DPT 470

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DPT 470
2012-02-11 14:55:56
Vital Signs

Basic Procedures
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  1. Vital sign
    Objective evidence (examination) of certain physiologucal functions fo the body that are essential to life
  2. Why are vital signs important?
    • Gives a picture of general physiological state of the individual: integral component o the "systems review"
    • Gives a picture of how the individual is responding to a particular treatment: safety, difficulty with treatment, done too much vs. can do more, progression vs. lack of progress
    • Simple and everyone is able to learn: health care workers, patient, family
  3. When are vitals taken?
    • Resting: before activitu/procedure, establish a baseline, compare to medical chart
    • During: monitor procedure - allows ongoing evaluation, critical component - ICU, cardiac or pulmonary patients
    • After: immediately after, 5 minutes after to compare to baseline
  4. How frequently are vitals taken?
    • 1st visit/initial exam: assess safety/baseline of physiologic state of patient
    • routine: seriously ill patients where activity could adversely effect physiologic state
    • periodically: certain patients to detemine responses to change in treatment
    • Ommitted in subsquent PT visits: general physiological state is stable and treatment does not involve strenuous activity/procedures
  5. Recording vital signs
    • Patient's medical chart contain daily measurements
    • serial measurements are more accurate than one time mearsurement
  6. Recording vital signs - PT
    • mentally record
    • notify nursing staff or physician
    • written documentation in progess note - adverse responses to treatment or program responses are reflected in vital signs measurements
  7. Types of vital signs
    • pulse
    • respiration
    • blood pressure
    • temperature
  8. pulse
    vibration of a wave of blood in arteries
  9. how to take a pulse
    • Patient/part of body in relaxed position
    • Use palpation skilss - use tips of first 2 or 3 fingers
    • place fingers over area
    • gently apply pressure to palpate pulse - not so hard as to obliterate the pulse
  10. how long to take a pulse
    • first time: full minute
    • habitually abnormal (rate, volume, rhythm): full minute
    • habitually normal: 30 seconds or 15 seconds
  11. evaluating a pulse
    • pulse rate
    • pulse amplitude
    • pulse rhythm
  12. Pulse rate - normal
    • newborn rate: 120-140 ppm
    • adult 60-100 ppm
    • know what is "normal" for each individual
  13. Pulse rate - fluctuations
    • morning: lower
    • afternoon: higher
  14. Pulse rate - abnormalities
    • Fast: tachycardia (>100 ppm)
    • Slow: bradycardia (<60 ppm)
  15. Factors that affect pulse rate
    • emotions
    • activity
    • drugs
    • body temperature
  16. pulse amplitude/ volume
    force or strength of the pulse
  17. Pulse amplitude varies with...
    • volume of blood in arteries
    • strength of heart's contractions
    • elasticity of blood vessels
  18. Categories of pulse amplitude
    • 0: absent; cannot palpate
    • 1+: weak or thready
    • 2+: normal; stronger pressure can obliterate
    • 3+: full and bonding; difficult to obliterate
  19. pulse rhythm
    spacing between beats
  20. Categories of pulse rhythm
    • regular: intervals between beats are the same
    • irregular (arrythmia): intervals between the beats are unequal
  21. Pulse - radial
    • most common
    • elbow and wrist relaxed
    • distal radius, volar surface of the wrist at the radial styloid
  22. Pulse - brachial
    • important for takign blood pressure
    • antecubital fossa, medial to insertion of biceps brachii
  23. Pulse - temporal
    just in front of the ear above external acoustic meatus
  24. Pulse - carotid
    • each side of the trachea
    • critical pulse
  25. Pulse - apical
    • located just below or over the left nipple
    • located with stethescope
    • directly measures heartbeat
  26. Pulse - femoral
    located in groin area midway between the pubic symphysis and ASIS
  27. Pulse - popliteal
    • located behidn the knee, very deep
    • difficult to palpate
  28. Pulse - posterior tibial
    • locaed immediately behind medial malleolus
    • look for warmth and color
  29. Pulse - dorsalis pedis
    • One branch: anterior medial ankle joint, over tal-navicular joint
    • One branch: anteriorly between 1st and 2nd metatarsals
    • look for warmth and color
  30. pulse deficit
    difference between more accurate apical pulse and radial pulse
  31. irregular force and rhythm
    sign of some forms of heart disease, overactive thyroid, and possibly some medication
  32. respiration
    • the intake and output of air or more exactly the act of breathing in O2 and expelling CO2
    • automatic process controlled by the respiratory center in the brian and the amount of CO2 in the blood stream
    • evaluate in terms of cycles - 1 inspiration + 1 expiration = 1 cycle
  33. respiration evaluation
    • rate
    • depth
  34. respiration rate - normal
    • newborn: 40/min; decrease as get older
    • adult: 10/12-20/min
  35. Respiration rate - abnormal
    • less than 8/min
    • more than 40/min
  36. Normal factors affecting the respiration rate
    • emotions
    • activity
    • fever
    • pain
    • blood gases
    • drugs
    • pressure on respiratory center of brain
    • poisons
  37. respiration depth
    amount of attempted air exchange
  38. respiration depth - shallow
    • intake or output of small amounts of air
    • characteristic of upper chest or apical breathers
  39. respiration depth - deep
    patient uses diaphragm and muscles of inspiration to take in and breath out air
  40. how to take respiration
    • subject should be relaxed
    • primarily observing rise/fall of chest wall
    • difficult = once patient notice you watching, they unconsciously change
    • suggestions: tell patient you are still taking their pulse, place hand gently on upper chest/shoulder and palpate rise/fall
    • how long: first time/consistently abnormal: full minute; consistently normal: 30 or 15 seconds
  41. dyspnea
