Baseline vital signs
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Baseline Vital Signs. Baseline Vital Signs. • Key signs used to evaluate a patient’s condition • First set is known as baseline vitals • Repeated vital signs compared to the baseline • Need at least 2 sets of vitals to show trending. Baseline Vital Signs. PRBELLS Pulse Respiration

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Baseline Vital Signs

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Baseline vital signs

Baseline Vital Signs


Baseline vital signs1

Baseline Vital Signs

• Key signs used to evaluate a patient’s condition

• First set is known as baseline vitals

• Repeated vital signs compared to the baseline

• Need at least 2 sets of vitals to show trending


Baseline vital signs2

Baseline Vital Signs

  • PRBELLS

    • Pulse

    • Respiration

    • Blood pressure

    • Eyes

    • Lung sounds

    • LOC - Level of Consciousness

    • Skins


Pulse

Pulse

• Rate

– Number of beats in 30 seconds x 2

– Number of beats in 15 seconds x 4

• Rhythm

– Regular or irregular

• Quality

– Bounding, strong, or weak (thready)


Normal pulse rates

Normal Pulse Rates

Adults 60 to 100 beats/min

Children 70 to 150 beats/min

Infants 100 to 160 beats/min

Fast = Tachycardia - over 100 in adults

Slow= Bradycardia - under 60 in adults


Pulse points

Pulse Points


Pulse points1

Pulse Points


Pulse points2

Pulse Points


Pulse oximetry

Pulse Oximetry


Pulse ox enemies

Pulse Ox Enemies


Respirations

Respirations

• Effort

– Normal or

Labored

• Noisy respiration

– Normal, stridor,

wheezing,

snoring, gurgling

• Depth

– Shallow or deep

• Rate

– Number of breaths

in 30 seconds x 2

• Rhythm

– Regular or irregular

• Quality

– Character of

Breathing


Respiratory rates

Respiratory Rates

Adults 12 to 20 breaths/min

Children 15 to 30 breaths/min

Infants 25 to 50 breaths/min


Common terms

Common Terms

• Bradypnea= slow breathing

• Tachypnea= fast breathing

• Eupnea= normal breathing

  • Apnea = no breathing


Blood pressure

Blood Pressure

• A drop in blood pressure may indicate:

– Loss of blood

– Loss of vascular tone

– Cardiac pumping problem


Equipment sphymanometer stethescope

EquipmentSphymanometer & Stethescope


Measuring blood pressure

Measuring Blood Pressure

• Diastolic

– Pressure during relaxing phase of the heart’s cycle

• Systolic

– Pressure during contraction

• Measured as millimeters of mercury (mm Hg)

• Recorded as systolic/diastolic


Blood pressure1

Blood Pressure


Auscultation of blood pressure

Auscultation of Blood Pressure

1. Place cuff on patient’s arm.

2. Palpate brachial artery and place stethoscope.

3. Inflate cuff until you no longer hear pulse sounds.

4. Continue pumping to increase pressure by an additional 20 mm Hg.

5. Note the systolic and diastolic pressures as

6. you let air escape slowly.

7. Korotkoff Sounds

8. 1st beat you hear is systolic

9. Last beat you hear is diastolic

10.As soon as pulse sounds stop, open the valve and release the air quickly.


Palpation of blood pressure

Palpation of Blood Pressure

  • Secure cuff.

  • Locate radial pulse.

  • Inflate to about 200 mm Hg.

  • Release air until pulse is felt.

  • Method only obtains systolic pressure.


Normal ranges of blood pressure

Normal Ranges of Blood Pressure

Infants (newborn to 1 year) 50 to 95(systolic)

Children (1 to 8 years) 80 to 110 mm Hg

(systolic)

Adults 90 to 140 mm Hg

(systolic)


Pupil assessment

Pupil Assessment

• P - Pupils

• E - Equal

• A - And

• R - Round

• R - Regular in size

• L - React to Light


Abnormal pupil reactions

Abnormal Pupil Reactions

• Fixed with no reaction to light

• Dilate with light and constrict without

light…that’s a brain problem!

• React sluggishly

• Unequal in size

• Unequal with light or when light is

removed


Pupil reactions

Pupil Reactions


Level of consciousness

Level of Consciousness

Name? Date? Place? Problem?


Lung sounds

Lung Sounds

Types of Lung Sounds

  • Lung sounds are typically broken down into three categories:

    • Normal (vesicular)

    • Decreased or absent

    • Abnormal (adventitious)


Lung sounds1

Lung Sounds

  • There are several types of abnormal lung sounds:

    • Wheezes are caused by air flowing rapidly through narrowed airway passages

    • Rhales are small bubbling or fine clicking sounds made when air is forced into collapsed alveoli and/or in the presence of fluid in the alveoli and/or bronchioles.

    • Rhonchi are low-pitched, sonorous, rumbling, bubbling or gurgling sounds.

    • Pleural rub, or friction rub, occurs when there is fluid in the pleural space between the lung tissue and the interior chest wall. There is commonly a grating, rubbing type of sound as the visceral (lung) and parietal (chest wall) pleura rub against each other.


Lung sounds2

Lung Sounds


Skins

Skins


Reassessment of vital signs

Reassessment of Vital Signs

  • Reassess stable patients every 15 minutes.• Reassess unstable patients every 5 minutes


Patient history

Patient History

SAMPLE

  • S - Signs & symptoms

    • OPQRST

  • A - Allergies

  • M - Medications

  • P - Past medical history

  • L - Last oral intake

  • E - Events leading to incident


S signs symptoms

S - Signs & Symptoms

OPQRST

O - Onset

When & How did the symptom begin?

P - Provokes/Palliates

What makes the symptom worse?

What makes the symptom better?


S signs symptoms1

S - Signs & Symptoms

OPQRST

Q - Quality

  • How would describe the pain?/What does the pain feel like?

  • DO NOT lead the patient

    R - Region/Radiation

  • Where is the pain?

  • Does the pain travel anywhere else?


S signs symptoms2

S - Signs & Symptoms

OPQRST

S - Severity

  • How bad is the pain? Scale of 1-10

    T- Time

  • How long have you had the symptom?


A allergies

A - Allergies

  • Medications

  • Foods

  • Environment


M medications

M- Medications

Are you taking any?

When did you last take your medication?

What are they?

What are they for?

May I see them?

May we take them with us?


P previous medical history

P - Previous Medical History

  • Pertinent

  • Related to this complaint

  • Complicating factor


L last oral intake

L - Last Oral Intake

Food and/or Drink?

What?

When?


E events leading up to the incident

E - Events leading up to the incident

What happened?

When?


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