ret 1024 introduction to respiratory therapy module 4.1 bedside assessment of the patient —...

RET 1024RET 1024Introduction to Respiratory Introduction to Respiratory TherapyTherapy

Module 4.1Module 4.1

Bedside Assessment of the PatientBedside Assessment of the Patient— Patient Interview, Medical History, Sensorium Patient Interview, Medical History, Sensorium and Vital Signsand Vital Signs

Beside Assessment of the PatientBeside Assessment of the Patient

RTs are playing an increasing role in the RTs are playing an increasing role in the clinical decision-making process when it clinical decision-making process when it comes to initiating, adjusting, or discontinuing comes to initiating, adjusting, or discontinuing respiratory therapy.respiratory therapy.

Bedside Assessment of the PatientBedside Assessment of the Patient

As never before, RTs need to develop As never before, RTs need to develop competent beside assessment skills in order competent beside assessment skills in order gather and interpret relevant patient datagather and interpret relevant patient data


Bedside assessment is the process of Bedside assessment is the process of interviewing the patient and examining the interviewing the patient and examining the patient for signs and symptoms of disease patient for signs and symptoms of disease and the effects of treatmentand the effects of treatment


Two key sources of patient dataTwo key sources of patient data

Medical HistoryMedical History

Physical ExaminationPhysical Examination


Medical History & Physical ExaminationMedical History & Physical Examination

Data gathered initially by the interview and physical Data gathered initially by the interview and physical examination help identify the need for subsequent examination help identify the need for subsequent diagnostic testsdiagnostic tests


Interviewing & Taking a Medical HistoryInterviewing & Taking a Medical History

1.1. Provides patient perspectiveProvides patient perspective Subjective informationSubjective information

2.2. Establishes rapport between clinician and patientEstablishes rapport between clinician and patient Facilitates the sharing of information and future evaluation and Facilitates the sharing of information and future evaluation and

treatment planstreatment plans

3.3. Obtains essential diagnostic informationObtains essential diagnostic information Objective informationObjective information

4.4. Monitors changes in the patient’s symptoms and Monitors changes in the patient’s symptoms and response to therapyresponse to therapy


Interview skills are an art form that Interview skills are an art form that takes time and experience to developtakes time and experience to develop


Patient interviews requires …Patient interviews requires … A genuine concern for othersA genuine concern for others

“ “People don’t care how much you know until they know People don’t care how much you know until they know

how much you care.”how much you care.”

Theodore Theodore RooseveltRoosevelt

EmpathyEmpathy

The ability to view the world from the patient’s The ability to view the world from the patient’s perspective; recognition of the patient’s feelings without perspective; recognition of the patient’s feelings without criticism - feeling criticism - feeling with with the patientthe patient


Patient interviews requires …Patient interviews requires …

The ability to listenThe ability to listen Active; listening is not a passive activityActive; listening is not a passive activity

Requires complete attentionRequires complete attention Preoccupation equates to missed informationPreoccupation equates to missed information

Includes observation of body languageIncludes observation of body language Facial expressions, eye movement, pain grimaces, Facial expressions, eye movement, pain grimaces,

restlessness, sighing restlessness, sighing


Structure and Technique for InterviewingStructure and Technique for Interviewing IntroductionIntroduction

Address patient by his or her surname, using Mr., Mrs., Address patient by his or her surname, using Mr., Mrs., Senor, Senora.Senor, Senora.

Introduce self and explain purpose of visitIntroduce self and explain purpose of visit Observe Observe social space; social space; 4 – 12 feet away from patient4 – 12 feet away from patient

Ensure privacyEnsure privacy Pull curtains if in semi-private roomPull curtains if in semi-private room Partially close door of roomPartially close door of room

Prevent interruptionsPrevent interruptions


Structure and Technique for InterviewingStructure and Technique for Interviewing To Begin The InterviewTo Begin The Interview

Move closer to patient; observe personal space; 2 – 4 Move closer to patient; observe personal space; 2 – 4 feetfeet

Assume physical position at same level of patient (pull Assume physical position at same level of patient (pull up a chair next to the bed)up a chair next to the bed)

Use appropriate eye contactUse appropriate eye contact


Structure and Technique for InterviewingStructure and Technique for Interviewing Questions and statements used in a Questions and statements used in a

conversational interviewconversational interview

Closed Questions; Closed Questions; focus on specific information, provide focus on specific information, provide clarificationclarification

““When did your cough start?”When did your cough start?”

Open-ended questions; Open-ended questions; encourages patients to describe encourages patients to describe events and priorities as they see them, helping bring out events and priorities as they see them, helping bring out concerns and attitudes and promote understandingconcerns and attitudes and promote understanding

““What brought you to the hospital” or “What happened What brought you to the hospital” or “What happened next?”next?”




Indirect questions; Indirect questions; less threatening because they sound less threatening because they sound like statementslike statements

““If I understand you correctly, it is harder for you to breathe If I understand you correctly, it is harder for you to breathe now than it was before your treatment.”now than it was before your treatment.”




Neutral questions; Neutral questions; a subset of open-ended questions. a subset of open-ended questions. They allow respondents to decide upon answers without They allow respondents to decide upon answers without overt direction or pressure from questionersovert direction or pressure from questioners

Open Ended:Open Ended: “What happened next?” “What happened next?”

Closed: Closed: “Would you say that you expectorated a teaspoon, “Would you say that you expectorated a teaspoon, tablespoon, or half a cup?” tablespoon, or half a cup?” (gives the patient a choice of (gives the patient a choice of responses while focusing on the type of information responses while focusing on the type of information needed)needed)




Reflecting (echoing); Reflecting (echoing); repeating words, thoughts, or repeating words, thoughts, or feelings that the patient just stated for purposes of feelings that the patient just stated for purposes of clarifying or stimulating elaboration from the patientclarifying or stimulating elaboration from the patient

Facilitating phrases; Facilitating phrases; e.g., “yes” or “I see” e.g., “yes” or “I see” used with eye used with eye contact and perhaps nodding of the head, show interest contact and perhaps nodding of the head, show interest and encourage patients to continue their storyand encourage patients to continue their story




Communicating empathy (support); Communicating empathy (support); shows your concern shows your concern for the patient as a human beingfor the patient as a human being

““That must have been very difficult for you.”That must have been very difficult for you.”


Structure and Technique for InterviewingStructure and Technique for Interviewing Alternate Sources for a Patient HistoryAlternate Sources for a Patient History

Various factors affect the patient’s ability or willingness to Various factors affect the patient’s ability or willingness to provide an accurate history, e.g., age, alterations in level provide an accurate history, e.g., age, alterations in level of consciousness, language, cultural barriers, emotional of consciousness, language, cultural barriers, emotional state, acuteness of the disease, etc.state, acuteness of the disease, etc.


Structure and Technique for InterviewingStructure and Technique for Interviewing Alternate Sources for a Patient HistoryAlternate Sources for a Patient History

In such cases, family members, friends, work associates, In such cases, family members, friends, work associates, previous physicians, and past medical records often previous physicians, and past medical records often provide a more accurate picture of the history and provide a more accurate picture of the history and progression of symptomsprogression of symptoms


Medical HistoryMedical History

Because dysfunctions of the respiratory system are Because dysfunctions of the respiratory system are often manifestations of other systemic disease often manifestations of other systemic disease processes, and because changes in pulmonary processes, and because changes in pulmonary functions may affect other body systems, functions may affect other body systems, a a cardiopulmonary assessment cannot be limited to the cardiopulmonary assessment cannot be limited to the chest; a comprehensive evaluation of the patient’s chest; a comprehensive evaluation of the patient’s entire health status is essentialentire health status is essential


Medical HistoryMedical History Demographic dataDemographic data

Name, Date of birth, Race, Religion, Occupation, Etc.Name, Date of birth, Race, Religion, Occupation, Etc.

