RET 1024L Introduction to Respiratory Therapy Lab Module 4.1 Bedside Assessment of the Patient —Vital Signs: Pulse, Respiratory Rate, Blood Pressure, Pulse Oximetry Blood Pressure, Pulse Oximetry

Bedside Assessment of the Patient Physical Examination  Vital Signs  Pulse Rate  Palpated at various sites  Temporal  Carotid  Apical (heart)  Brachial  Radial  Femoral  Popliteal  Posterior Tibial  Dorsalis - Pedis

Bedside Assessment of the Patient Physical Examination  Vital Signs  Pulse Rate  Radial artery most common site to palpate pulse  Use first, second, or third finger to palpate – not thumb  Ideally, counted for 1 minute, but can be counted over 15 or 30 seconds and then multiplied appropriately to determine the pulse per minute

Bedside Assessment of the Patient Physical Examination  Vital Signs  Respiratory Rate  Counting breaths: Breathing should be counted for one full minute (60 seconds)  Look at chest and abdomen rise and fall  Feel the chest or abdomen rise and fall by placing your hand on the person's chest or abdomen  Listen to the breaths if the person is breathing loud enough

Bedside Assessment of the Patient Physical Examination  Vital Signs  Respiratory Rate  Do not ask the patient to “breathe normally” while you are counting respiratory rate – they will inadvertently change the pattern and rate  Try counting the respiratory rate by observing the chest and abdomen while continuing to palpate the radial artery. The patient will think you are still taking their pulse and will not change their respiratory pattern and rate

Bedside Assessment of the Patient Physical Examination  Measuring BP  Commonly measured using auscultation  Sphygmomanomete r and stethoscope  BP cuffs come in different sizes

Bedside Assessment of the Patient Physical Examination  Measuring BP  Most BP cuffs are marked with an O or an  indicating where the cuff should be placed over the brachial artery

Bedside Assessment of the Patient Physical Examination  Measuring BP  Palpate the brachial artery and then wrap the deflated cuff snugly around the patient’s upper arm, ensuring it is properly positioned over the brachial artery. The lower edge should be about 1 inch above the antecubital fossa

Bedside Assessment of the Patient Physical Examination  Measuring BP  Grasp the inflation bulb in such a way that you can inflate the cuff and, with your thumb and index finger, easily open and close the valve

Bedside Assessment of the Patient Physical Examination  Measuring BP  While palpating the brachial pulse, inflate the cuff to approximately 30 mm Hg above the point at which the pulse can no longer be felt

Bedside Assessment of the Patient Physical Examination  Measuring BP  Place the diaphragm of the stethoscope over the artery and deflate the cuff at a rate of 2 – 3 mm Hg/sec while observing the manometer

Bedside Assessment of the Patient Physical Examination  Measuring BP  The systolic pressure is recorded at the point at which the first Korotkoff sounds are heard. The point at which the sounds become muffled is the diastolic pressure Korotkoff sounds; partial obstruction of blood flow creating turbulence and vibration

Bedside Assessment of the Patient Measuring BP

Bedside Assessment of the Patient  Pulse oximetry  SpO2