What are the four vital signs?
Temperature, pulse, respiration, and blood pressure
What is the normal adult average temperature?
98.6 degrees Fahrenheit
What is the range for normal body temperature?
96-99.6 degrees Fahrenheit
When is normal body temperature the lowest?
During least activity (sleep)
What age group tends to have higher fevers: children or adults?
Children
What is the term to describe how most fevers vary during their course but don’t fully return to normal until they resolve?
Remittent
What part of the nervous system regulates temperature?
Hypothalamus
What are the three typical phases of a fever?
1 Chills (shivering/rigors) 2 Hot stage (set point of fever) 3 Sweating (heat dissipates)
What occurs when a temperature rapidly rises from normal to fever level?
Febrile convulsions
What type of fever occurs, resolves, then recurs again in a few days?
Relapsing (uncommon in the U.S.)
What is the normal range for a fever?
Patient’s normal to 105 degrees Fahrenheit
What is the range for hyperpyrexia?
Above 105 degrees Fahrenheit
When a patient exhibits hyperpyrexia, what condition can be assumed?
Damage to hypothalamus or heat stroke
Fevers are dangerous because of the possibility of what condition occurring?
Dehydration
What is the rate of water loss to the amount able to be absorbed by the body during exercise?
Lose 22 oz of water every 20 minutes
Absorb 6 oz every 20 minutes
(22 loss:6 gain)
What are the three phases of dehydration?
1 Heat cramps
2 Heat exhaustion
3 Heat stroke
If a patient presents with cold, clammy, sweaty skin and symptoms of dizziness, faintness, headache, or rapid, shallow breathing, what stage of dehydration would you suspect he/she is in?
Heat exhaustion
If a patient presents with hot dry skin and symptoms of dyspnea, arrhythmia, dilated pupils, possible seizures, coma, and even death, what stage of dehydration would you suspect he/she is in?
Heat stroke
If a patient presents with involuntary muscle hypertonicity of the legs and abdomen, what stage of dehydration would you suspect he/she is in?
Heat cramps
At what temperature do we see hyperthermia?
95 degrees Fahrenheit or less
How much blood is pumped into the arteries with every heartbeat that is felt with a pulse?
5 tablespoons
What three things are measured with the pulse?
Rate, rhythm, amplitude
What is the normal range and average resting pulse?
60-90 beats per minute (72 average)
What pulse range is indicative of bradycardia?
Less than 60 per minute
What pulse range is indicative of tachycardia?
More than 100 per minute
What is the physiologic tachycardia effect on pulse due to elevated temperature?
10 bp raise for every degree over 100
What is the cause for pathologic tachycardia?
Oxygen deficit (examples = anemia, hemorrhage, shock, or congestive heart failure)
What is the cause of physiologic tachycardia?
Normal response to exertion, anxiety, exercise, excitement or elevated temperature
What is the common heart beat irregularity that is more prominent in children where the heart rate speeds up with each inspiration and slows again with expiration?
Sinus arrhythmia
What is the common heart beat irregularity that involves disorganized electrical activity in the atria accompanied by a rapid, irregular ventricular response?
Atrial fibrillation
What is the common heat beat irregularity that involves ventricular depolarization occurring earlier than expected resulting in occasional skipped beats?
Premature ventricular contraction (PVC’s)
Which common irregularity usually accompanies pre-existing heart disease and necessitates emergency care?
Atrial fibrillation
What is the scale used to measure the amplitude of a pulse?
0 absence 1 weak, feeble 2 expected/normal 3 full/increased 4 water-hammer, bounding
What is the normal appearance of the contour of a pulse?
Smooth, domed-shaped wave
How could pain or paresthesia of vascular origin be differentiated from that of neurologic origin?
1 check dermatome vs vascular distribution
2 check extremity warmth and skin color
3 check capillary refill time
4 compare peripheral pulse amplitude
If one side of the body’s peripheral pulse feels weaker than the other, one of what three things can be assumed?
Compression, constriction, or obstruction of an arterial lumen
What condition could be apparent if a strong radial and weak or absent femoral pulses are found?
Coarctation of the aorta
A bruit is heard best with what part of the stethoscope?
