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Mastering Vital Signs: Pulse, Blood Pressure, and Respiratory Rate Review

Understand the procedures for assessing vital signs, pulse strength, and documenting blood pressure readings. Learn about factors affecting vital signs, normal ranges, and the role of pulse, blood pressure in patient care.

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Mastering Vital Signs: Pulse, Blood Pressure, and Respiratory Rate Review

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  1. PTA 103 • Vital Signs • Review of Procedures • Review of Pain Assessment tools • Pulse • Blood Pressure • Respiratory Rate • Pain

  2. Pulse • Measures heart rate (HR = pulse/min) • Measured by palpation or auscultation (using stethoscope) • Normal ranges • 60-100/min in adults • 100-130/min in infants • 80-120/min in children 1-7

  3. Normal Factors Affecting Pulse Increases • Age • Gender (male>female) • ↑ Environmental temp • Infection • Physical activity and activity tolerance • Emotional status • Some medications • Cardiopulmonary disease

  4. Documentation of Pulse • HR standard is pulses/minute (best if measured over 30-60 seconds) • Site of measurement • Temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, pedal • Right or left • Radial pulse is most common (also allows for access to hospital ID bracelet for confirmation) • Can include subjective quality descriptors • e.g., strong, weak, regular, etc.

  5. Identifying Pulse Strength • A numbering system (0-4+) can be used to document a description of pulse strength • Refer to Table 22-2 for descriptions and definitions

  6. Role of PTA • HR can be used to make comparisons with PT evaluation • HR can be used to educate patients/clients in activity limits • Abnormal HR readings at rest and in response to activity should result in communication back to the PT

  7. Blood Pressure • Important to establish baseline values and monitor patient response to activity • Special populations to consider • Pts>65 yrs old; pts <=2 yrs old • Deconditioned/debilitated • Hx of cardiovascular problems • Hx of trauma or diseases which impact cardiovascular function

  8. Key Words related to Blood Pressure Monitoring • Diaphoresis – sweating • Dyspnea – difficulty breathing • Hypertension – high blood pressure • Hypotension – low blood pressure • SOB – shortness of breath • Syncope – fainting • Tachycardia – HR high (>100)

  9. Accepted Normal BP values • Birth to 3mos: 80/35 to 60/65 mm Hg • 3 mos to 1 yr: 90/60 to 100/67 mmHg • Children 1-4yrs: 100-108/60 mm Hg • Add 2mmHg/year to 100mmHg/60-70mmHg • Adolescents: 100/65 to 120/75 mmHg • Adults: 120/80 mmHg • Elderly (>65yrs): 120/80-140/90 mmHg • A similar reference, slightly varied scale is in Cameron, Table 22-3

  10. Abnormal BP Ranges • Prehypertension: 120/80-139/89 mm Hg • Stage 1 HTN: 140/90-159/99 mm Hg • Stage 2 HTN: 160/100-179/109 mm Hg • Stage 3 HTN: 180/110-209-119 mm Hg • Stage 4 HTN: >210/120 mm Hg • Hypotension: Systolic <100 mm Hg

  11. Documentation of BP • Included side and location of measurement • Document if patient smoked, ingested caffeine, or exercised within the last 30 minutes

  12. Common Errors in BP measures • Cuff is deflated too fast • Should be 2mm Hg/second • Cuff is underinflated • Cuff is too small/big • Cuff is incorrectly positioned • Unable to hear pulse clearly/consistently with stethoscope

  13. Role of the PTA • PTAs should be aware of factors that affect BP • Educate at risk patients (smoking, obesity, sedentary) • Consider effects of age, medication, infection, gender/race on BP levels when selecting activity-based interventions • Plan for monitoring during bedside activities, positioning, or functional training

  14. Documentation of Respiration • RR = breaths (inhalation + exhalation) / min • Note depth, rhythm, and character • Avoid providing detailed information about measurement procedure to avoid abnormal measures

  15. Documentation of %O2 Sat • May indicate progress with use of or need for supplemental oxygen • Supplemental O2 is generally indicated for sat <=88% • Quantify endurance capacity for activity in rehabilitation settings • Indicate a need to communicate with PT/health care personnel to optimize stable O2 Sat levels with activity

  16. Documentation of Pain • Onset • Location • Temporal (change over time) pattern • Quality (sharp, shooting, constant, intermittent, etc.) • Intensity • May include formal pain assessment • VAS, McGill, NRS, Faces Pain Rating Scale

  17. Documentation of Vital Signs • Vital sign measures are included in the ‘O’ of the SOAP note • Data is optimally collected before, during and after activity • Data is compared to document progress, verify safe progressions, or support a need to communicate with the primary PT.

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