PTA 103PTA 103

Vital Signs Vital Signs – Review of ProceduresReview of Procedures– Review of Pain Assessment toolsReview of Pain Assessment tools– PulsePulse– Blood PressureBlood Pressure– Respiratory RateRespiratory Rate– PainPain

PulsePulse

Measures heart rate (HR = Measures heart rate (HR = pulse/min)pulse/min)

Measured by palpation or Measured by palpation or auscultation (using stethoscope)auscultation (using stethoscope)

Normal rangesNormal ranges– 60-100/min in adults60-100/min in adults– 100-130/min in infants100-130/min in infants– 80-120/min in children 1-780-120/min in children 1-7

Normal Factors Affecting Pulse Normal Factors Affecting Pulse IncreasesIncreases

AgeAge

Gender (male>female)Gender (male>female)

↑↑ Environmental tempEnvironmental temp

InfectionInfection

Physical activity and activity tolerancePhysical activity and activity tolerance

Emotional statusEmotional status

Some medicationsSome medications

Cardiopulmonary diseaseCardiopulmonary disease

Documentation of PulseDocumentation of PulseHR standard is pulses/minute (best if HR standard is pulses/minute (best if measured over 30-60 seconds)measured over 30-60 seconds)

Site of measurementSite of measurement– Temporal, carotid, brachial, radial, femoral, Temporal, carotid, brachial, radial, femoral,

popliteal, posterior tibial, pedalpopliteal, posterior tibial, pedal– Right or leftRight or left– Radial pulse is most common (also allows for Radial pulse is most common (also allows for

access to hospital ID bracelet for confirmation)access to hospital ID bracelet for confirmation)

Can include subjective quality descriptorsCan include subjective quality descriptors– e.g., strong, weak, regular, etc.e.g., strong, weak, regular, etc.

Identifying Pulse StrengthIdentifying Pulse Strength

A numbering system (0-4+) can be A numbering system (0-4+) can be used to document a description of used to document a description of pulse strengthpulse strength

Refer to Table 22-2 for descriptions Refer to Table 22-2 for descriptions and definitionsand definitions

Role of PTARole of PTA

HR can be used to make HR can be used to make comparisons with PT evaluationcomparisons with PT evaluation

HR can be used to educate HR can be used to educate patients/clients in activity limitspatients/clients in activity limits

Abnormal HR readings at rest and in Abnormal HR readings at rest and in response to activity should result in response to activity should result in communication back to the PTcommunication back to the PT

Blood PressureBlood PressureImportant to establish baseline Important to establish baseline values and monitor patient response values and monitor patient response to activityto activitySpecial populations to considerSpecial populations to consider– Pts>65 yrs old; pts <=2 yrs oldPts>65 yrs old; pts <=2 yrs old– Deconditioned/debilitatedDeconditioned/debilitated– Hx of cardiovascular problemsHx of cardiovascular problems– Hx of trauma or diseases which impact Hx of trauma or diseases which impact

cardiovascular functioncardiovascular function

Key Words related to Blood Key Words related to Blood Pressure MonitoringPressure Monitoring

Diaphoresis – sweatingDiaphoresis – sweating

Dyspnea – difficulty breathingDyspnea – difficulty breathing

Hypertension – high blood pressureHypertension – high blood pressure

Hypotension – low blood pressureHypotension – low blood pressure

SOB – shortness of breathSOB – shortness of breath

Syncope – faintingSyncope – fainting

Tachycardia – HR high (>100)Tachycardia – HR high (>100)

Accepted Normal BP valuesAccepted Normal BP valuesBirth to 3mos: 80/35 to 60/65 mm HgBirth to 3mos: 80/35 to 60/65 mm Hg3 mos to 1 yr: 90/60 to 100/67 mmHg3 mos to 1 yr: 90/60 to 100/67 mmHgChildren 1-4yrs: 100-108/60 mm HgChildren 1-4yrs: 100-108/60 mm Hg– Add 2mmHg/year to 100mmHg/60-70mmHgAdd 2mmHg/year to 100mmHg/60-70mmHgAdolescents: 100/65 to 120/75 mmHgAdolescents: 100/65 to 120/75 mmHgAdults: 120/80 mmHgAdults: 120/80 mmHgElderly (>65yrs): 120/80-140/90 mmHgElderly (>65yrs): 120/80-140/90 mmHg

A similar reference, slightly varied scale is A similar reference, slightly varied scale is in Cameron, Table 22-3in Cameron, Table 22-3

Abnormal BP RangesAbnormal BP RangesPrehypertension: 120/80-139/89 mm HgPrehypertension: 120/80-139/89 mm Hg

Stage 1 HTN: 140/90-159/99 mm HgStage 1 HTN: 140/90-159/99 mm Hg

Stage 2 HTN: 160/100-179/109 mm HgStage 2 HTN: 160/100-179/109 mm Hg

Stage 3 HTN: 180/110-209-119 mm HgStage 3 HTN: 180/110-209-119 mm Hg

Stage 4 HTN: >210/120 mm HgStage 4 HTN: >210/120 mm Hg

Hypotension: Systolic <100 mm HgHypotension: Systolic <100 mm Hg

Documentation of BPDocumentation of BP

Included side and location of Included side and location of measurementmeasurement

Document if patient smoked, Document if patient smoked, ingested caffeine, or exercised within ingested caffeine, or exercised within the last 30 minutesthe last 30 minutes

Common Errors in BP Common Errors in BP measuresmeasures

Cuff is deflated too fastCuff is deflated too fast– Should be 2mm Hg/secondShould be 2mm Hg/second

Cuff is underinflatedCuff is underinflated

Cuff is too small/bigCuff is too small/big

Cuff is incorrectly positionedCuff is incorrectly positioned

Unable to hear pulse Unable to hear pulse clearly/consistently with stethoscopeclearly/consistently with stethoscope

Role of the PTARole of the PTAPTAs should be aware of factors that affect PTAs should be aware of factors that affect BPBP– Educate at risk patients (smoking, obesity, Educate at risk patients (smoking, obesity,

sedentary)sedentary)– Consider effects of age, medication, infection, Consider effects of age, medication, infection,

gender/race on BP levels when selecting gender/race on BP levels when selecting activity-based interventionsactivity-based interventions

– Plan for monitoring during bedside activities, Plan for monitoring during bedside activities, positioning, or functional training positioning, or functional training

Documentation of RespirationDocumentation of Respiration

RR = breaths (inhalation + RR = breaths (inhalation + exhalation) / minexhalation) / min

Note depth, rhythm, and characterNote depth, rhythm, and character

Avoid providing detailed information Avoid providing detailed information about measurement procedure to about measurement procedure to avoid abnormal measuresavoid abnormal measures

Documentation of %ODocumentation of %O22 Sat Sat

May indicate progress with use of or May indicate progress with use of or need for supplemental oxygenneed for supplemental oxygen– Supplemental OSupplemental O2 2 is generally indicated is generally indicated

for sat <=88%for sat <=88%

Quantify endurance capacity for Quantify endurance capacity for activity in rehabilitation settingsactivity in rehabilitation settingsIndicate a need to communicate with Indicate a need to communicate with PT/health care personnel to optimize PT/health care personnel to optimize stable Ostable O22 Sat levels with activity Sat levels with activity

Documentation of PainDocumentation of PainOnsetOnsetLocationLocationTemporal (change over time) patternTemporal (change over time) patternQuality (sharp, shooting, constant, Quality (sharp, shooting, constant, intermittent, etc.)intermittent, etc.)Intensity Intensity May include formal pain assessmentMay include formal pain assessment– VAS, McGill, NRS, Faces Pain Rating VAS, McGill, NRS, Faces Pain Rating

ScaleScale

Documentation of Vital SignsDocumentation of Vital Signs

Vital sign measures are included in Vital sign measures are included in the ‘O’ of the SOAP notethe ‘O’ of the SOAP note

Data is optimally collected before, Data is optimally collected before, during and after activityduring and after activity

Data is compared to document Data is compared to document progress, verify safe progressions, or progress, verify safe progressions, or support a need to communicate with support a need to communicate with the primary PT.the primary PT.