Bell
What does the presence of a bruit mean?
Compressed, constricted, or partially obstructed arterial lumen
How can venous insufficiency be assessed?
Inspect for swelling, varicosities, edema, erythema/cyanosis while patient is standing
What is the normal adult respiratory rate?
12-20 breaths per minute
What rate defines tachypnea?
More than 20 breaths per minute
What is the rate at which breathing rate increases due to physiologic tachypnea from elevated temperature?
4 breaths per minute for every degree over 100
What kinds of things can lead to pathologic tachypnea?
Hyperventilation, lung congestion/obstruction, airway constriction, rib/intercostals/pleural pain
What rate defines bradypnea?
Less than 12 breaths per minute
What is air-trapping?
Increasingly difficult and prolonged expulsion of air
What is hyerpnea?
Deep labored breathing
What is examples of deep and rapid breathing?
Hyperventilation and Kussmaul
What is the term for an occasional deep breath?
Sigh
What is hypopnea?
Abnormally shallow respirations
What is dyspnea?
Distressful or uncomfortable breathing
What is orthopnea?
Shortness of breath that begins or gets worse when lying down
What is the palpatory systolic blood pressure?
Where the pulse is first FELT when releasing pressure from the cuff
What is an auscultatory gap?
Transient period of silence of the Korotkoff sounds
What are Korotkoff sounds?
Audible noises created by turbulent blood flow through the partially open lumen of the brachial artery
What is the auscultatory systolic blood pressure?
Where the pulse is first HEARD while releasing pressure from the cuff
What is the term for the point at which the blowing sounds become softer and begin to fade when listening for blood pressure?
First or mid-diastolic blood pressure
What is the end diastolic blood pressure?
The point at which audible blowing sounds completely stop being heard
In what kind of situation is the mid-diastolic BP used to denote diastolic BP?
High cardiac output conditions where sounds may be heard all the way to zero pressure
What is the pulse pressure?
Difference between the systolic and diastolic pressures
What is a better indicator of heart disease: systolic or diastolic BP alone or abnormal pulse pressure?
Abnormal pulse pressure (according to some studies)
There should be no more than how many mmHg of difference between the systolic blood pressure in both arms?
10 mmHg
Which arm can have a 5-10 mmHg difference in systolic blood pressure and why?
Right arm; due to additional bifurcation (Poiseuille’s Law)
Which are higher and why: leg or arm blood pressures?
Leg blood pressures; due to greater muscle mass
If arm BP is higher than leg BP, what can we suspect?
Young people - coarctation of aorta
Elderly people - Stenosis of aorta
What is the normal range for systolic blood pressure?
100-140 mmHg
What is the normal range for diastolic blood pressure?
60-90 mmHg
What usually increases systolic blood pressure?
Increased cardiac output
What usually increases diastolic blood pressure?
Increased peripheral (arterial) resistance
Strong emotion like anxiety raises what kind of blood pressure?
BOTH systolic and diastolic
What should be the measurement for pulse pressure?
40 mmHg (+/- 10 mmHg)
What does a wide pulse pressure indicate?
Additional arterial stretch with every heartbeat and wear and tear on the arteries
What is the average adult normal blood pressure?
120/80 mmHg
What should be the ideal width of the blood pressure cuff?
1/3-1/2 the circumference of the arm
What kind of hypertension accounts for about 92% of cases?
Essential/idiopathic hypertension
What kind of hypertension accounts for 8% of cases?
Secondary
What is the top cause of secondary hypertension?
Adrenal disease (also hyperthyroidism, coarctation of aorta, polycythemia, preeclampsia)
What are the blood pressure ranges for prehypertension?
Systolic = 120-139 mmHg Diastolic = 80-89 mmHg
What percent of the adults in U.S. and Canada have high blood pressure?
25%
What are examples of noninvasive activities that can help 75% of the hypertension cases in the U.S. and Canada?
Slow breathing exercises
Concord grape juice
Sodium reduction and weight loss
Moderate exercise
What is the treatment for stage 1 hypertension?
Diuretics
What is the treatment for stage 2 hypertension?
Diuretics and medications
What is the treatment for stage 3 hypertension?
Combination medications