CLASS 2 - VITAL SIGNS Flashcards
(90 cards)
What are the special considerations you would take when performing an assessment of an infant (0-1 or 2y) in terms of:
- positioning
- preparation
- sequence of assessment
The major task to achieve is their trust + increase their comfort. A parent should always be present to understand normal growth + dvlpmnt and for the child’s feeling of security.
Positioning
- supine on padded examination table.
- Once the baby can sit without support (~6mo), as much of the examination as possible should be performed while the baby is in the parent’s lap.
- by ages 9-12 mo the baby is acutely aware of their surroundings. Anything outside of their range of view is “lost”, so keep parents in full view.
Preparation
- maintain warm environment
- have parents remove clothing of infant (leave diaper on if a boy)
- keep hands + stethoscope warm
- use soft, crooning voice
- eye contact
- smile
- smooth + deliberate mvmts
- offer pacifier or bright toy to distract baby when being fussy
- let them touch the stethoscope
Sequence
- if baby is sleeping, listen to heart, lung, and abdominal sounds first.
- perform the least distressing steps first and save invasive steps (examining eye, ear, nose, throat) until last
- elicit moro (startle) reflex at end of exam bc it may cause baby to cry
What are the special considerations you would take when performing an assessment of a toddler (1 or 2 - 3y) in terms of:
- positioning
- preparation
- sequence of assessment
The major task to achieve is their trust + increase their comfort. A parent should always be present to understand normal growth + dvlpmnt and for the child’s feeling of security.
Positioning
- sitting up in parent’s lap for all of examination
- when the toddler must be supine (for abdominal examination), move chairs to sit knee-to-knee with parent, and have toddler lie in parents lap w toddler’s legs in your lap
Preparation
- security object such as a blanket or teddy bear is helpful
- greet child + accompanying parent by name. For a child 1-6 yo, focus on parent more to allow the child to gradually warm up to you and size you up, then turn your attention gradually to the child, at first to a toy or object they are holding, or compliment the child’s clothes or hair.
- signs the child is ready: eye contact, smiling, talking to you, accepting a toy or piece of equipment
- they do not like to be w/o clothing. Have the parent undress the child one piece at a time
- do not offer the child a choice as they like to say “no”. Use clear, firm instructions.
- however, children like to make choices. Enhance autonomy when possible by offering limited options. “Should i listen to your heart next, or your tummy?”
- demonstrate procedures on parent or a plush toy
- praise child when they are cooperative
Sequence
- begin w games such as cranial nerve testing
- start w non-threatening areas
- save distressing procedures for last
What are the special considerations you would take when performing an assessment of a preschooler (3-6yo) in terms of:
- positioning
- preparation
- sequence of assessment
Children this age are often cooperative, helpful, and easy to involve. However, they fear any body injury or mutilation and so the child will recoil from invasive procedures.
Positioning
- 3 yo children: parent should be present, child may be held on parent’s lap during examination
- 4 or 5 yo will usually feel comfortable on the “big kid” examination table
Preparation
- don’t offer a choice when there isn’t one.
- enhance autonomy - limited choices when possible.
- allow child to play w equipment to reduce fears
- have them “help” you by holding equip
- use games (listening to teddy bear heart sounds, blow out penlight, etc)
- examine thorax, abdomen, extremities, and genitalia first
- assess head, eye, ear, nose, + throat last.
What are the special considerations you would take when performing an assessment of a school age child (6-12yo) in terms of:
- positioning
- preparation
- sequence of assessment
Positioning - sitting on examination table
Preparation - break ice w small talk about family, friends, sports, music, school; demonstrate equipment; children should undress on their own - leave underpants on, don a gown and use a drape
Sequence - H2T
What are the special considerations you would take when performing an assessment of an adolescent (13-18yo) in terms of:
- positioning
- sequence of assessment
Positioning - sitting on examination table, examine adolescent alone w/o parent or sibling present
Sequence - H2T, examine genitalia last
What are the special considerations you would take when performing an assessment of an older adult (60+)?
- positioning - needs to be organized + energy/time efficient –> sitting or lying; can be supine, semi-recumbent, semi-Fowler’s - HOB 30
- Pace of exam may need to be slowed w rest periods.
- Visual / hearing impairments v confusion - do not confuse them.
- do not startle your patient - announce what you are doing + ask for permission
What are some things you would assess in terms of a patient’s physical appearance?
age, sex, gender expression
LOC
Skin colour (is it even? Appropriate for their ethnicity? Redness?)
Facial features (any signs of distress? symmetrical face?)
What are some things you would assess in terms of a patient’s body structure?
stature, nutrition, symmetry, posturem position, body build, contour
What are some things you would assess in terms of a patient’s behaviour?
facial expression (does it match their mood + affect?)
mood + affect
speech (do they articulate clearly? rapid speech? disorganized? slow speech?)
dress (appropriate for the weather?)
personal hygiene (are they clean?)
–> tells us about coping and client’s ability for self care
What are some things you would assess in terms of a patient’s mobility?
Gait
ROM
Give a brief walk through of a full H2T assessment of a patient
Hair: no lumps, lesions, infestations
Head shape - normal cephalic?
If they wear glasses, what for? Ask them to take glasses off and examine pupils. Are they equal + round? Use penlight to be sure they react to light, make sure eyes accommodate bilaterally by making them look at the pen as you move it to their nose.
Pull down lower eye. Is conjunctiva pink? Is the sclera white?
EARS: any hearing aids? Any environmental factors like at work any loud noises, etc. Look inside ears for redness, drainage. Note any piercings. Any skin breakdown behind ears?
NOSE: ask patient to tilt head up + proceed to look inside nose for drainage, redness, signs of deviated septums. Have you had any trauma to the nose? Any surgeries? Ask patient to plug one nostril and breathe in. repeat on other side.
MOUTH: ask patient to open up + say ah. Look at mucous membranes in cheek – are they pink + moist? Are their teeth intact? Does their uvula rise + fall midline? Note their lip colour + any dryness.
NECK:
ROM: Cervical spine - ask patient to look up + down and to both sides.
Carotid arteries – check for carotid pulse
auscultate on neck
CHEST
Examine patient for laboured breathing (are they using accessory muscles?)
Auscultate for long sides on front (anterior) and back (posterior) side
Auscultate for heart sounds on anterior + posterior
Check for heart murmurs w/ bell of stethoscope
ARMS
• note lumps, legions, scars, radial pulse, capillary refill
• fingernails, signs of clubbing
Lay patient back, listen to pulse for 1 full minute
Since patient is laying down, check abdomen next. Lift patient’s shirt. Note contours of abdomen. Position of umbilicus. Any lumps, lesions, pulsations, scarring, hernias. Auscultate abdomen (aorta, all 4 quadrants for active bowel sounds)
Palpate areas of stomach + ask for pain, report any tenderness.
Check pulse on feet
Have patient lift up knees and check for edema on lower extremities
Sit patient up – check muscle strength on upper and lower extremities
What is crepitation?
Crunching / popping sensation/sound in tissue or joints
OTC account for what % of administered drugs
60%
Define homeostasis and give examples. Is it constantly present?
stability of systems that maintain life
pH, concentration of ions in ECF, osmolality , glucose levels, arterial oxygen tension
constantly present
Define allostasis and give examples. Is it constantly present?
Adaptation to changing internal + external environment (how our body adapts when we become sick) arterial BP, heart rate, body core temp, conc of circulating horomes, sleep-wake cycle, energy metabolism temporary process (ex - under stress)
Describe systemic circulation
LA / LV to aorta and body and back to RA / RV
arteries supply tissues w oxygenated blood, veins return blood to pulm circ
Describe pulmonary circulation
RA / RV –> pulm artery to lungs –> pulm veins to LA/LV
takes deoxy blood to lungs, reoxygenates it and returns it to systemic circ
What is the formula for Cardiac Output?
CO = HR x SV
expressed in L /min
What is cardiac preload?
- The volume of blood returned to the heart at the end of diastole that exerts pressure on the ventricle walls
- The filling force applied to the heart.
Describe the Frank-Starling Mechanism
when the heart stretches, it generates more force to effectively pump the increased load.
this has limits as the heart needs to stay elastic.
What is cardiac afterload?
- the pressure the ventricles must overcome to eject blood into the arteries.
- during contraction, the L ventricle must generate more pressure than aortic diastolic pressure
- also called SVR.
what is the relationship between afterload and stroke volume?
increased afterload can decrease stroke volume
What is the formula for MAP?
MAP = (SBP+DBP+DBP)/3
What MAP value is required to perfuse your brain? (aka the normal value)
65
