‘VITAL SIGNS (PT101) Yat Signs (carina sions) + Inacators of the body's physiological status and response to physical act, environmental cantons, ‘and emotional stressors + Provide quantitative measures of the status ofthe 100b9m) ‘+ Palptation: sensation of a rap or irregular pulse rate Perceived by the patent without actualy palpating a peripheral pulse + Influencing fotos: o Age © Gender © Emotional status, stress © Physical acti level ‘tytn ‘+ Pattern of pulsations and the intervals between them 2 Arythma/ dpsrynmia Refers to an irregular rhythm in which pubes are not evenly spaced Quality (ampitude or volume) + Refers to the amount of force created by the ejected ‘blood against the arterial wal during each ventricular contraction + Weak/thready: the puise i smal, easy obtterated ‘Bounding: increased volume the pulse i large, cicut to biterate Key terms for Pulse + Bigerinal ‘0 Abnormality in pulse rhythm where two beats ‘occur In rapid succession (double systole peak) ‘+ Pulsus atrans (attemating puse) ‘0 marked by a fluctuation in ampiituse between ‘eats (weak and strong, wth minimal change In overall thyghm ‘+ Paradoxical pulse (pulsus paradorus) ‘Decreased amplitude of the rpesure wave detected during quit inspration witha return te full amplitude on expiration Scale for grading Pulse Pulse | Descr No percepibie pulse even with maximum pressure [ Grade | 0 Barely perceptible easy obiterated with slight pressure; fades in and out irs e Diicut to palpate; slighty stronger then ‘thready; canbe obiterated with ight pressure —_ ‘Normal | Easy to palpate; requires moderate pressure tocblterate ‘4 [Bounding | very strong; hyperactive; 6 not obiterated swith moderate pressure Factors Inuencing Pulse "Age ‘Gender Emotions/Stress Erercise Medleations ‘Steric or Local Heat Pulse Stes Fetal rates: ave. 120-160 bpm ‘Neworn: 70-190bpm (ave. 1200p) + Adult: 60-5006 + Men: sighty lower pulse rates than women Increase HR to provide adtiona blood flow to mutes and to meet the increased oxygen requirement ‘Know the resting and predicted mazmal HRs (Karvonen's Formula) + 15-30mins therapeutic exercise 1 Should not exceed 60-90 % of predicted HRs cations 1+ Beta-blockes: block sympathetic beta receptors and crease both resting HR and Hr response to exercise Perform aerative measurement {Ratings of Perceived Exertion (RPE scale) ‘Systemic or Local Heat + Fever: HR increases + Leca appications of thermal modalities: HR increases Putse sites oe [Pulse site | Location Tndication for Temporal Over ‘superior When radial pulse | ang iter’ to te ee inacceanle; often | ted wth fot Used by | rentheslogats for montorng strat Carotid] On ether side of the Tower | During shock or neck, below the Jaw, fingers | cardiac ares, cover thyrod cartlage between | often used _ with the trachea and medial border | infants; used to of SOM; pressure should not be | monitor cranial ‘ppied.blateraly or high on | circulation enly the neck to avoid stimulation of | accessible other the carat sinus and 2 | peripheral pulses subsequent refer drop in pulse | cficuk or too es ae soa Serer — eae femme |omtae operat, [Toor | Secrest” | mate meee ay |Poe Sop eee, aa nar — Rn ere paracdiatt oe [opaeren Raeraniee to | emerans cats" | Pll a eres — Se Garena [etamre iene ir | the symphysis pubis; typically | Soa monitored in supine soroaston reel et crm cane recreates Cet pose ten or ow Scevety compromised tect)Pulse Oximetry © Provides a measure of arterial blood ‘oxygenation that updated with each pulse © Onygen is cared in the blood in two forms: : In ater plasma Combined with haemoglobin © Measures arterial ood oxygen saturation ‘Normal evel 96-1008 ‘90% need for administration of supplemental ‘onygen Monitored by palpation using the fst three oF the index ‘and third finger of one hand Measuring Radia Puse Assemble equipment ‘© Watch (or wall ack) with a second hand Wash hands Procedure 1. Explain procedure and ratonae in terms appropiate tothe patient's understanding 2, Ensure patient understanding, safety, and comfort, 3. Supine: FA supported acoss the patients chest (Fat his/her side with partial Rexion ofthe ‘bow 4A. Siting: FA can rest across the pts thigh, wth pillow support or PTs arm 5. Place the fist three fngers squarely and fmty ‘over the rail pulse; use only enough pressure to feel the pulse accurately. It te pressure Is too great, it wil acide the artery ‘6 Determine the rate by counting the puke for 30 secs x2; 60secs cunt to improve accuracy ‘Note the rhythm and quay ofthe pulse 7. Wash hands ‘Measuring Apical Pulse ‘Assemble equipment ‘© Watch (or wal dock with a second hand © Stethoscope (2 Antiseptic wipes for deaning the earpieces and prolonged inspiratory phases with each breathe, folowed by 3 prolonged expiratory phase Causes: damage tothe upper pat of the pons + Cheyme-Stokes Breathing | D characteraed By periods of respirations during which the spontaneous tidal volume stats | ‘halon and progressively