DPT 470

Objective evidence (examination) of certain physiologucal functions fo the body that are essential to life

• Gives a picture of general physiological state of the individual: integral component o the "systems review"
• Gives a picture of how the individual is responding to a particular treatment: safety, difficulty with treatment, done too much vs. can do more, progression vs. lack of progress
• Simple and everyone is able to learn: health care workers, patient, family

• Resting: before activitu/procedure, establish a baseline, compare to medical chart
• During: monitor procedure - allows ongoing evaluation, critical component - ICU, cardiac or pulmonary patients
• After: immediately after, 5 minutes after to compare to baseline

• 1st visit/initial exam: assess safety/baseline of physiologic state of patient
• routine: seriously ill patients where activity could adversely effect physiologic state
• periodically: certain patients to detemine responses to change in treatment
• Ommitted in subsquent PT visits: general physiological state is stable and treatment does not involve strenuous activity/procedures

• Patient's medical chart contain daily measurements
• serial measurements are more accurate than one time mearsurement

• mentally record
• notify nursing staff or physician
• written documentation in progess note - adverse responses to treatment or program responses are reflected in vital signs measurements

• pulse
• respiration
• blood pressure
• temperature

vibration of a wave of blood in arteries

• Patient/part of body in relaxed position
• Use palpation skilss - use tips of first 2 or 3 fingers
• place fingers over area
• gently apply pressure to palpate pulse - not so hard as to obliterate the pulse

• first time: full minute
• habitually abnormal (rate, volume, rhythm): full minute
• habitually normal: 30 seconds or 15 seconds

• pulse rate
• pulse amplitude
• pulse rhythm

• newborn rate: 120-140 ppm
• adult 60-100 ppm
• know what is "normal" for each individual

• morning: lower
• afternoon: higher

• Fast: tachycardia (>100 ppm)
• Slow: bradycardia (<60 ppm)

• emotions
• activity
• drugs
• body temperature

force or strength of the pulse

• volume of blood in arteries
• strength of heart's contractions
• elasticity of blood vessels

• 0: absent; cannot palpate
• 1+: weak or thready
• 2+: normal; stronger pressure can obliterate
• 3+: full and bonding; difficult to obliterate

spacing between beats

• regular: intervals between beats are the same
• irregular (arrythmia): intervals between the beats are unequal

• most common
• elbow and wrist relaxed
• distal radius, volar surface of the wrist at the radial styloid

• important for takign blood pressure
• antecubital fossa, medial to insertion of biceps brachii

just in front of the ear above external acoustic meatus

• each side of the trachea
• critical pulse

• located just below or over the left nipple
• located with stethescope
• directly measures heartbeat

located in groin area midway between the pubic symphysis and ASIS

• located behidn the knee, very deep
• difficult to palpate

• locaed immediately behind medial malleolus
• look for warmth and color

• One branch: anterior medial ankle joint, over tal-navicular joint
• One branch: anteriorly between 1st and 2nd metatarsals
• look for warmth and color

difference between more accurate apical pulse and radial pulse

sign of some forms of heart disease, overactive thyroid, and possibly some medication

• the intake and output of air or more exactly the act of breathing in O2 and expelling CO2
• automatic process controlled by the respiratory center in the brian and the amount of CO2 in the blood stream
• evaluate in terms of cycles - 1 inspiration + 1 expiration = 1 cycle

• rate
• depth

• newborn: 40/min; decrease as get older
• adult: 10/12-20/min

• less than 8/min
• more than 40/min

• emotions
• activity
• fever
• pain
• blood gases
• drugs
• pressure on respiratory center of brain
• poisons

amount of attempted air exchange

• intake or output of small amounts of air
• characteristic of upper chest or apical breathers

patient uses diaphragm and muscles of inspiration to take in and breath out air

• subject should be relaxed
• primarily observing rise/fall of chest wall
• difficult = once patient notice you watching, they unconsciously change
• suggestions: tell patient you are still taking their pulse, place hand gently on upper chest/shoulder and palpate rise/fall
• how long: first time/consistently abnormal: full minute; consistently normal: 30 or 15 seconds