Date and source of history Date and source of history and estimation of the and estimation of the reliability of the historianreliability of the historian

Patient’s condition Patient’s condition at time of historyat time of history


Medical HistoryMedical History Chief complaintChief complaint

Reason for seeking treatment (admitting diagnosis)Reason for seeking treatment (admitting diagnosis)

History of present illnessHistory of present illness Chronological description of each symptomChronological description of each symptom

OnsetOnset FrequencyFrequency LocationLocation SeveritySeverity Etc.Etc.


Medical HistoryMedical History Past medical historyPast medical history

Childhood diseasesChildhood diseases Hospitalization, surgeries, injuries, accidents Hospitalization, surgeries, injuries, accidents Major illnessMajor illness AllergiesAllergies MedicationsMedications

Family historyFamily history Familial disease historyFamilial disease history Marital historyMarital history


Medical HistoryMedical History Social / environmental historySocial / environmental history

Alcohol and cigarette consumptionAlcohol and cigarette consumption Occupational links to diseaseOccupational links to disease

Gas / Chemical fumesGas / Chemical fumes DustsDusts

Living arrangementsLiving arrangements Religious and social activitiesReligious and social activities Recent travel or other event that might impact healthRecent travel or other event that might impact health


Medical HistoryMedical History Review of systemsReview of systems

Head-to-toe review of all body systems (done by a Head-to-toe review of all body systems (done by a physician, located in “History & Physical section of physician, located in “History & Physical section of chart)chart)

Eyes, ears, nose, mouth, throatEyes, ears, nose, mouth, throat SkinSkin Cardiorespiratory systemCardiorespiratory system Digestive systemDigestive system Genitourinary systemGenitourinary system Endocrine systemEndocrine system Nervous systemNervous system … … and moreand more


Physical ExaminationPhysical Examination

Acute problemAcute problem Abbreviated examinationAbbreviated examination

StableStable More complex assessmentMore complex assessment


Physical ExaminationPhysical Examination General AppearanceGeneral Appearance

Facial expressionFacial expression PainPain AnxietyAnxiety AlertnessAlertness MoodMood Mental capacityMental capacity Respiratory distressRespiratory distress



Diaphoresis (sweating)Diaphoresis (sweating) FeverFever PainPain Severe stressSevere stress Increased metabolismIncreased metabolism Acute anxietyAcute anxiety



Level of anxiety or distressLevel of anxiety or distress Severity of current problemSeverity of current problem

PositionPosition Pulmonary hyperinflationPulmonary hyperinflation

Upright, elbows braced Upright, elbows braced on tableon table



Personal hygienePersonal hygiene Duration and impact of illness on daily activitiesDuration and impact of illness on daily activities May indicated psychiatric disorderMay indicated psychiatric disorder

Nutritional statusNutritional status Well nourished or emaciatedWell nourished or emaciated


Physical ExaminationPhysical Examination Levels of Consciousness Levels of Consciousness (common clinical terms for (common clinical terms for

the varying levels of the varying levels of depressed consciousnessdepressed consciousness))

Conscious (alertness)Conscious (alertness) Evaluate sensoriumEvaluate sensorium

Oriented to Person, Place, Time (“oriented x 3”)Oriented to Person, Place, Time (“oriented x 3”)




May occur with:May occur with: Poor cerebral blood flow or poorly oxygenated blood Poor cerebral blood flow or poorly oxygenated blood

perfusing the brainperfusing the brain

(restless, confused, disoriented)(restless, confused, disoriented) Chronic degenerative brain disordersChronic degenerative brain disorders Medication side effectsMedication side effects Drug overdoseDrug overdose


Physical ExaminationPhysical Examination Levels of Consciousness Levels of Consciousness (common clinical terms for the (common clinical terms for the

varying levels of varying levels of depressed consciousnessdepressed consciousness)) ConfusedConfused

Decrease of consciousnessDecrease of consciousness Slow mental responsesSlow mental responses Dulled perceptionDulled perception Incoherent thoughtsIncoherent thoughts

DeliriousDelirious HallucinationsHallucinations Easily agitatedEasily agitated IrritableIrritable




