Medical Case Study: Mr. Smith's Vital Signs

Through basic observations, health professionals are able to evaluate the performance of an individual’s health status. In relation to Casey, it is noted in her Observation Chart that in the time span of two hours the patient’s health status had changed from being relatively normal (to the patient) to an increased respiratory rate, heart rate and temperature as well as a decrease in blood pressure. It is also noted that the patient has a score of 8 in the pain scale (compared to the score of zero two hours previously), relating to the lower abdomen. Programs such as Between the Flags acknowledges the fact that the early recognition of deterioration of patients can reduce harm to patients through designing and implementing systems which provide a structural response in the event of a deteriorating patient, such as Rapid Response and Clinical Review. There are two phases involved in the rapid response, which includes the afferent phase and the efferent phase. The afferent phase focuses on the overall monitoring and recognising the deteriorating patient whereas

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Pulse oximeter used to check his oxygen saturation level, which was 98% on air with no central or peripheral cyanosis. Since Mr Devi, does not seem to have any sign of abnormal respiration. The next assessment is circulation, where there are many physical signs to look for. The colour of the hand and digits, are they blue, pink, pale or mottled. Also need to measure for capillary refill time (CRT) by applying cutaneous pressure for 5 Sec on a fingertip held at heart level of Mr. Devi. The normal value of CRT is usually less than 2 second prolonged CRT suggests poor peripheral perfusion. Measure his Blood Pressure (B/P), count pulse rate by listening to the heart with a stethoscope or palpate peripheral and central pulses, assessing for the presence, rate, quality, regularity and equality. All of this assessment indicates the cardiovascular system in the patient is within the normal range or is there any emergency measures should take (Resus.org.uk 2016). However, Mr Devi’s circulation is a concern because his HR was 110bpm which is higher than normal range, the normal heart beat for adults ranges from 60-100bpm. Also his BP was 190/99mmhg with mean arterial pressure (MAP) of

110/62, a pulse oximetry reading (Pox) of 92%. At this time Mr. B should have been placed on

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

An evaluation of Mrs Smith circulation was the next step carried out by the nurse, as in the breathing assessment Mrs Smith pallor was noted as being flushed and the patient appeared confused this could be associated with poor cardiac output. The nurse recorded the patient’s blood pressure using a dinamap it was measured at 88/50, it was then rechecked manually to ensure accuracy. The pulse was checked manually for rate and rhythm it was recorded as 98 beats per minute. Capillary refill was checked, was found to be normal.

The pulse is an indication of an individual’s heart rate. When checking for a pulse in the primary survey, begin with palpating the patient’s radial or carotid artery (Basic Patient Care 2012, p. 50). This may reveal a normal (60-100 beats/min), tachycardia (<100 beats/min), bradycardia (> 60 beats/min) or asystole heart rate. Additionally, the capillary refill may also provide details about a patient’s cardiovascular status. This is performed by applying pressure to the nail bed and calculating the time it to takes to refill to a normal color, which should take no more then a few seconds otherwise suggesting capillary closure (Mick J Sanders, 2012, p. 1400). An additional accessory to Circulation is Hemorrhages, these involve more through examinations of the pulse, blood pressure and warmth of peripheries of patients. Additionally, you must thoroughly look for indication of bleeding, specifically in the areas around the chest, abdomen and externally seen by the eye.

As I did the physical exam I explained to the patient that I would listen to the arteries with a stethoscope for an abnormal sound which will let me know if there is poor circulation due to plaque? I also explained to the patient that by checking the pulse in the ankle and legs it would also indicate if

SEIDAL, H, M., BALL, J, W., DAINS, J, E., BENEDICT, G, W. (2006) Mosby’s Guide to Physical Examination. 6th edn. Philadelphia: Elsevier.

The sequencing that I will be using to assess the abdomen would be inspection, auscultation, percussion, and palpation. I would inspect the abdomen for the shape of the abdomen, skin masses and abnormalities. Inspection will give me clues whether I should percuss or palpate the abdomen. Then, I would auscultate the abdomen for altered bowel sounds. It is important to auscultate the abdomen first. Percussion and palpation tends to intensify peristalsis which can result to false interpretation of bowel sounds (Jarvis, 2012). When I proceed to the patient’s abdominal examination, it is important to know the anatomy of the abdomen where each organ is located. I would percuss M.M’s abdomen and check for abnormal fluid and masses. According to Jarvis (2012), flank dullness upon percussion may indicate fluid in the abdomen or ascites. I would do palpation last if not contraindicated. Palpation is used for detection of masses and tenderness, but because of the pain that palpation may trigger, it should be done in a careful manner.

tells you that he began feeling changes in his heart rhythm about 10 days ago. He has hypertension

The patient’s past medical history revealed diabetes mellitus type 2, hypertension, and smoking. Whereas the patient’s

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

The head to toe physical assessment is to be performed in less than 10 minutes using a stethescope, pen light, your hands, and observational skills. It comprises of four different techniques: IPPA inspection, palpation, percussion, and auscultation. This sequence, in apparent order, is used for al systems except for the abdominal assessment, which requires auscultation before palpation and percussion. Inspection is visually examining the person, focusing on one area of the body at a time. Palpation is using touch, feeling for texture, size, consistency, and location of body parts. Auscultation is listening for sounds within the body, mainly listening the lungs, heart, as well as the abdomen with the use of a stethoscope. Percussion is tapping an area of the body with the fingers and is usually a special assessment skill that the RN or physician uses, not a practical student nurse.

Vital signs are measurements of the body’s most basic functions. They are very useful in detecting and monitoring medical problems. There are five main types of vital signs which are temperature, pulse, respiration, blood pressure, and pain. They can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere.