Download PTA 103

PTA 103
Vital Signs
– Review of Procedures
– Review of Pain Assessment tools
– Pulse
– Blood Pressure
– Respiratory Rate
– Pain
Pulse
Measures heart rate (HR =
pulse/min)
Measured by palpation or
auscultation (using stethoscope)
Normal ranges
– 60-100/min in adults
– 100-130/min in infants
– 80-120/min in children 1-7
Normal Factors Affecting Pulse
Increases
Age
Gender (male>female)
↑ Environmental temp
Infection
Physical activity and activity tolerance
Emotional status
Some medications
Cardiopulmonary disease
Documentation of Pulse
HR standard is pulses/minute (best if
measured over 30-60 seconds)
Site of measurement
– Temporal, carotid, brachial, radial, femoral,
popliteal, posterior tibial, pedal
– Right or left
– Radial pulse is most common (also allows for
access to hospital ID bracelet for confirmation)
Can include subjective quality descriptors
– e.g., strong, weak, regular, etc.
Identifying Pulse Strength
A numbering system (0-4+) can be
used to document a description of
pulse strength
Refer to Table 22-2 for descriptions
and definitions
Role of PTA
HR can be used to make
comparisons with PT evaluation
HR can be used to educate
patients/clients in activity limits
Abnormal HR readings at rest and in
response to activity should result in
communication back to the PT
Blood Pressure
Important to establish baseline
values and monitor patient response
to activity
Special populations to consider
– Pts>65 yrs old; pts <=2 yrs old
– Deconditioned/debilitated
– Hx of cardiovascular problems
– Hx of trauma or diseases which impact
cardiovascular function
Key Words related to Blood
Pressure Monitoring
Diaphoresis – sweating
Dyspnea – difficulty breathing
Hypertension – high blood pressure
Hypotension – low blood pressure
SOB – shortness of breath
Syncope – fainting
Tachycardia – HR high (>100)
Accepted Normal BP values
Birth to 3mos: 80/35 to 60/65 mm Hg
3 mos to 1 yr: 90/60 to 100/67 mmHg
Children 1-4yrs: 100-108/60 mm Hg
– Add 2mmHg/year to 100mmHg/60-70mmHg
Adolescents: 100/65 to 120/75 mmHg
Adults: 120/80 mmHg
Elderly (>65yrs): 120/80-140/90 mmHg
A similar reference, slightly varied scale is
in Cameron, Table 22-3
Abnormal BP Ranges
Prehypertension: 120/80-139/89 mm Hg
Stage 1 HTN: 140/90-159/99 mm Hg
Stage 2 HTN: 160/100-179/109 mm Hg
Stage 3 HTN: 180/110-209-119 mm Hg
Stage 4 HTN: >210/120 mm Hg
Hypotension: Systolic <100 mm Hg
Documentation of BP
Included side and location of
measurement
Document if patient smoked,
ingested caffeine, or exercised within
the last 30 minutes
Common Errors in BP measures
Cuff is deflated too fast
– Should be 2mm Hg/second
Cuff is underinflated
Cuff is too small/big
Cuff is incorrectly positioned
Unable to hear pulse
clearly/consistently with stethoscope
Role of the PTA
PTAs should be aware of factors that affect
BP
– Educate at risk patients (smoking, obesity,
sedentary)
– Consider effects of age, medication, infection,
gender/race on BP levels when selecting
activity-based interventions
– Plan for monitoring during bedside activities,
positioning, or functional training
Documentation of Respiration
RR = breaths (inhalation +
exhalation) / min
Note depth, rhythm, and character
Avoid providing detailed information
about measurement procedure to
avoid abnormal measures
Documentation of %O2 Sat
May indicate progress with use of or
need for supplemental oxygen
– Supplemental O2 is generally indicated
for sat <=88%
Quantify endurance capacity for
activity in rehabilitation settings
Indicate a need to communicate with
PT/health care personnel to optimize
stable O2 Sat levels with activity
Documentation of Pain
Onset
Location
Temporal (change over time) pattern
Quality (sharp, shooting, constant,
intermittent, etc.)
Intensity
May include formal pain assessment
– VAS, McGill, NRS, Faces Pain Rating
Scale
Documentation of Vital Signs
Vital sign measures are included in
the ‘O’ of the SOAP note
Data is optimally collected before,
during and after activity
Data is compared to document
progress, verify safe progressions, or
support a need to communicate with
the primary PT.