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Baseline Vital Signs (BLOOD PRESSURE (MEASURING BLOOD PRESSURE (Palpation…

- - - - 3 types of shpygmomanometer: aneroid - glass enclosed circular gauge with a needle that registers the B/P as it descends the calibrations on the dial; Mercurey - mercury in glass tube - more reliable - read at eye level; electronic - cuff with built in pressure transducer reads systolic & diastolic
      - cuff - inflatable rubber, tube connects to the manonometer, another to the bulb, important to have correct cuff size (judge by circumference of the arm not age)
      - Support arm at heart level, palm turned upward - above heart causes false low reading
      - cuff too wide - false low reading
      - cuff too narrow - false false high reading
      - Cuff too loose - false high listen for Korotkoff sounds - series of sounds created as blood flows through an artery after it has been occluded with a cuff then cuff pressure is gradually released
  - - - Large cuff 1 inch above artery, same procedure as arm, systolic pressure in legs maybe 10-40mm hg higher
      - if unable to palpate a pulse - you may use a doppler stethscope
  - - - infants (newborn to 1 year): 50 to 95 systolic
        
        children (1-8 years): 80 to 110 mmHG (systolic)
        
        Adults 90 -140 mm Hg systolic
- - - - Oral: posterior sublingual pocket - under tongue (close to carotid artery)
        
        No hot or cold drinks or smoking 20 minutes prior to temperature taking. Must be awake & alert, Not for small children (bite down)
      - INFRARED TYMPANIC (EAR) - sensor probe shaped like an otoscope in external in external opening of ear canal. Ear canal must be sealed & probe sensor aimed at tympanic membrane - return to charging unit after use
      - Axillary: Bulb in center of axilla. Lower arm position across chest
        
        Non invasive - good for children. Less accurate (no major blood vessels nearby)
      - Rectal: side lying with upper leg flexed, insert lubricated bulb (1 -1/2/ 2 inches adult) ( 1/2 inch infant)
        
        When unsafe or inaccurate by mouth (unconscious, disoriented or irrational) Side lying position - leg flexed
      - Ear: close to hypothalamus - sensitive to core temperature changes; Adult pull pinna up and back; child pull pinna down & back
        
        Rapid measurement; Easy accessibility; Cerumen impaction distorts reading; Otitis media can distort reading
- - - - Need at least 2 sets of vitals to show trending *note Nica! What the hell do the mean By trending? Twitter??
    - - Upon client admission
        
        According to doctor/physician's or the institutions policy or standard of practice
        
        3.When assessing the client during home health visit
        
        Before & after a surgical/invasive diagnostic procedure
        
        Before and after the administration of meds/ therapy that affect cardiovascular, respiratory & temperature control functions
        
        When client's general physical conditions change *LOC/ Pain Level
        
        1 more item...
- - - - QUALITY: BOUNDING, STRONG, OR WEAK (THREADY)
  - - - Carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis
      - Assess: rate rhythm, strength - can assess by using palpation, & auscultation
  - - - Lub: close of atrioventricular (AV) values - tricuspid & mitral valvels
      - Dub: close of semilunar valves - aortic & pulmonary valves
    - - RATE (NORMAL): 60-100, average 80 bpm
      - Tachycardia: greater than 100 bpm
      - Bradycardia: less than 60 BPM
        
        Rhythm - pattern of the beats (regular or irregular)
      - STRENGTH/SIZE - or amplitude, the volume of blood pushed against the wall of an artery during, the ventricular contraction
        
        weak/thready (lacks fullness)
        
        full, bounding (volume higher than normal)
        
        imperceptible (cannot be felt or heard)
        
        0 --------- 1+ ----- 2+ --------3+ ------- 4+ Absent Weak Normal Full Bounding
        
        Normal heart rate chart Age Heart Rate: B/M
        
        ADULTS: 60-80 BPM; CHILDREN: 70-150 BPM INFANTS: 100-160 BPM
        
        FAST = Tachycardia - over 100 in adults
        
        SLOW: Bradycardia - under 60 in adults
        
        Pulse points
        
        Radial Artery: Wrist
        Brachial Artery: Inner Elbow
        Popliteal Artery: Behind Knee
        Posterior Tibial Artery: Ankle
        Dorsalis Pedis Artery: Foot
        Femoral Artery: Groin
        Carotid Artery: Neck
        Facial Artery: Face
        Temporal Artery: Side Forehead
        
        CLEARER VERSION OF THE PULSE POINTS PICTURE
        
        Pulse oximetry: machine to take pulse; will use in the community
        
        Tension - or elasticity, the compressibilty of the arterial wall, is pulse obliterated by slight pressure (low tension or soft)
      - Stethoscope
        
        Diaphragm - high pitched sounds, bowel, lung & heart sounds - tight seal
        
        Bell - low pitched sounds, heart & vascular sounds, apply bell; lightly (hint the of Bell with the "L" for LOW)
- - - - N - 12-20 breaths/min - adult - Eupnea - normal rate & depth breathing
        
        Abnormal increase - tachypnea; Abnormal decrease -bradypnea; Absence of breathing - apnea
      - DEPTH: Amt. of air inhaled/exhaled; normal (deep & even movements of chest); shallow (rise & fall of chest is minimal); SOB shortness of breath (shallow &rapid)
      - RYTHM
      - REGULARITY OF INHALATION/EXHALATION
      - Normal (very little variation in length of pauses b/w I&E)
  - - - Dyspnea: difficulties/labored breathing
      - Cheyne- Strokes - alternating periods of apnea and hyperventilation, gradual increase & decrease in rate & depth of respiration with period of apnea at the end of each cycle
  - - - Bradypnea = slow breathing; Tachypnea = fast breathing; Eupnea = normal breathing; apnea = no breathing
- - - - client's normal range of vital signs may differ from the standard normal range.
        ex. Aion taking note Ivy's BP and notices that its way higher than normal. Ensue a mini freak out. Then Ivy explains that its normal for her and still functioning. Then goes on to explain that its part of family history of cholesterol from both sides of her genetic pool and cannot be helped. However, she tries to watch her diet whenever she can.