    • patient is making a definite effort to get more O2 and get rid of CO2
    • temporary and normal vs permanent and abnormal
    • refers to audible labored breathign, dilated nostrils, distressed anxious expression
    • may include actual gasping and possible cyanosis
  42. orthopenea
    breathing difficulty has increased so significantly that patient can only breath in partially/full upright position
  43. apnea
    temporary cessation of breathing
  44. anoxia
    time period in which the patient is without O2
  45. hypoxia
    time period in which the inspired air contianed an inadequate amount of O2
  46. cheyne-stokes
    • irregular periodic pattern that is symptom of problem with brain's respiratoy center; ften precedes death
    • patient breaths deeply/rapidly for approx. 30 sec, then stops breathign for approx 10 sec
    • goes from slow/shallow to faster/eeper till they taper off
  47. cyanosis
    • bluish color of skin, fingernails, etc.
    • measure of decreased O2 intake
    • usually begins in lips and mucous membranes, nailbeds, then entire body
  48. body temperature
    • measure of heat of the body - balance between heat produced and heat loss
    • not a vital sign that physical therpaists usually take - be aware of readings in chart or observed symptoms
    • taken frequently and primarily with acutely ill patients
  49. temperature ranges - normal
    • Normal: 97-99 (depending on method)
    • oral: 98.6
    • rectal: 99
    • axillary: 97
  50. temperature ranges - abnormal
    • sub-nromal: below 98.6 (listles, pale, skin gets cool/cold clammy)
    • moderate fever: 100-103 (flushed, eyes are glassy, skin is warm, agitated)
    • high fver: 103-205 (increase symptoms)
    • danger: >105 (death)
  51. temperature - common areas
    • oral: most common
    • rectal: most accurate
    • axillary: least accurate
  52. factors affecting temperature
    • increase: exercise, emotions, drugs, eating
    • decrease: extreme/ prolonged cold, shock, drugs
  53. pyrexia
    • evaluation of body temperature above normal
    • fever
  54. crisis
    • actual point when a prolonged fever breaks
    • sweats, chills, weak, tired
  55. peripheral blood pressure
    force exerted against the walls of blood vessels and the force essentially responsible for the flow of blood through the arteries, capillaries and veins
  56. peripheral blood pressure - interaction
    cardiac output and peripheral resistance
  57. dependent on peripheral blood pressure
    • velocity of arterial blood
    • volume of blood
    • elasticity of arterial walls
  58. blood pressure - systolic blood pressure
    • highest point of pressure on the arterials walls
    • when the left ventricle contracts and pushes blood into the aorta
  59. blood pressure - diastolic blood pressure
    lowest point of pressure constantly present on the arterial walls
  60. how to measure blood pressure
    • directly: actually open artery and use catheter
    • indirectly: common; "auscultatory" method - what we use; mearsured in millimeters of mercury = mmHg
  61. Use of forearm for blood pressure
    • can be used where upper arm cannot be used
    • systolic blood pressure is higher - may differ as much as 20 mmHg
    • not interchangeable with values from upper arm
  62. blood pressure in special populations - children
    • should be measured in those who are at least 3 years of age; younger if special medical conditions exist
    • auscultation is more accurate than electronic
    • use of the riht arm is recommended
    • body height and age are used to determine normals
  63. blood pressure in special populations - PICC
    • Peripherially inserted central catheter (PICC)
    • avoid measure in the upper arm
  64. blood pressure in special populations - dialysis shunt or fistula
    measure in opposite arm
  65. blood pressure in special populations - obesity
    if cuff is too small, can be measured in the forearm
  66. blood pressure in special population - lymphedema
    measured in opposite arm of unilateral mastectomy
  67. blood pressure in special population - pregnancy
    • important: most common medical complication
    • tends to decrease 10mmHg in early gestation
  68. blood pressure in special population - CABG
    • coronary artery bypass graft (CABG)
    • avoid using that arm initially after surgery
  69. how to record blood pressure
    • systolic/diastolic in mmHg: systolic/first diastolic/ second diastolic; first sound/muffing of consecutive Korotkoff sounds (phase 1); silence
    • may only be able to hear first and last sound initially, but with more practice you will be able to distinguidh actuall sound changes
  70. physical therapy documentation - blood pressure
    • blood pressure reading
    • which arm was used
    • position of the patient
    • state if an alternative site was used
    • rest of after activity
  71. normal blood pressure values (adult)
    • systolic: 90-120 mmHg
    • diastolic: 60-80 mmHg
    • average male: 120/80mmHg
    • average female: slightly lower than male
  72. abnormal blood pressure values
    • prehypertension: 120-139 SBP or 80-89 DBP
    • stage 1 hypertension: 140-159 SBP or 90-99 DBP
    • stage 2 hypertension: >160 SBP or >100 DBP

    • hypotension: <90/60 mmHg
    • to be declared "hypotensive" or "hypertensive" must display PATTERN of abnormal values
  73. factors affecting INCREASE in blood pressure
    • anxiety
    • excitement
    • large meals
    • exercise
    • cold
    • distended bladder
    • initial acute sharp pain
    • time of day
  74. factors affecting DECREASE in blood pressure
    • sleep
    • prolonged pain
    • hemorrhage
    • shock
    • very fast/slow heart rate
    • certain drugs
    • time of day
  75. skin turgor
    • access by evaluative "tenting" of skin
    • how: gently pinch skin and relasing, observe speed ot return to normal (3 sec)
    • check forehead/ sternal area/ back hand
    • mesaure of hydration
  76. edema
    • edema: accumulation of excessive amount of watery fluid in cells, tissue, or serous cavities
    • dependent
    • pitting vs. nonpitting
  77. physical signs of vital signs
    • skin color, texture
    • skin temperature
    • facial expression
    • alertness
    • EKG