• patient is making a definite effort to get more O2 and get rid of CO2
• temporary and normal vs permanent and abnormal
• refers to audible labored breathign, dilated nostrils, distressed anxious expression
• may include actual gasping and possible cyanosis

breathing difficulty has increased so significantly that patient can only breath in partially/full upright position

temporary cessation of breathing

time period in which the patient is without O2

time period in which the inspired air contianed an inadequate amount of O2

• irregular periodic pattern that is symptom of problem with brain's respiratoy center; ften precedes death
• patient breaths deeply/rapidly for approx. 30 sec, then stops breathign for approx 10 sec
• goes from slow/shallow to faster/eeper till they taper off

• bluish color of skin, fingernails, etc.
• measure of decreased O2 intake
• usually begins in lips and mucous membranes, nailbeds, then entire body

• measure of heat of the body - balance between heat produced and heat loss
• not a vital sign that physical therpaists usually take - be aware of readings in chart or observed symptoms
• taken frequently and primarily with acutely ill patients

• Normal: 97-99 (depending on method)
• oral: 98.6
• rectal: 99
• axillary: 97

• sub-nromal: below 98.6 (listles, pale, skin gets cool/cold clammy)
• moderate fever: 100-103 (flushed, eyes are glassy, skin is warm, agitated)
• high fver: 103-205 (increase symptoms)
• danger: >105 (death)

• oral: most common
• rectal: most accurate
• axillary: least accurate

• increase: exercise, emotions, drugs, eating
• decrease: extreme/ prolonged cold, shock, drugs

• evaluation of body temperature above normal
• fever

• actual point when a prolonged fever breaks
• sweats, chills, weak, tired

force exerted against the walls of blood vessels and the force essentially responsible for the flow of blood through the arteries, capillaries and veins

cardiac output and peripheral resistance

• velocity of arterial blood
• volume of blood
• elasticity of arterial walls

• highest point of pressure on the arterials walls
• when the left ventricle contracts and pushes blood into the aorta

lowest point of pressure constantly present on the arterial walls

• directly: actually open artery and use catheter
• indirectly: common; "auscultatory" method - what we use; mearsured in millimeters of mercury = mmHg

• can be used where upper arm cannot be used
• systolic blood pressure is higher - may differ as much as 20 mmHg
• not interchangeable with values from upper arm

• should be measured in those who are at least 3 years of age; younger if special medical conditions exist
• auscultation is more accurate than electronic
• use of the riht arm is recommended
• body height and age are used to determine normals

• Peripherially inserted central catheter (PICC)
• avoid measure in the upper arm

measure in opposite arm

if cuff is too small, can be measured in the forearm

measured in opposite arm of unilateral mastectomy

• important: most common medical complication
• tends to decrease 10mmHg in early gestation

• coronary artery bypass graft (CABG)
• avoid using that arm initially after surgery

• systolic/diastolic in mmHg: systolic/first diastolic/ second diastolic; first sound/muffing of consecutive Korotkoff sounds (phase 1); silence
• may only be able to hear first and last sound initially, but with more practice you will be able to distinguidh actuall sound changes

• blood pressure reading
• which arm was used
• position of the patient
• state if an alternative site was used
• rest of after activity

• systolic: 90-120 mmHg
• diastolic: 60-80 mmHg
• average male: 120/80mmHg
• average female: slightly lower than male

• prehypertension: 120-139 SBP or 80-89 DBP
• stage 1 hypertension: 140-159 SBP or 90-99 DBP
• stage 2 hypertension: >160 SBP or >100 DBP

• hypotension: <90/60 mmHg
• to be declared "hypotensive" or "hypertensive" must display PATTERN of abnormal values

• anxiety
• excitement
• large meals
• exercise
• cold
• distended bladder
• initial acute sharp pain
• time of day

• sleep
• prolonged pain
• hemorrhage
• shock
• very fast/slow heart rate
• certain drugs
• time of day

• access by evaluative "tenting" of skin
• how: gently pinch skin and relasing, observe speed ot return to normal (3 sec)
• check forehead/ sternal area/ back hand
• mesaure of hydration

• edema: accumulation of excessive amount of watery fluid in cells, tissue, or serous cavities
• dependent
• pitting vs. nonpitting

• skin color, texture
• skin temperature
• facial expression
• alertness
• EKG