gets deeper wth ‘each breathe, then gets progressively more ‘halo with each breathe. © followed by perc of apes that can last anywhere from 15 seconds to 120 seconds (2 Causes: Strokes, traumatic brain injuries, brain tures, carbon oxide poisoning, metabolic encephalopathy + Bots Breathing ‘© periods, or “dusters” fay rapid resprations of cose to equal depth foloned by reular perods of apnea that can last between 15 seconds to 120 seconds. very smlar to Cheyen-Stokes except the ‘Spontaneous tidal volume is equal throughout ‘he period of respraton 2 Causes: ‘Damage tothe medulla oblongata by stroke (CVA) or trauma + pressure on the medulla due to uncal ‘oF tenorilhermaion “+ Kussmaul Respication 1 Labored hyperventilation characterized by & deep and rapid respiratory pater. © Causes lat stages ofa severe metabolic ‘cidsis | + Ataxe Breathing SA completely irregular breathing pattern with {regular pauses and unpredictable periods of apnea, fo Asbreathing continues to deteriorate ataxic breathing begins fo merge with agonal respirations. © Cause * damage tothe medulla oblongate ‘secondary to trauma or stroke, + Ths respiratory patter inccates a very poor prognas Procedure for Monitoring Respiration ‘Assemble equipment Watch (or wall lock) wit a second hand + Wash hands + Procedure ‘© Ensure patent saety and comfort. Respations typlcaly montored withthe patient ether supine or siting Note: The patient should bein a quiet resting poston for at least 5 minutes ror to ‘monitoring resprations ‘9 Expose chest area; i area cannot be exposes and respratons are not ready observaie, place patent's arm across chest and keep fingers postioned as if continuing to mentor the rade pulse © Aste patient breathes, observe the rise and fal of the chest; note the amount of effort equred or audible sounds produced during breathing (pormaly respiration is efforess and silent) Using the second hand of a watch or dock, determine the rate by counting respirations {either inspirations or exprations, but not both) for 30 secs and mutiny by 2 co _Identfy the rhythm (regulary of inspirations and expiration); note deviations trom normal Uninterrupted, even spacing If any Imregulates are noted, count fora ful 60 ‘seconds to accommodate the fluctuations and ‘ensure an accurate count + Refersto systole pressure + Highest pressure extend by the blood against the arterial was Diastolic pressure + Lowest pressure Pulse pressure ‘+ Mathematical diference between the systolic and asta pressures + BPaCO x PVR force the Dood exerts against a vessel wal ‘Blood Pressure Regulation + Vasometor center ‘Located blateraly nthe lowe pons and upper media © ASsits In providing the stable arterial required ‘to maietan Blood low to body tissue organs © Transmas impulses through sympathetic nerves toall esses ofthe body ‘© Toncaly active, producing 2 siow, continual fring in all vasoconstrictor nerve fibers + Srreentos (sesrecear) ‘Stimulates by stretch ofthe vessal wal rom alterations in pressure Have ahigh concentration inthe wal of the Internal carotid arteries above the catia bifurcation and in the walls of the arch ofthe ort © Located at the corotié sinuses ‘© Results in an inhibition ofthe vasoconstretor canter of the medula and excation of the vogal center 9 Deereased HR, decreased force of cardiac contraction, and vasadiaion + Chemoreceptors ‘Stimulated by reduced arterial oxygen ‘concentration, increases in carbon doxide tension, and increased hysrogen on concentrations 0 Located atthe cacti bodes and aortic bodies Factors Affecting Blood Pressure Blood Volume 2 Diameter or Elstioty Cardiac Outout + he + Brercise + Vabalva manewer {Postural (Orthostaic) Hypotension Arm PostionFacod Voune the amount of eeulating Wood nthe body recy tates presure rn Hawtin the boy + Firpowleme shock 9 Bh emergency condition in ich severe bod and uid oss mate the heart uneble o pump rcreme “219 300d the body Excess fad + Decrease © Reduced fd vekume © Dare 2 dehyaration Diameter or Elsticty of Arteries + Tefluences the vascular resistance + The higher the resistance to blood flow resuks to an Increase in systolic pressure (Cardiac Output ‘+ “Increased amounts of blood pumped into the arteries, age Devas ofthe vessesdtend sug im ahigher SP curing OEE 88 + Physical acti wil nerease cardiac output, wth consequent linear increase n OP Vassaiva Maneuver ‘Attempt to exhale withthe gti, nose, and mouth closed ‘+ Increase in intrathoracic pressure wth an accompanying ‘colagse ofthe veins ofthe chest wall ‘+ Internal stabilize the abdominal and chest wal during etlods of rapid and exertion such as lifting a heavy object ‘+ Valsalva maneuver: ‘© | blood ow tothe heart © | venous return © Drop in arterial pressure Posture (Onthostati) hypotension + “associated wit prolonged immobilty and periods of bed rest ‘+ Ts the sudden drop in BP that occurs when movement to upright postures i inated ‘Arm Postion ‘+ BP may vary as much as 20 mig by altering