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Baseline Vital Signs

Baseline Vital Signs


Key signs used to evaluate a patients condition
First set is known as baseline vitals
Repeated vital signs compared to the baseline
Need at least 2 sets of vitals to show trending

Baseline Vital Signs

PRBELLS

Pulse
Respiration
Blood pressure
Eyes
Lung sounds
LOC - Level of Consciousness
Skins

Rate

Pulse

Number of beats in 30 seconds x 2


Number of beats in 15 seconds x 4

Rhythm
Regular or irregular

Quality
Bounding, strong, or weak (thready)

Normal Pulse Rates


Adults 60 to 100 beats/min
Children 70 to 150 beats/min
Infants 100 to 160 beats/min
Fast = Tachycardia - over 100 in adults
Slow= Bradycardia - under 60 in adults

Pulse Points

Pulse Points

Pulse Points

Pulse Oximetry

Pulse Ox Enemies

Respirations
Rate
Number of breaths
in 30 seconds x 2

Effort
Normal or
Labored

Rhythm
Regular or irregular

Noisy respiration
Normal, stridor,
wheezing,
snoring, gurgling

Quality
Character of
Breathing

Depth
Shallow or deep

Respiratory Rates
Adults 12 to 20 breaths/min
Children 15 to 30 breaths/min
Infants 25 to 50 breaths/min

Common Terms
Bradypnea= slow breathing
Tachypnea= fast breathing
Eupnea= normal breathing
Apnea = no breathing

Blood Pressure
A drop in blood pressure may indicate:
Loss of blood
Loss of vascular tone
Cardiac pumping problem

Equipment
Sphymanometer & Stethescope

Measuring Blood Pressure


Diastolic
Pressure during relaxing phase of the hearts
cycle
Systolic
Pressure during contraction
Measured as millimeters of mercury (mm Hg)
Recorded as systolic/diastolic

Blood Pressure

Auscultation of Blood Pressure


1. Place cuff on patients arm.
2. Palpate brachial artery and place stethoscope.
3. Inflate cuff until you no longer hear pulse sounds.
4. Continue pumping to increase pressure by an
additional 20 mm Hg.
5. Note the systolic and diastolic pressures as
6. you let air escape slowly.
7. Korotkoff Sounds
8. 1st beat you hear is systolic
9. Last beat you hear is diastolic
10.As soon as pulse sounds stop, open the
valve and release the air quickly.

Palpation of Blood Pressure


1.
2.
3.
4.
5.

Secure cuff.
Locate radial pulse.
Inflate to about 200 mm Hg.
Release air until pulse is felt.
Method only obtains systolic pressure.

Normal Ranges of Blood Pressure


Infants (newborn to 1 year)

50 to 95(systolic)

Children (1 to 8 years)

80 to 110 mm Hg
(systolic)

Adults

90 to 140 mm Hg
(systolic)

Pupil Assessment
P - Pupils
E - Equal
A - And
R - Round
R - Regular in size
L - React to Light

Abnormal Pupil Reactions


Fixed with no reaction to light
Dilate with light and constrict without
lightthats a brain problem!
React sluggishly
Unequal in size
Unequal with light or when light is
removed

Pupil Reactions

Level of Consciousness

Name? Date? Place? Problem?

Lung Sounds
Types of Lung Sounds
Lung sounds are
typically broken down
into three categories:
Normal (vesicular)
Decreased or
absent
Abnormal
(adventitious)

Lung Sounds
There are several types of abnormal lung sounds:
Wheezes are caused by air flowing rapidly through narrowed
airway passages
Rhales are small bubbling or fine clicking sounds made when
air is forced into collapsed alveoli and/or in the presence of
fluid in the alveoli and/or bronchioles.
Rhonchi are low-pitched, sonorous, rumbling, bubbling or
gurgling sounds.
Pleural rub, or friction rub, occurs when there is fluid in the
pleural space between the lung tissue and the interior chest
wall. There is commonly a grating, rubbing type of sound as the
visceral (lung) and parietal (chest wall) pleura rub against each
other.

Lung Sounds

Skins

Reassessment of Vital Signs


Reassess stable patients every 15
minutes.
Reassess unstable patients every 5
minutes

Patient History
SAMPLE
S - Signs & symptoms
OPQRST

A - Allergies
M - Medications
P - Past medical history
L - Last oral intake
E - Events leading to incident

S - Signs & Symptoms


OPQRST

O - Onset
When & How did the symptom begin?

P - Provokes/Palliates
What makes the symptom worse?
What makes the symptom better?

S - Signs & Symptoms


OPQRST
Q - Quality
How would describe the pain?/What does the
pain feel like?
DO NOT lead the patient

R - Region/Radiation
Where is the pain?
Does the pain travel anywhere else?

S - Signs & Symptoms


OPQRST
S - Severity
How bad is the pain? Scale of 1-10

T - Time
How long have you had the symptom?

A - Allergies
Medications
Foods
Environment

M - Medications
Are you taking any?
When did you last take your medication?
What are they?
What are they for?
May I see them?
May we take them with us?

P - Previous Medical History


Pertinent
Related to this complaint
Complicating factor

L - Last Oral Intake


Food and/or Drink?
What?
When?

E - Events leading up to the


incident
What happened?
When?