LethargicLethargic SleepySleepy Arouses easilyArouses easily Responds appropriately when arousedResponds appropriately when aroused

ObtundedObtunded Awakens only with difficultyAwakens only with difficulty Responds appropriately when arousedResponds appropriately when aroused




StuporousStuporous Does not awaken completelyDoes not awaken completely Decreased physical and mental activityDecreased physical and mental activity Responds to pain and deep tendon reflexesResponds to pain and deep tendon reflexes Responds slowly to verbal stimuliResponds slowly to verbal stimuli




ComatoseComatose UnconsciousUnconscious Does not respond to stimuliDoes not respond to stimuli Does not move voluntarilyDoes not move voluntarily Loss of reflexes with deep or prolonged comaLoss of reflexes with deep or prolonged coma


Physical ExaminationPhysical Examination Vital SignsVital Signs

Body temperatureBody temperature Pulse ratePulse rate Respiratory rateRespiratory rate Blood pressureBlood pressure Pulse oximetry Pulse oximetry

Considered the 5Considered the 5thth vital sign in many patient care vital sign in many patient care settingssettings



An important part of the assessment processAn important part of the assessment process Most frequently used clinical measurementsMost frequently used clinical measurements

Provide useful information about patient’s clinical condition Provide useful information about patient’s clinical condition when compared with normal values and/or with a series of when compared with normal values and/or with a series of measurementsmeasurements

Abnormal vital signs Abnormal vital signs May be first clue to adverse reactions to treatmentMay be first clue to adverse reactions to treatment

Improved vital signsImproved vital signs Positive effects of treatmentPositive effects of treatment



Body TemperatureBody Temperature

Routinely measures for signs of inflammation or Routinely measures for signs of inflammation or infectioninfection

Core Temperature: Normal – 98.6Core Temperature: Normal – 98.6 F (37 F (37 C) – C) – “afebrile”“afebrile”



Body TemperatureBody Temperature Hyperthermia – Hyperthermia – body temperature body temperature

AKA: “AKA: “fever” orfever” or “febrile”“febrile” Increases metabolic rate (Increases metabolic rate ( oxygen consumption, oxygen consumption,

CO2 production), accompanied by CO2 production), accompanied by heart rate heart rate and and ventilation to maintain homeostasis ventilation to maintain homeostasis

NOTE: NOTE: This condition may This condition may eventually lead eventually lead to respiratory failureto respiratory failure



Body TemperatureBody Temperature Hypothermia – Hypothermia – body temperaturebody temperature

Excessive heat loss (e.g., prolonged exposure to Excessive heat loss (e.g., prolonged exposure to cold)cold)

Inadequate heat productionInadequate heat production Impaired hypothalamic thermoregulation (e.g., Impaired hypothalamic thermoregulation (e.g.,

head injury, stroke)head injury, stroke)



Body TemperatureBody Temperature Hypothermia – Hypothermia – body temperaturebody temperature

Decreased pulse and respiratory rateDecreased pulse and respiratory rate Patient indicates coldnessPatient indicates coldness Shivering (generates heat)Shivering (generates heat) Pale or bluish cool, waxy skinPale or bluish cool, waxy skin HypotensionHypotension DisorientationDisorientation Drowsy or unresponsiveDrowsy or unresponsive ComaComa



Body TemperatureBody Temperature Measured Measured

Rectum(reflects core temperature)Rectum(reflects core temperature) Ear – tympanic membrane (reflects core temperature)Ear – tympanic membrane (reflects core temperature) Oral (most common), about 1Oral (most common), about 1 F lower than rectal F lower than rectal

temptemp Axilla (1Axilla (1 - 2 - 2 F lower than oral temp) F lower than oral temp)



Pulse RatePulse Rate Palpated at various sites Palpated at various sites

TemporalTemporal CarotidCarotid Apical (heart)Apical (heart) BrachialBrachial RadialRadial FemoralFemoral PoplitealPopliteal Posterior TibialPosterior Tibial Dorsalis - PedisDorsalis - Pedis