arm postion + Patient shouldbe sitting wth arm in horizontal, supported poston at heat level Classification of BP for 18y/0 and abo. =P Systolic BP Diastolic BP Classifcation __| (mmHg) (eomitg) Normal 120, <0 Prehypertension — | 120-139, 30.85 Hypertension | 140-159 T3098 stage 1 2160 | 2100 | stage 2 J} Equipment Requirements ‘+ Spygmomanometer 1 Bld pressure cult © Const (© Bladder Na, inflatable; covered with cotton or nylon sleeve © Two tubes ‘© Rubber bub © Pressure manometer ‘+ Mercury or aneroid + Stethoscope ‘© Binaurals: designed for use in both ears (© Distal sensing microphones (nead or chestpece) Bel shape + Fat dsk daptragm Korotkott’s Sound ‘+ Low frequency sound + Auscuatory 980 fe Temporary disappearance of sound normally heard aver the brachial artery between phase 2 {82 and may cover as much as 4OmmHg Not Mdentfyng this gap may lead to Underestimation of systolic and overestimation Of castoic pressure + Phase I: the fist dear, faint, rhythm taping sound ‘that gracual Increases In intensity fs heard. The period ‘when blood intl flows trough the artery recorded ts systoe pressure. This represents the highest pressure In the arterial system during ventricular contraction. Be ert for an auseultatory aa. ‘+ Phase I: A murmur or swshing sound is heard as artery widens and more blood laws through atery + Phase It: Sounds become crisp, more intense, and Jude; blood is now Nowing relatively unobetrcted + Phase 1V: sound s distinc, abrupt muffing; soft blowing quality. "In chen less than 13 years of, pregnant women, and patients with hgh cardia output or Deripheral vasodiaton, sounds are often Near at levels far levels approaching O mmHg In these situation, for ‘esto pressure, but both muffing (phase IV) and ‘dsappearance (chase V) should be recorded ‘+ Phase V: Last sound is hear is recorded as diastolic pressure in aduRs Procedure for Measuring Brachial BP Assemble equipment Stethoscope © Spygmomanometer Antiseptic wipes + Wash hands S Procedure ‘9 Explan procedure and rationale in terms appropriate tothe patent's understancing ‘© ASSist the patient to the desired poston ‘© Use antiseptic wipe to clean the earieces and head of stethoscope ‘© Expose the patients arm Wrap the defiated cuff snugly and eveniy around the patients bare arm ~ inch above antecubital fossa Ensure the anerold gauge s easly visible Locate and palpate the radia artery onthe distal forearm of culled UE ‘© Ghose the valve ofthe BO cutt ‘© Teflate the BP cuff to 30mg above the level at wich the radial pulse fs no longer fe. © Place the earpleces of the stethoscope (titing them slightly forward) into ears © Locate and palpate the brachial artery sightly ‘ove medal to the antecubital fost © Ose the valve of the BP cu end inflate the cut Release the valve careful, allowing air out slowly 2=immbig per heartbeat Watch the manometer closely and nate the point which the frst sound is heard ‘© Clean the head and earpieces of stethoscope ‘wth antiseptic wipes Pain Assessment + Recognized asthe "th vial sign” since Is a primary ‘symptom in many physical therapy practices + Subjective finding obtain during question or interviewing 2 patient ‘+ Pain and the patients sefreport ofthe seventy and ‘ocaton of pain shoul be the primary source of Information, Referred Pain + Embryologic development + Mutisegmental innervation ‘Direct pressure and shared pathways Embyologcal Development Peel Prse pe m3+ Changed in curation (how longi ats)? of Pain Frequency and Duration of Pin ‘How kg oo the symtoms ast? + Doyou have tis pan nght now? + Dia you note these symptoms tis morning immediately then you woke up? Pater of Pan + Tellme about the pattern of your pan/symptoms. + When does your (rame the volved body pan) hurt? ‘+ Desebe your pin/ symptoms from fest wating up a the morning to gong to bed t night? + Have you ever experienced anfting he this before? + Tiyes, do these episodes occur more or less often than ath? ‘+ How does your pan/symptomys) change with time? + Are your symptoms worsen the morning or evening? Aggravating Factors + What bengs your pan (symptoms) on? + Wher kinds of tings mete your pan (symptoms) worse \ (eg, eating evercse, rest, specie postions, exctement, sess)? \ + Whot mates the pain better? 4] ‘How dos rest affect the pain/symptors? + Are your srmotoms aggravated or eleved by any \ } ‘actives? I yes, what? a ay wat . ops his protiem elected your daly We at worker yj Ww | + How hs this poten acted your obit career jis \ youre wut vance Ses te case / i\ orive)? i \\ \ ‘Associated Symptoms. + na eho sets ave oh tat you con / { \ associate with this? f | \ ‘Sources of Pain & / » + Musculoskeletal vs. Systemic ry 1 1 + Gime { \\ + Sore th \) : + teene crracerteso Pon b keer ection Stepan of sersaton + imeety 2 Dorton 2 Freaiency an baton 2 pre Location of ain + Gan yeu show me xy where ou po ete? Dect ot an hit des fe he? + Mas the pa changed mn qualty since fst began? + Changed in ntensty?