Physical Rehabilitation (2014).pdf

Examination of Vital Signs Chapter 2 Thomas J. Schmitz, PT, PhD LEARNING OBJECTIVES CHAPTER OUTLINE 1. Discuss the rationale for including vital NORMATIVE VITAL S...

Examination of Vital Signs Chapter 2 Thomas J. Schmitz, PT, PhD LEARNING OBJECTIVES CHAPTER OUTLINE 1. Discuss the rationale for including vital NORMATIVE VITAL SIGN DATA 31 Doppler Ultrasound and Pulse sign measures in the patient examination. ALTERATIONS IN VITAL SIGN VALUES: Oximetry 60 2. Explain the relevance of vital signs data to OVERVIEW OF INFLUENTIAL RESPIRATION 63 assigning a diagnostic label, determining VARIABLES 34 Respiratory System 63 the prognosis, and establishing a plan Lifestyle Patterns and Patient Inspiration 64 of care. Characteristics 34 Expiration 64 3. Recognize the importance of vital signs Culture and Ethnicity 34 data in determining physiological Regulatory Mechanisms 64 PATIENT OBSERVATION 35 Factors Influencing Respiration 65 response to treatment and evaluating patient progress. TEMPERATURE 37 Parameters of Respiration 66 4. Describe the procedure for monitoring Thermoregulatory System 37 Patterns of Respiration 66 temperature, pulse, respiration, blood Abnormalities in Body Temperature 40 Respiratory Examination 68 pressure, and hemoglobin oxygenation. Factors Influencing Body BLOOD PRESSURE 70 5. Differentiate between normal and Temperature 41 Blood Pressure Regulation 70 abnormal values or ranges for each Types of Thermometers 42 vital sign. Factors Influencing Blood Pressure 70 Hand Hygiene 44 6. Identify the normative variations in vital Equipment Requirements 72 Measuring Body Temperature 48 signs and the factors that influence these Korotkoff’s Sounds 72 PULSE 52 changes. Measuring Brachial Blood Pressure 77 Rate 52 7. Explain the rationale for using pulse Measuring Popliteal (Thigh) Blood oximetry in the presence of unstable Rhythm 52 Pressure 78 hemoglobin oxygenation levels. Quality 52 Recording Results 79 8. Describe the recommended elements for Factors Influencing Heart Rate 54 RESOURCES 79 documentation of vital signs data. Pulse Sites 55 SUMMARY 79 Monitoring Pulse 55 Automated Heart Rate Monitoring 59 E xamination of body temperature, heart (pulse) cardiovascular/pulmonary practice patterns.1 Although rate (HR), respiratory rate (RR), and blood pres- not considered a primary vital sign, pulse oximetry is an sure (BP) provides the physical therapist with important related measure that provides information on important data about the status of the cardiovascular/ arterial blood (hemoglobin) oxygen saturation levels. pulmonary system. Owing to their importance as indi- Pulse oximetry data allow the therapist to screen and cators of the body’s physiological status and response to monitor for hypoxemia (decreased oxygen concentrations physical activity, environmental conditions, and emo- of atrial blood). Hypoxemia is often associated with pul- tional stressors, they are collectively referred to as vital monary disorders that impair ventilation of the lungs signs. Because many important clinical decisions are (e.g., pneumonia, chronic obstructive pulmonary disease based in part on these measures, accuracy is essential. [COPD], anemia, respiratory muscle weakness, and The Guide to Physical Therapist Practice includes circulatory impairments). examination of vital signs (HR, RR, and BP) in the Also referred to as cardinal signs, vital signs provide cardiovascular/pulmonary systems review for each of quantitative measures of the status of the cardiovascular/ the four major categories of practice patterns. Vital signs pulmonary system and reflect the function of internal are also identified among the tests and measures used to organs. Variations in vital signs are a clear indicator that characterize or quantify circulatory status. Pulse oximetry some change in the patient’s physiological status has is included in the ventilation and respiration/gas ex- occurred. Taken at rest and during and after exercise, change category of tests and measures for each of the these measures also provide important data on aerobic 30  CHAPTER 2 Examination of Vital Signs 31 capacity and endurance. Together with other examination The physical therapist’s clinical decision making will data, vital sign measures assist the physical therapist in determine which vital signs should be measured and the making clinical judgments to do the following:1 frequency of measurement for an individual patient within a specific context (e.g., self-paced ambulation on 1. Assign a diagnostic label and classify patient findings level surfaces vs. stair climbing). Although taking vital sign within a specific practice pattern. measures may be delegated to a physical therapist assistant 2. Determine the prognosis and plan of care (POC), (PTA) or other support personnel, the physical therapist including identification of anticipated goals and will evaluate and determine the significance of the data. expected outcomes, and selection of specific interventions. 3. Evaluate patient progress through reexamination at NORMATIVE VITAL SIGN DATA periodic intervals during an episode of care. Multiple resources provide normal vital signs values 4. Evaluate the effectiveness of selected interventions across age groups. Normative data are typically presented in achieving anticipated goals and expected outcomes as averages or as a range of values for the age group from (changes in impairment, activity limitations, and which they were derived; using a range reflects the vari- disabilities and changes in health, wellness, and ability of values designated as normal. Tables 2.1 and fitness). 2.2 are examples of normative vital signs data presented 5. Determine if a referral to another practitioner is by age using ranges (Table 2.1) and a combination of warranted. averages and ranges (Table 2.2).2,3 Table 2.1 Comparison of Normal Vital Signs for Various Ages Reported as Ranges Age Temperature °F (°C) Pulse Rate Respiratory Rate Blood Pressure (mm Hg) Newborn 98.6-99.8 (37-37.7) 120-160 30-80 Systolic: 50-52 Diastolic: 25-30 Mean: 35-40 3 yr 98.5-99.5 (36.9-37.5) 80-125 20-30 Systolic: 78-114 Diastolic: 46-78 10 yr 97.5-98.6 (36.3-37) 70-110 16-22 Systolic: 90-132 Diastolic: 5-86 16 yr 97.6-98.8 (36.4-37.1) 55-100 15-20 Systolic: 104-108 Diastolic: 60-92 Adult 96.8-99.5 (36-37.5) 60-100 12-20 Systolic: