Chapter 9 Vital Signs and SAMPLE History DOT Directory

Transcription

1 Chapter 9 Vital Signs and SAMPLE History

2 U.S. Objectives U.S. Objectives are covered and/or supported by the PowerPoint Slide Program and Notes for Emergency Care, 11th Ed. Please see the Chapter 9 correlation below. *KNOWLEDGE AND ATTITUDE Identify the components of vital signs. Slide Describe the methods used to obtain a breathing rate. Slide Identify the attributes that should be obtained when assessing breathing. Slide Differentiate between shallow, labored, and noisy breathing. Slide Describe the methods to obtain a pulse rate. Slide 9, Identify the information obtained when assessing a patient s pulse. Slides Differentiate between a strong, weak, regular, and irregular pulse. Slide Describe the methods used to assess skin color, temperature, and condition (capillary refill in infants and children). Slides 17, Identify the normal and abnormal skin colors. Slide 18 (cont.)

3 U.S. Objectives *KNOWLEDGE AND ATTITUDE Differentiate between pale, blue, red, and yellow skin color. Slide Identify the normal and abnormal skin temperature. Slide Differentiate between hot, cool, and cold skin temperature. Slide Identify normal and abnormal skin conditions. Slide Identify normal and abnormal capillary refill in infants and children. Slide Describe the methods used to assess the pupils. Slide Identify normal and abnormal pupil size. Slides Differentiate between dilated (big) and constricted (small) pupil size. Slides Differentiate between reactive and nonreactive pupils and equal and unequal pupils. Slides 22, Describe the methods used to assess blood pressure. Slides Define systolic pressure. Slides (cont.)

4 U.S. Objectives *KNOWLEDGE AND ATTITUDE Define diastolic pressure. Slides Explain the difference between auscultation and palpation for obtaining a blood pressure. Slides 25, Identify the components of the SAMPLE history. Slides Differentiate between a sign and a symptom. Slide State the importance of accurately reporting and recording the baseline vital signs. Slides Discuss the need to search for additional medical identification. Slides 42, Explain the value of performing the baseline vital signs. Slides Recognize and respond to the feelings patients experience during assessment. Slide Defend the need for obtaining and recording an accurate set of vital signs. Slides Explain the rationale of recording additional sets of vital signs. Slide Explain the importance of obtaining a SAMPLE history. Slides 6-8 (cont.)

5 U.S. Objectives *SKILLS Demonstrate the skills involved in assessment of breathing Demonstrate the skills associated with obtaining a pulse Demonstrate the skills associated with assessing the skin color, temperature, condition, and capillary refill in infants and children Demonstrate the skills associated with assessing the pupils Demonstrate the skills associated with obtaining blood pressure Demonstrate the skills that should be used to obtain information from the patient, family, or bystanders at the scene.

6 Baseline Vital Signs

7 Baseline Vital Signs Vital signs are outward signs of what is going on inside the body. Baseline vital signs are the first measurements you will take. (cont.)

8 Baseline Vital Signs Pulse Respirations Skin Pupils Blood Pressure

9 Pulse Count for 30 seconds Multiply by Example: 40 x 2 = 80

10 Pulse Rate Adults generally /minute Tachycardia is pulse more than 100/minute. Bradycardia is pulse less than 60/minute.

11 Pulse Quality Strong or weak Regular or irregular

12 Carotid Pulse

13 Brachial Pulse

14 Radial Pulse

15 Respirations Count for 30 seconds Multiply by 2 Example: 6 x 2 = 12

16 Respiratory Quality Normal Shallow Labored Noisy

17 Check Skin Color, Temperature, and Condition

18 Abnormal Skin Colors Pale Cyanotic Flushed Jaundiced

19 Abnormal Skin Temperature Hot Cool Cold

20 Abnormal Skin Condition Wet Very dry

21 Infants and Children: Check Capillary Refill

22 Pupils

23 Abnormal Pupil Conditions Constricted pupils Unequal pupils Dilated pupils

24 Pupils Size Dilated Constricted Equality Reactivity To light Nonreactive (fixed)

25 Blood Pressure Blood pressure measurement normally includes two readings: Systolic Diastolic Measured by a sphygmomanometer Measured in millimeters of mercury (mmhg) (cont.)

26 Blood Pressure Normal systolic is usually no more than 120 mmhg. Systolic greater than 140 mmhg is considered hypertension. Diastolic is normally mmhg. Diastolic greater than 90 mmhg is considered hypertension. (cont.)

27 Blood Pressure Adult female May be 8 10 mmhg lower than in an adult male Hypertension is considered at same levels as in an adult male. (cont.)

28 Blood Pressure Child 1 10 years old: (Child s age x 2) + 80 mmhg Child or adolescent older than age 10: Minimum systolic of 90 mmhg (cont.)

29 Auscultating Blood Pressure

30 Auscultating Blood Pressure

31 Palpating Blood Pressure

32 Palpating Blood Pressure

33 Noninvasive Blood Pressure Device

34 Pulse Oximetry Measures oxygen circulating in the blood Results: % = normal 91 95% = hypoxia 86 90% = significant hypoxia < 85% = severe hypoxia

35 Pulse Oximeter

36 Pulse Oximeter Precautions Not accurate in shock or hypothermia False readings in carbon monoxide poisoning Movement and nail polish can cause inaccurate readings. Batteries must be in good condition.

37 Pulse Oximetry Note Do not withhold oxygen from a patient who may need it because the oximeter reads normal.

38 Reassessment of Vital Signs Stable patient (every 15 minutes) Unstable patient (every 5 minutes)

39 SAMPLE History

40 SAMPLE History S A M P L E = Signs and symptoms = Allergies = Medications = Pertinent past history = Last oral intake = Events leading to injury or illness

41 Signs and Symptoms Signs: smell, see, feel, hear Symptoms: cannot observe patient tells you

42 Allergies To medications To foods To environment

43 Medications Prescription and over-the-counter Current Recent

44 Pertinent Past History

45 Last Oral Intake

46 Events Leading to Illness or Injury Sequence of events that led to illness or injury

47 Interview Strategies Position yourself appropriately. Identify yourself. Speak in a normal voice. Use your patient s name.

48 Review Questions 1. Name the vital signs. 2. Explain why vital signs should be taken more than once. 3. Explain the meaning of the letters S-A-M-P-L-E in patient assessment.

49 Street Scenes What is your primary concern for this patient? What vital signs should be taken even if a no transport decision is being considered? (cont.)

50 Street Scenes Ideally, what should the patient history include? What other patient history information should be obtained? (cont.)

51 Street Scenes Should you take another set of vital signs? How might you get the patient to rethink her decision not to be transported?