Vital Signs and Arterial Pulse Assessment

Vital Signs

• Vital signs are a crucial aspect of assessing a patient's overall health.
• Core vital signs include temperature, pulse, blood pressure, and respiratory rate.
• These vital signs provide immediate information about a patient's current condition and can indicate potential issues.

Arterial Pulse

• The palpable pulse in an artery reflects pressure waves generated by blood ejection from the left ventricle.
• Pulse assessment involves evaluating rate, rhythm, volume, character, collapsing pulse, radial/femoral delay, and blood vessel wall characteristics.
• Rate is determined by counting beats in 15 seconds and multiplying by 4. Bradycardia is a pulse rate below 60 bpm, while tachycardia is above 100 bpm.
• Common causes of bradycardia include medication, athletic conditioning, and sinoatrial/atrioventricular node dysfunction. Sinus tachycardia is a common cause of tachycardia.
• Rhythm can be regular or irregular. Sinus rhythm is typically regular but can vary with respiratory cycles, especially in children and athletes (sinus arrhythmia). Irregularly irregular rhythm, such as in atrial fibrillation, is indicated by varied and random pulse intervals. Regularly irregular rhythms (like in ventricular bigeminy) have a consistent interval between irregular beats..
• Pulse volume reflects the pressure wave strength. High volume suggests strong pulses, commonly occurring in exercise, pregnancy, or conditions like thyrotoxicosis; low volume suggests weaker pulses, which may be linked to conditions such as aortic stenosis or shock.
• Pulse character describes pulse quality (e.g., strong, weak, collapsing, and more).
• Collapsing pulse, or water-hammer pulse, is characterized by a sudden rise and fall in the pulse amplitude. This is associated with aortic regurgitation, persistent ductus arteriosus, and sometimes, fever or thyrotoxicosis.
• A delay in the pulse reaching an artery (radial/femoral delay) can point to pathology (e.g., aortic arch aneurysm, subclavian/aortic coarctation).

Blood Pressure

• Measure blood pressure using the brachial artery, preferably taking readings on both arms and selecting the higher value for assessment.
• Position the patient comfortably seated or lying down, supporting the arm at heart level
• A properly sized blood pressure cuff should be placed over the brachial artery.
• Inflate the cuff until the pulse disappears and gradually deflate. The first sound heard (Korotkoff sound phase I) represents systolic pressure. The last sound heard (Korotkoff sound phase V) represents diastolic pressure.

Respiratory Rate

• Respiratory rate (breaths per minute) is typically assessed quietly, without drawing attention to the patient, to avoid influencing the rate.
• A normal resting respiratory rate is between 12-15 breaths/min for adults.
• Anxious patients might have a slightly higher rate (15-20 breaths/min).
• Rates over 20 breaths/min are considered abnormal in adults.
• Rapid breathing (tachypnea) can be caused by various factors, including fever, asthma, COPD, pneumonia, and pulmonary edema.
• Slow breathing (bradypnea) can result from opioid toxicity, hypothyroidism, increased intracranial pressure, hypothalamic lesions, and hypercapnia.
• The depth of breathing (shallow or deep) can also have diagnostic significance. Shallow breathing may indicate chest pain, pneumonia, while deeper breathing might suggest metabolic acidosis.

Temperature

• Temperature measurement duration depends on the type of thermometer (e.g., 'half-minute' thermometers). Accurately measure body temperature.
• Temperature is usually taken in the mouth or armpit (axilla) for conscious adults and in the rectum for unconscious or elderly patients using low-reading thermometers
• Special thermometers or techniques might be employed for children.
• Normal body temperature is generally considered to be between 36.6°C–37.2°C, but factors like time of day and menstrual cycle can affect measurements.
• An abnormally high temperature (over 37.7°C in the afternoon and 37.2°c in the mornings) often indicates a fever or possible hyperthermia.
• In contrast, a body temperature lower than 35°C might suggest hypothermia.

This quiz covers essential aspects of vital signs assessment, including core vital signs such as temperature, pulse, blood pressure, and respiratory rate. It also delves into the specifics of arterial pulse, focusing on evaluation techniques and conditions like bradycardia and tachycardia.