Patient Assessment: Vitals

1. Monday, June 9, 2014 Patient Assessment: Vitals

2. Review • Let’s review the 4 vital signs! • Heart rate • Respiratory rate • Blood pressure • Temperature

3. Heart Rate • What does heart rate tell you? • Tells you part of the patient’s story – how your body is being supplied by oxygenated blood • Where can you measure heart rate? • 11 sites, 8 discussed last class • How do you describe (document) heart rate? • Site, rate, rhythm, depth

4. Respiratory Rate • Describe the process of breathing • Inhalation and expiration: exchange of gases in the body • What does respiratory rate tell you? • Tells you how much oxygen you may need, and how much carbon dioxide to expel • How does respiratory rate relate to heart rate? • Hold your breath • Your body needs oxygen, but needs to also get rid of gas wastes: CO2

5. Blood Pressure • What is blood pressure? • A ratio of the pressure in your arteries when your heart contracts & relaxes • Systolic vs diastolic • What is hypotension vs hypertension? • Hypo – below normal, ie. shock • Hyper – above normal, ie. cardiovascular disease • What does blood pressure tell you? • Tells you whether oxygenated blood is getting delivered properly

6. Temperature • What does temperature tell you? • The body self-regulates its temperature to ensure cellular reactions work best • What is hypothermia vs hyperthermia? • Temperature below or above normal can seriously affect body function • What is the difference between core and peripheral temperature? • Core: taken by ear (T) & rectum (PR) • Peripheral: taken by armpit (Ax), mouth (PO)

7. Let’s Take Some Vitals! • Manual blood pressure • 1) Make sure patient has not been doing any strenuous activity for about 5 minutes. • 2) Take cuff and secure it around patient’s arm, placing the tubing centre to the patients brachial artery site • 3) Locate the radial pulse, and inflate the cuff until you cannot feel the pulse anymore (obliteration), making note of the mmHg

8. Let’s Take Some Vitals! • Manual blood pressure continued • 4) Now place your stethoscope on this site and listen for a pulse. Inflate cuff above the obliteration point by 30-40mmHg. • 5) Slowly deflate cuff at 2-3mmHg per second, and make note when you begin to hear the pulse again. That’s your systolic! • 6) Continue to deflate and make note when you no longer hear the pulse. That’s your diastolic!

9. Vital Signs Review Game

10. HR 100 • What is the normal heart range for an adult? • 60-100 Back to the Board

11. HR 200 • What is the normal heart rate range for an infant? • 110-180 BPM Back to the Board

12. HR 300 • What is tachycardia? • Increased heart rate over the normal range Back to the Board

13. HR 400 • There are 11 sites to palpate pulse. 8 were in the last presentation: name 3 of these sites. • Apical • Radial • Femoral • Popliteal • Brachial • Carotid • Dorsalispedis • Temporal Back to the Board

14. HR 500 • What are the 4 components of documenting of heart rate? • 1) Site • 2) Rate • 3) Rhythm • 4) Depth Back to the Board

15. RR 100 • How is respiratory rate measured? • Respirations per minute Back to the Board

16. RR 200 • What is the normal range for a child? • 20-25 respirations per minute Back to the Board

17. RR 300 • Name 2 of the 3 components of documenting respiratory rate. • 1) Rate • 2) Rhythm • 3) Depth Back to the Board

18. RR 400 • What is the process in which your diaphragm flattens and chest expands allowing exchange of oxygen in your lungs? • Inhalation Back to the Board

19. RR 500 • Name 2 things that can affect your ability to breath: Bonus points if you can explain how. • Airway is obstructed • Lung tissue is poor (ie. inflammation, thickened) • Lung cannot inflate properly (ie. collapsed, pressure against lung space) Back to the Board

20. Temp 100 • What is the normal range for temperature? • 35.0-37.5*C Back to the Board

21. Temp 200 • What site is denoted by the letter “O”? • Oral temperature site Back to the Board

22. Temp 300 • Name the 4 sites to take temperature. • Oral • Rectal • Axillary • Tympanic Back to the Board

23. Temp 400 • What is the difference between core and peripheral temperatures? • Core refers to temperatures closest to internal organs • Peripheral refers to temperatures away from internal organs Back to the Board

24. Temp 500 • Which type of temperature sites is the most accurate? Bonus points if you can explain why. • Core temperature sites such as tympanic & rectal • Because they are a better at measuring the temperature of your internal organs and less influenced by fluctuations of your environment Back to the Board

25. BP 100 • What is the normal blood pressure of an adult? • 120/80 Back to the Board

26. BP 200 • What is the unit of measure for blood pressure? • mmHg or “millimetres of mercury” Back to the Board

27. BP 300 • What is the difference between systolic & diastolic pressures? • Systolic is a measures of the pressure in the arteries when the heart contracts • Diastolic is a measure of the pressure when the arteries relax Back to the Board

28. BP 400 • What is the normal blood pressure of an infant? • 90/55 Back to the Board

29. BP 500 • Give 3 symptoms of hypotension. • Dizziness, light-headedness, syncope (fainting), cold/clammy skin, fatigue, shallow breathing, blurred vision, lack of concentration, nausea Back to the Board

30. Critical Thinking 600 • BEFORE taking vital signs, what are some observations you can make that may affect how you interpret your findings? Back to the Board

31. Critical Thinking 700 • A 20 year old man comes into the ER with a stab wound to the stomach. His vitals are T-37.2*C (PO), BP-88/60, HR-121, RR-24. Explain the relationship between his blood pressure and his heart rate. Back to the Board

32. Critical Thinking 800 • A 77 year old lady becomes increasingly confused so her family takes her to see the doctor. Her vitals are T-37.7*C (PO), BP-109/68, HR-108 and RR-18. The nurse takes a rectal temperature and it’s T-38.2*C (PR). What does this finding mean? Back to the Board