vital signs

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Improvement in a patient's _________ is strong evidence that a treatment is having a positive effect.

vital signs

what are the VITAL SIGNS :

Pulse rate Temperature Respiratory rate Blood pressure Oxygenation

plays an important role in regulating heat loss and can initiate peripheral vasodilation a

hypothalamus

The respiratory system also helps remove excess heat through ventilation by warming the inspired air which subsequently exhales.

hypothalamus

● can result or from normal activities (Exercise) ● caused by disease is called fever=febrile ● fever increases the body's metabolic rate, increasing both oxygen consumption and CO2 production.

HYPERTHERMIA/HYPERPYREXIA

- body temp below normal ● most common cause: prolonged exposure to cold, to which the hypothalamus responds by initiating shivering (to generate heat) and vasoconstriction (to conserve heat) ● Because hypothermia reduces oxygen consumption and CO2 production, patients with hypothermia may exhibit slow, shallow breathing and reduced pulse rate.

hepothermia

___-____ beats/min- normal Adult pulse rate with a regular rhythm

60-100 bpm

-Pulse may be assessed by palpation ● If the carotid site is used, great care must be taken to avoid the carotid sinus area.

pulse rate

Pulmonary disease almost always causes a decrease in arterial 02 content and an increase in oxygen consumption. In this situation the heart tries to maintain adequate 02 delivery to tissues by increasing cardiac output..

pulse rate

__________- is increased primarily by increasing the heart rate.

Cardiac output

Tachycardia- the PR exceeds 100/min ○ common causes:

exercise fear, anxiety low blood pressure anemia, fever, reduced arterial oxygen levels and certain medications.

____________ -PR <60/min ○ is less common than tachycardia but can occur with hypothermia, as a side effect of medications, with certain cardiac arrhythmias and with traumatic brain injury.

bradycardia

● most common site used to palpate the pulse. ● The 2nd and 3rd fingertips pads (not the thumb) are used to palpate. ● Ideally, the PR is counted for 1 minute, especially if the pulse is irregular

RADIAL ARTERY

● a significant decrease in pulse strength (>10mmHg) during spontaneous inhalation. ● can be qualified with a blood pressure cuff and is common in patients with acute obstructive pulmonary disease, especially patients experiencing asthma attack. ● also, may signal a mechanical restriction of the pumping function of the heart as can occur with constrictive pericarditis or cardiac tamponade

PULSUS PARADOXUS (PARADOXICAL PULSE)

● an alternating succession of strong and weak pulses ● suggest L-sided heart failure and usually is not related to respiratory disease.

PULSUS ALTERNANS

RESPIRATORY RATE ● Normal resting adult value:

12-20 bpm

______ is counted by watching the abdomen or chest wall move in and out.

In some cases, the RT may need to place a hand on the patient's abdomen to confirm breathing rate. ideally the patient should be unaware that the RR is being counted.

● The arterial blood pressure is the force exerted against the wall of the arteries as the blood moves through them.

BLOOD PRESSURE

● the peak force exerted in the major arteries during contraction of the left ventricle. ● BP increases with age. ● N range: 90-140mmHg

systolic pressure

the force in the major arteries remaining after relaxation of the ventricle. ● N: 60-90mmHg

diastolic pressure

Pulse pressure-the difference between systolic and diastolic pressures. ○ N: _______ mmhg ○ when pulse pressure is <30mmHg, the peripheral pulse is difficult to detect.

30-40mmHg

● Arterial blood pressure >140/90mmHg ● Is a common medical problem in adults and is 90% of causes is unknown (primary hypertension)

HYPERTENSION

Hypertension is called a_______. Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms

"silent killer".

When symptoms of hypertension do occur, they can include:

a. early morning headaches b. nosebleeds c. irregular heart rhythms d. vision changes e. buzzing in the ears

Severe hypertension can cause :1-7

fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors

Sustained HPN can cause CNS abnormalities: 1-3

headaches, blurred vision and confusion.

Other potential consequences of HPN: 1-3

Uremia (renal insufficiency), CHF, and cerebral hemorrhage→ Stroke.

Acute, severe elevation of BP can cause acute neurologic, cardiac and renal failure and is called ____________

acute hypertensive crisis

3 SUBCATEGORIES OF HYPERTENSION

stage 1 HPN STAGE 2 HPN PREHYPERTENSION

SUBCATEGORIES OF HYPERTENSION _______ ● occurs when the systolic blood pressure is 140 to 190mmHg or diastolic BP is 90- 99mmHg

Stage 1 HPN

SUBCATEGORIES OF HYPERTENSION _______ ● occurs when the systolic blood pressure is 160 or greater or the diastolic BP is 100mmHg or greater

Stage II HPN

SUBCATEGORIES OF HYPERTENSION ______________ ● systolic BP between 120mmHg and 139 mmHg or diastolic BP bet 80 and 89mmHg ● This last category is not a disease state and does not require treatment but is used to assess the risk of eventually developing hypertension

Prehypertension

-A systolic arterial blood pressure <65mmHg. ● A decrease of more than 40mmHg from baseline. This expanded definition acknowledges that patients with baseline hypertension may have inadequate tissue perfusion at a blood pressure that may be considered normal for most patients.

hypotension

Inadequate delivery of oxygen and nutrients to the vital organs relative to their metabolic demand.

shock

nice to know

-Hypotension is not synonymous with shock. -In shock, vital organs are in imminent danger of receiving inadequate blood flow (under perfusion) and impaired oxygen delivery to tissues (tissue hypoxia),

Shock is usually treated aggressively with ____,______ or ______or a combination of these depending on the cause and severity of shock.

fluids, blood products, or vasoactive drugs

__________includes left ventricular failure (cardiogenic) and reduced blood volume (hypovolemia or hypovolemic) caused by either hemorrhage or severe fluid loss

Hypodynamic states

_____________-occur with profound systemic vasodilation (peripheral vascular failure) associated with overwhelming infection (septic shock), systemic allergic reaction (anaphylaxis) or severe liver failure

Hyperdynamic states

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