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PTA 103

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

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PTA 103

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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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