African American girls, white boys from
lower-income families
Can slight reduction of weight improve BP and other risk factors? What are the recommended
rate of optimum weight loss per week and over 6 months?
Even reducing weight by 5% to 10% can improve blood pressure, lipid levels, and glucose tolerance and
reduce the risk of diabetes or hypertension.
A weight loss goal of ½ to 1 pound per week is recommended because more rapid weight loss does not lead to better results at 1 year. A 10% weight reduction over 6 months is recommended, or a decrease of 300 to 500 kcal/day, for people with BMIs between 27 and 35.
What is the recommended daily sodium intake?
For hypertensive patients, the recommended daily sodium intake is less than 2,400mg or 1 teaspoon
How much calorie/hour is used by a 154 pound man when walks 3.5 miles per hour, and
runs/jogs 5 miles/hour?
280 calories/hour are used when walking 3.5 mph
590 calories/hour are used when running 5 mph
What is the appropriate size of a BP cuff? What happens if you use a too tight or too lose a
cuff? Know the steps of accurate BP measuring. What happens if the arm is positioned too high
or too low instead of heart level?
Width of the inflatable bladder of the cuff should be about 40% of upper arm circumference (about 12-
14 cm in the average adult). Length of the inflatable bladder should be about 80% of upper arm
circumference (almost long enough to encircle the arm).
If the cuff is too tight, the blood pressure will read high.
If the cuff is too loose, the blood pressure will
read low on a small arm and high on a large arm.
If the arm is positioned too high, the blood pressure will read lower. If the arm is too low, then the
blood pressure will read higher.
What is the position of the lower border of the cuff? Which side of the chest piece of
stethoscope is used when measuring BP?
The lower border of the cuff should be about 2.5cm or 1 inch above the antecubital crease.
The bell should be used to measure BP, but many use the diaphragm.
Classify normal and abnormal blood pressures. How will distinguish coarctation of aorta by
measuring blood pressure?
Normal: < 120 (systolic) / < 80 (diastolic)
▪ Prehypertension: 120-139 / 80-89
▪ Hypertension (Stage 1): 140-159 / 90-99
▪ Hypertension (Stage 2): ≥ 160 / ≥ 100
Coarctation of the aorta is detected by comparing the blood pressures of the arms to the legs and the
timing and volume of the radial pulse to the femoral pulse.
What are the 4 aspects of a pulse will you examine? Classify normal and abnormal heart rates.
Rate , Rhythm , contour , amplitude
Normal rate is between 50-90 beats per minutes; tachycardia is above 90 and bradycardia is below 50.
Define orthostatic hypotension. How will you diagnose it?
Orthostatic (postural) hypotension is a drop in systolic blood pressure of ≥ 20 mm Hg or in diastolic
blood pressure of ≥ 10 mmHg within 3 minutes of standing.
It is diagnosed by measuring blood pressure with the patient in supine position for at least 10 minutes,
and then again within 3 minutes of standing up.
What are the 4 parameters of respiration will you examine? What is the normal rate of
respiration?
The four parameters of respiration are rate, rhythm, depth, and effort of breathing. Normal respiration
rate is between 12 and 20 breaths per minute