Pulse RatePulse Rate Radial artery most common site to palpate pulse Radial artery most common site to palpate pulse

Use first, second, or third finger to palpate – not thumbUse first, second, or third finger to palpate – not thumb

Ideally, counted for 1 minute, but can be counted over Ideally, counted for 1 minute, but can be counted over 15 or 30 seconds and then multiplied appropriately to 15 or 30 seconds and then multiplied appropriately to determine the pulse per minutedetermine the pulse per minute



Pulse RatePulse Rate Normal RatesNormal Rates

New born (100 – 180 beats/min)New born (100 – 180 beats/min) Toddler (80 – 130 beats/min)Toddler (80 – 130 beats/min) Child (65 – 100 beats/min)Child (65 – 100 beats/min) Adult (60 – 100 beats/min)Adult (60 – 100 beats/min)



Pulse RatePulse Rate Bradycardia; < 60 beats/minBradycardia; < 60 beats/min

Physically fit athletesPhysically fit athletes HypothermiaHypothermia Head injuryHead injury Side effects of medicationSide effects of medication With certain cardiac arrhythmiasWith certain cardiac arrhythmias



Pulse RatePulse Rate Tachycardia; > 100 beats/minTachycardia; > 100 beats/min

ExerciseExercise Fear, anxietyFear, anxiety Low blood pressure (hypotension)Low blood pressure (hypotension) AnemiaAnemia DehydrationDehydration FeverFever Arterial blood oxygen (hypoxemia)Arterial blood oxygen (hypoxemia) Certain medicationsCertain medications



Pulse RatePulse Rate Note rhythmNote rhythm

Normally, rhythm is regularNormally, rhythm is regular

Certain conditions such as inadequate blood Certain conditions such as inadequate blood flow and oxygen supply to the heart or an flow and oxygen supply to the heart or an electrolyte imbalance, can cause the heart to electrolyte imbalance, can cause the heart to beat irregularlybeat irregularly



Pulse RatePulse Rate StrengthStrength

Reflects the strength of left ventricular Reflects the strength of left ventricular contraction and volume of blood flowing to the contraction and volume of blood flowing to the peripheral tissuesperipheral tissues

Should be strong and throbbing Should be strong and throbbing



Pulse RatePulse Rate StrengthStrength

Weak ventricular contractions combined with Weak ventricular contractions combined with inadequate blood volume will result in in a weak inadequate blood volume will result in in a weak threadythready pulse pulse

Increased heart rate combined with a large blood Increased heart rate combined with a large blood volume with generate a full, volume with generate a full, boundingbounding pulse pulse



Pulse RatePulse Rate Pulsus paradoxusPulsus paradoxus;; pulse decreases markedly in pulse decreases markedly in

strength during inspiration and returns to normal strength during inspiration and returns to normal during exhalation – common among patients during exhalation – common among patients experiencing severe asthmatic episodesexperiencing severe asthmatic episodes

Pulsus alternansPulsus alternans;; strength of patient’s pulse varies strength of patient’s pulse varies every other beat while the rhythm remains regular every other beat while the rhythm remains regular (left-sided heart failure)(left-sided heart failure)



Respiratory RateRespiratory Rate Normal resting rateNormal resting rate

Newborn (30 – 60 breaths/min)Newborn (30 – 60 breaths/min) Toddler (25 – 40 breaths/min)Toddler (25 – 40 breaths/min) Preschool (20 – 25 breaths/min)Preschool (20 – 25 breaths/min) Adult (12 – 20 breaths/min)Adult (12 – 20 breaths/min)



Respiratory RateRespiratory Rate Ideally counted when the patient is not awareIdeally counted when the patient is not aware Counted by watching the chest wall and abdomen Counted by watching the chest wall and abdomen

move in and outmove in and out One good method is to count the respiratory rate One good method is to count the respiratory rate

immediately after taking the pulse, while leaving immediately after taking the pulse, while leaving the fingers over the patient’s arterythe fingers over the patient’s artery



Respiratory RateRespiratory Rate Tachypnea; abnormally high respiratory rateTachypnea; abnormally high respiratory rate

ExertionExertion FeverFever Arterial hypoxemiaArterial hypoxemia Metabolic acidosisMetabolic acidosis AnxietyAnxiety PainPain



Respiratory RateRespiratory Rate Bradypnea; slow respiratory rateBradypnea; slow respiratory rate

Head injuriesHead injuries HypothermiaHypothermia Side effect of certain medications (narcotics)Side effect of certain medications (narcotics) Severe myocardial infarctionSevere myocardial infarction Drug overdoseDrug overdose



Respiratory PatternRespiratory Pattern Apnea – no breathingApnea – no breathing

Asthmatic breathing – prolonged exhalationAsthmatic breathing – prolonged exhalation

Kussmaul’s – deep and fast (associated with diabetic Kussmaul’s – deep and fast (associated with diabetic acidosis) acidosis)



Respiratory PatternRespiratory Pattern Cheyne-Stokes – increases and decreases in depth Cheyne-Stokes – increases and decreases in depth

and rate with periods of apnea (low cardiac output as and rate with periods of apnea (low cardiac output as in CHF)in CHF)

Biot’s – similar to Cheyne-Stokes except tidal Biot’s – similar to Cheyne-Stokes except tidal volumes are identical in depth (increased intracranial volumes are identical in depth (increased intracranial pressurepressure))



Respiratory RateRespiratory Rate Apneustic – sustained inspiratory effort (damage to Apneustic – sustained inspiratory effort (damage to

pons associated with head trauma, severe brain pons associated with head trauma, severe brain hypoxemia, lack of blood flow to brain)hypoxemia, lack of blood flow to brain)



Blood Pressure (BP)Blood Pressure (BP) Systolic pressureSystolic pressure; peak pressure exerted in the arteries ; peak pressure exerted in the arteries

during contraction of the left ventricleduring contraction of the left ventricle Adult normal: 90 – 140Adult normal: 90 – 140

Diastolic pressureDiastolic pressure; ; pressure in arteries after relaxation of pressure in arteries after relaxation of the ventriclesthe ventricles

Adult normal: 60 – 90Adult normal: 60 – 90 Pulse pressurePulse pressure; difference between systolic and diastolic ; difference between systolic and diastolic

blood pressureblood pressure Adult normal: 35 – 40Adult normal: 35 – 40



Blood Pressure (BP)Blood Pressure (BP) Recorded as systolic / diastolic (e.g., 120/80 mm Hg)Recorded as systolic / diastolic (e.g., 120/80 mm Hg) Hypertension;Hypertension; BP persistently elevated BP persistently elevated

e.g., systolic > 140 or diastolic > 90 e.g., systolic > 140 or diastolic > 90 Factors associated with hypertension include arterial Factors associated with hypertension include arterial

disease, obesity, a high serum sodium level, disease, obesity, a high serum sodium level, pregnancy, obstructive sleep apnea, a family history of pregnancy, obstructive sleep apnea, a family history of high blood pressurehigh blood pressure

Can cause headaches, blurred vision, confusion, renal Can cause headaches, blurred vision, confusion, renal failure (uremia), CHF, cerebral hemorrhage, leading to failure (uremia), CHF, cerebral hemorrhage, leading to strokestroke



Blood Pressure (BP)Blood Pressure (BP) Recorded as systolic / diastolic (e.g., 120/80 mm Hg)Recorded as systolic / diastolic (e.g., 120/80 mm Hg) HypertensionHypertension

HeadachesHeadaches Tinnitus (ringing in the ears)Tinnitus (ringing in the ears) Light-headedness, confusionLight-headedness, confusion Easy fatigabilityEasy fatigability Cardiac palpitationsCardiac palpitations Blurred visionBlurred vision Renal failure (uremaia), CHF, cerebral hemorrhage, Renal failure (uremaia), CHF, cerebral hemorrhage,

leading to strokeleading to stroke



Blood Pressure (BP)Blood Pressure (BP) Recorded as systolic / diastolic (e.g., 120/80 mm Hg)Recorded as systolic / diastolic (e.g., 120/80 mm Hg) HypertensionHypertension

