Most common (+ overlooked) reasons for abnormal vitals?

  1. 1
    I was thinking a very useful thread for students, new nurses, etc., would be one in which everyone weighs in on most common and/or overlooked reasons for abnormal vitals.

    I'm thinking along the lines of:

    Hypertension: "white coat" anxiety, stress
    Bradycardia: possible baseline for an athlete
    Low temp: ensure pt. hasn't recently drank cold fluids

    Also, maybe some more commonly seen combinations:

    tachycardia and hypotension: dehydration.

    Would love to see some of the responses from the seasoned nurses here, maybe see some stuff we never would have thought of.
    PayitForwardHolistic likes this.
  2. 32 Comments so far...

  3. 0
    Hypotension: pt is a chronic renal or liver pt and low is their baseline (of course make sure it actually IS their baseline).
  4. 3
    Sinus arrythmia in children.

    Also kids with cardiac issues may have different baseline O2 Sats. We get lots of partially repaired kids with 75-85% being their baseline. In fact if we give them O2 and get them over their high parameter we can harm them by causing them to shunt blood.

    We have lots of neuro kids whose baselines temps are lower than normal. It's important to know that. If they have a temp of 99.0 they may actually be quite ill.

    Kids compensate well, and they hide their illness, until they crash. If a child has a lower temp than normal (and they don't have neuro issues), or running a fever, have slightly higher BP than normal (and not upset or kicking), slightly tachycardic, and slightly tachypneic, I call the MD. They might be going septic. What usually happens next is very rapidly they lose their BP and start third spacing and then get very very sick. So peds RNs are trained to be very aware of small changes in a patient that might indicate big problems.
    bsartor, KelRN215, and LadyFree28 like this.
  5. 0
    Fever, tachypnea, tachycardia, decreased SpO2 --> post aspiration
  6. 13
    How bout this. The patient is actually deteriorating right in front of the nurses eyes, and if the nurse has limited experience, human psychology kicks in and denial takes over. For example your patient has a low BP so you keep cycling the BP cuff until you get a number that is accpetable. Disaster looms right around the corner.
    dudette10, ParisAntonel, bebbercorn, and 10 others like this.
  7. 2
    Or you look up at the monitor, see a HR of 220 and think "that can't be real, the pt must be moving around." Nope, perfectlyregularcomplexes.... SVT. Time to grab the adenosine! Yup happened to me
    ParisAntonel and GrnTea like this.
  8. 1
    Low BP, increased respirations, lowering temperature, climbing WBCs, increasing HR....suspect sepsis, particularly if patient is there for any kind of infection.

    Low BP, increased respirations, increasing HR, unchanged temperature, patient dizzy, SOB, change in LOC - suspect hemorrhage, esp if patient is there for GI bleed, surgery, cardiac cath
    Last edit by not.done.yet on Feb 12
    motherof3sons likes this.
  9. 1
    Elevated BP and HR- pain

    recovery room nurse
    kenderella89 likes this.
  10. 0
    Lower temps might be baseline for patients with some types of endocrine disorders, namely hypothyroid. It's also common in liver disease. They may live with temps in the 96 F range.

    Cushing's triad: htn, bradycardia, abnormal breathing pattern. Wide pulse pressure! Ok so maybe this one isn't that common. Hopefully.
  11. 0
    Tylenol tanking BP in neuro patients


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