This document provides guidance on gathering baseline vital signs and taking a patient history. It discusses measuring and evaluating a patient's respiratory rate, breathing quality, pulse, skin features, pupils, blood pressure, and pulse oximetry. Normal ranges for vital signs are provided for different age groups. It also describes the SAMPLE method for obtaining a comprehensive health history, including signs/symptoms, allergies, medications, pertinent medical history, last oral intake, and relevant events.

1. Baseline Vital Signs & History Taking CHAPTER 5

2. Gathering Patient Information Some information readily available: Some information involves detective work

3. Baseline Vital Signs “Signs of life” The first set taken Traditionally: Breathing Pulse Skin Pupils Blood pressure Pulse Oximetry (6th vital sign)

4. Baseline Vital Signs Items needed: Sphygmomanometer (BP cuff) Stethoscope Wristwatch (not your cell phone) Penlight Pen and notebook BSI

5. Respiratory Rate # of breaths per minute Normal Respiratory Rates Adult 12-20 Adolescent (11-16) 12-20 School aged (6-10) 15-30 Preschool aged (3-5) 20-30 Toddler (1-3) 20-30 Infant (older) 20-30 Infant (younger) 25-40 Newborn (birth to 30 days) 30-60

6. Respiratory Rate How to count

7. Breathing Quality Normal breathing Average chest wall motion One inch of expansion No accessory muscles Exhalation twice as long as inhalation No abnormal lung sounds

8. Breathing Quality Shallow breathing Only slight chest or abdominal wall expansion

9. Breathing Quality Labored breathing May include abnormal sounds Grunting stridor Accessory muscle use Neck Abdominal Nasal flaring Gasping Retractions

10. Breathing Quality Noisy breathing Snoring Wheezing Gurgling Crowing or stridor http://www.youtube.com/watch?v=VA9C_aCH7F0 http://www.youtube.com/watch?v=jjf7LZxrwK8&feature=related

11. Breathing Rhythm Regularity Irregularity

12. Pulse Location of pulses Carotid Femoral Radial Brachial Popliteal Posterior tibial Dorsalispedis

13. Pulse Rate Elderly 90 Adult 60-80 Adolescent 60-105 Older child 60-120 Younger child 80-150 Infant 120-150

14. Pulse Quality and rhythm Strong or weak Regular or irregular Pulsusparadoxus- pulse becomes weaker during inhalation.

15. Skin Color Paleness or pallor Cyanosis Flushing Mottling Also, check the color of the mucosa

16. Skin Temperature Hot Cool Cold

17. Skin Condition Dry Moist Clammy = cool and moist Diaphoretic = profuse sweating

18. Capillary Refill Time it takes for compressed capillaries to fill. < 2 seconds for infants, children, male adults < 3 seconds for females < 4 seconds for elderly

19. Pupils Size Equality Reactivity

20. Pupils Dilated- cardiac arrest, drugs Constricted- narcotics, central nervous system disorder Unequal- stroke, head injury, artificial eye, eye drops, previous eye or head trauma Nonreactive- cardiac arrest, brain injury, drugs

21. Blood Pressure Systolic blood pressure Ventricle of heart while contracted Diastolic blood pressure Ventricle of heart at rest Measured in mmHg (millimeters mercury) Always expressed as even numbers

22. Blood Pressure “Normal” Adult male 100+ age… to age 40…. Diastolic 60-85 Adult female 90+ age… to age 40… Diastolic 60-85 Adolescent 90- mmHg Child 90 + 2 x age (upper limit) Child 70 + 2 x age (lower limit) Taken by Palpation Auscultation

23. Orthostatic Vital Signs Tilt test Suspected volume loss Heart rate increases more than 20 bpm Blood pressure decreases more than 20 mmHg

24. Pulse Oximetry 97-100% Reading < 95 needs to be investigated

25. Pulse Oximetry Limitations Shock Hypothermia Movement Nail polish Carbon monoxide Cigarettes Anemia

26. SAMPLE History S- Signs and Symptoms O- Onset P- Provocation Q- Quality R- Radiation S- Severity T- Time

27. SAMPLE A- Allergies Medications Food Environmental

28. SAMPLE Medications Prescription Over-the-counter Birth control Illicit drugs Herbals

29. SAMPLE Pertinent past history Underlying medical problems Surgeries, procedures, or trauma History of current complaint

30. SAMPLE Last oral intake (Last menstrual cycle)

31. SAMPLE Events Leading up to injury