Hypertensive crisis; Hypertensive crisis; an acute, severe elevation of BP an acute, severe elevation of BP causing neurological, cardiac, and renal failurecausing neurological, cardiac, and renal failure

Sustained hypertension leads to thickening and Sustained hypertension leads to thickening and inelasticity of the arterial walls and resistance to blood inelasticity of the arterial walls and resistance to blood flow. This process in turn causes the left ventricle to flow. This process in turn causes the left ventricle to distend and hypertrophy. Left ventricular hypertrophy distend and hypertrophy. Left ventricular hypertrophy may lead to congestive heart failure (CHF).may lead to congestive heart failure (CHF).



Blood Pressure (BP)Blood Pressure (BP) Hypotension;Hypotension; BP < 90/60 mm Hg BP < 90/60 mm Hg

Blood pressure is not adequate for normal perfusion Blood pressure is not adequate for normal perfusion and oxygenation of vital organsand oxygenation of vital organs

Associated with peripheral vasodilation, decreased Associated with peripheral vasodilation, decreased vascular resistance, hypovolemia, and left ventricular vascular resistance, hypovolemia, and left ventricular failurefailure

Analgesics (pain relievers) such as Demerol and Analgesics (pain relievers) such as Demerol and morphinemorphine

Severe burnsSevere burns Prolonged diarrhea and vommittingProlonged diarrhea and vommitting



Blood Pressure (BP)Blood Pressure (BP) Postural hypotension; abrupt fall in BP when standingPostural hypotension; abrupt fall in BP when standing

Occurs in hypovolemic patientsOccurs in hypovolemic patients May cause syncope (fainting)May cause syncope (fainting) Confirmed by measuring BP in sitting and supine Confirmed by measuring BP in sitting and supine

positionspositions Treated with administration of fluid or vasoactive drugsTreated with administration of fluid or vasoactive drugs


Physical ExaminationPhysical Examination Measuring BPMeasuring BP

Commonly measured Commonly measured using auscultationusing auscultation

Sphygmomanometer Sphygmomanometer and stethoscopeand stethoscope

BP cuffs come in BP cuffs come in different sizesdifferent sizes



Pulse oximetryPulse oximetry SpO2SpO2



Pulse oximetryPulse oximetry Establishes an immediate baseline SpO2 valueEstablishes an immediate baseline SpO2 value Excellent monitor by which to assess the patient’s Excellent monitor by which to assess the patient’s

response to respiratory careresponse to respiratory care Adult normal: 95% - 99%Adult normal: 95% - 99% Values between 91% - 94% represent mild hypoxemiaValues between 91% - 94% represent mild hypoxemia

May not require supplemental oxygenMay not require supplemental oxygen

Values between 86% - 90% indicate moderate hypoxemiaValues between 86% - 90% indicate moderate hypoxemia Requires supplemental oxygenRequires supplemental oxygen

Values below 85% indicate severe hypoxemiaValues below 85% indicate severe hypoxemia Warrant immediate medical attentionWarrant immediate medical attention


SpO2 and PaO2 Relationship for the Adult and NewbornSpO2 and PaO2 Relationship for the Adult and Newborn

AdultAdult NewbornNewborn

Oxygen StatusOxygen Status SpO2SpO2 PaO2PaO2 SpO2SpO2 PaO2PaO2

NormalNormal 95-99%95-99% 75-10075-100 91-96%91-96% 60-8060-80

Mild hypoxemiaMild hypoxemia 91-94%91-94% 60-7560-75 88-90%88-90% 55-6055-60

Moderate hypoxemiaModerate hypoxemia 86-90%86-90% 50-6050-60 85-89%85-89% 50-5850-58

Severe hypoxemiaSevere hypoxemia <85%<85% <50<50 <85%<85% <50<50

ret 1024 introduction to respiratory therapy module 4.1 bedside assessment of the patient —...

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