Vital signs

ID NURSING · Jan 20, 2009

:)Hi there~

This patient's BP was really quite low! The reading broken down is: The systolic number is the pressure when the heart contracts pumping blood to the body. The diastolic number is the pressure when the heart is relaxed in between beats.

Did this patient have any symptoms like lightheadedness, syncope, fatigue or difficulty with vision associated with the bradycardia?

Let me know what happened... A good web site would be American Heart Association... http://www.americanheart.org

Phillygryl, LPN · Jan 20, 2009

I have to call back and find out about the client myself!! The client is non verbal but thankfully the assistant who takes care of her observed her exagerated body movements. No syncope and since she doesn't talk she cannot express how she feels!!!

ID NURSING · Jan 20, 2009

Well I think you did the right thing by sending her to the ER. It is difficult to know what is really going on with some patients especially this one, but her vitals speak for themselves, maybe there is an underlying problem....it's hard not knowing how they are feeling. Hopefully you will be able to follow-up with this patient soon.

Dragonnurse1, ASN, RN · Jan 20, 2009

Sending the patient to the hospital was the right thing to do but your vital signs as you listed were lacking, I take it that the heart rate was 76 but what were her respirations and what was her temperature? If she had a low temp

Vital signs and the meanings there of depend some times on where the patient is, home, ER, floor, unit or extended care.

In a younger person that was able to talk and move on their own - those VS could be signs of dehydration but without having the patient move we could not be sure.

There is something called "positional hypotension", this occurs when a body remains in one position too long. You get the patient repostioned and wait 5 minutes and retake the VS if they are the same or worse off they go to the hospital. On the other hand if the VS improve and the extreme tremors relax back to the normal tremor that patient has the patient had been stuck in a position that was hurting her and you fixed it.

You did good! :yeah:

Pepperlady · Jan 20, 2009

There is very little that can be determined with the information given but a few inferences could possibly be made What can be said is that the patient is hypotensive, I would be more concerned with the systolic rather than that diastolic. Generally, in dehydration pulse will go up, in sepsis with an elevated temperature heart rate will go up.... but those are generalizations.

I would like to know what medications the patient was on. What was her neuro status. What was her previous blood pressure and pulse.

Some patients function quite normally with those vitals, again, knowing her previous vitals would be an indication of where she normally functions.

:
Did this patient have any symptoms like lightheadedness, syncope, fatigue or difficulty with vision associated with the bradycardia?
Let me know what happened... A good web site would be American Heart Association... http://www.americanheart.org

She wasn't bradycardic given a pulse of 74, bradycardia is defined as a pulse below 60 bpm.

ID NURSING · Jan 20, 2009

Yes you are right......Oops....I read her pulse being in the 40's.:uhoh21:

kmoonshine, RN · Jan 20, 2009

I hope that you repeated a manual BP (we once had a student reporting that a pt was hypotensive; turns out that the student was taking the pts blood pressure with her arm up in the air, rather than down at the pts side).

I probably would have done a little more investigating, because you'll usually find someone tachycardic when their BP is acutely low (but this isn't always the case, especially if the pt is on beta-blockers). Its also important to assess peripheral pulses, skin temp, presence/absence of diaphoresis, temperature, etc. You also need to figure in the pts medical history - if the pt is on lots of meds, has a cardiac history, has a foley in place, or is at high risk for infection - then its quite possible that something more is going on.

Daytonite, BSN, RN · Jan 20, 2009

phillygryl. . .this kind of information would be found in some of the assessment website links on the student nurse assistance forum, particularly the medical school ones. what you are looking for is medical condition tie-ins and that is something taught to medical students. in particular, i like the ucsd practical guide to clinical medicine which has a page on vital signs. the link for it is on post 4 or 5 of the sticky i've listed for you here:

https://allnurses.com/nursing-student-assistance/health-assessment-resources-145091.html - health assessment resources, techniques, and forms

pink85 · Jan 20, 2009

That is what I was thinkng... What is her normal b/p. If you didn't know or this was abnormal for her then the ER was certainly the right think to do. It is better to err on the side of caution. that is what I would want you to do for my family member!